Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis

Abstract

Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new “apps” available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments).

The Impact and Consequences of SARS-CoV-2 Pandemic on a Single University Dermatology Outpatient Clinic in Germany

“…While 18 cases with malignant melanoma were documented in 2018 and 16 in 2019, only three cases with malignant melanoma were seen in 2020 within the same period in March and April. Since early malignant melanoma is an asymptomatic disease, patients’ awareness regarding the medical necessity of a consultation might be underestimated [ 20 ]. However, especially in regard to malignant diseases, it is of utmost importance that diagnoses are made at the earliest stage possible and that therapeutic treatment interruptions, which could possibly affect medical outcomes, are avoided [ 21 ].…”

Accessing Mole-Scanning through Community Pharmacy: A Pilot Service in Collaboration with Dermatology Specialists

“…Instead, the UK pursues education programs to raise awareness of signs and symptoms, risk factors and the need to self-check to promote earlier detection and thus reduce mortality. Early diagnosis and treatment of malignant melanoma is key not only in improving outcomes for the patient but also from an economic perspective [ 7 , 8 ]. Kakushadze et al observed a more than three-fold increase in melanoma treatment costs between stages II and III [ 9 ].…”

Importance of sonography of the skin and subcutaneous tissue in the early diagnosis of melanoma in-transit metastasis with the presentation of two cases

“…The guidelines as to the frequency of controls in subsequent years after a surgery and the types of tests conducted during follow-ups differ slightly between countries. Patients are recommended to do self-checks, and medical check-ups are performed, from 1 to 6 per year, including the following: sonography of the lymph nodes and abdomen, chest X-ray, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), blood tests including complete blood count, creatinine levels, a liver function test, lactate dehydrogenase levels and β-S100 [ 18 , 19 ]. In oncology centers in Poland, check-ups are made every 3 to 4 months during the first 2 years after a primary melanoma surgery, then every 6 months for the next 3 years and then once a year.…”