Structured Surveillance Model Proven Efficient for Detecting Subsequent Melanoma in High-Risk Persons

People with primary melanoma tend to be at elevated risk for developing a subsequent melanoma, making effective surveillance methods a useful intervention for them. A structured surveillance program that incorporates full-body examinations that includes total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI) can be useful for detecting new melanomas in high-risk patients, according to the results of a study recently published in JAMA Dermatology.

The study, led by researchers affiliated with multiple institutions in Australia, including the University of Sydney, built upon the findings of a previous study that found multiple benefits, including fewer excisions of lesions and lower healthcare costs, from a structured surveillance program in a single setting by expanding it to gauge its effectiveness in multiple settings.

For this prospective cohort study, the researchers recruited 593 participants from 4 high-risk melanoma clinics in New South Wales, Australia. All of them had been assessed between 2012 and 2018 and were determined to have a very high risk of melanoma — in fact, 92.1% of the participants had multiple primary melanomas, a much higher percentage than in the previous study.

The researchers analyzed the results of the use of a structured protocol in which clinicians were aided in their examinations by TBP and SDDI at baseline and follow-up visits every 6 months. Clinicians were most likely to find new melanomas using total-body photography (54 of 171 primary melanoma cases), followed by sequential digital dermoscopy imaging (50 of 171). The use of these aids also resulted in a favorable benign-to-malignant excision ratio.

“[O]ur results showed similar outcomes across centers, indicating that the diagnostic tools and structured surveillance protocol were more important than the clinical specialty,” they wrote. “The low number needed to excise or biopsy was associated with the use of photography surveillance affecting the threshold for biopsy and would also be expected to be lower for clinicians experienced in skin cancer detection and for regions with higher incidence of melanoma.”

Is this level of surveillance necessary for everyone? Perhaps not. The researchers noted that close surveillance was recommended for nearly everyone in the study’s cohort because of previous melanoma. That level of surveillance might not be as necessary for people at low or average risk for melanoma. In that case, using an algorithm or risk prediction model could help determine who would be at high risk and thus would benefit the most from the structured surveillance model.

Disclosure: Multiple authors declared affiliations with and received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Guitera P, Menzies SW, Coates E, et al. Efficiency of detecting new primary melanoma among individuals treated in a high-risk clinic for skin surveillance. JAMA Dermatol. Published online March 17, 2021. doi:10.1001/jamadermatol.2020.5651