Total-Body Photography and Sequential Digital Dermoscopy Assist in Early Diagnosis of Primary Melanoma in High-Risk Individuals
In a study intended to help define optimal screening in individuals at high risk of melanoma, Moloney et al evaluated use of full-body examinations every 6 months along with dermoscopy and total-body photography for all patients and sequential digital dermoscopy imaging as indicated. The study, reported in JAMA Dermatology, showed a high diagnostic yield for new primary melanomas, particularly during the first 2 years of follow-up.
Study Details
This prospective observational study involved 311 very high-risk patients from the Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia enrolled between February 2006 to February 2011 and followed for up to 5 years. Patients had to have a history of invasive melanoma and dysplastic nevus syndrome, history of invasive melanoma and at least three first-degree or second-degree relatives with melanoma, history of at least two primary invasive melanomas, or a CDKN2A or CDK4 mutation. Patients underwent full-body examination and total-body photography every 6 months, with sequential digital dermoscopy imaging every 3 or 6 months for equivocal lesions and excision of atypical lesions.
Diagnostic Yield
Over a median follow-up of 3.5 years, 75 primary melanomas were detected, including 14 at the baseline visit. The median Breslow thickness of postbaseline incident melanomas was in situ (interquartile range = in situ to 0.60 mm). Overall, 38% of the melanomas were detected by total-body photography and 39% by sequential digital dermoscopy imaging.
Of five melanomas with Breslow thickness > 1 mm, three were histologically desmoplastic and two had nodular components. The benign-to-malignant excision ratio was 1.6:1 for all lesions and 4.4:1 for melanocytic lesions.
Increased Early Detection
A total of 44 of the primary melanomas identified after the baseline visit (72%) were diagnosed in the first 2 years of follow-up. There was increased cumulative incidence in the first 2 years, with continued identification of new primary melanomas out to 5 years. The risk of new primary melanoma was 12.7% at year 2 and 18.2% at year 4, with the incidence of detection in the final 3 years of follow-up being half that in the first 2 years (incidence density ratio = 0.43, P = .0002).
The investigators concluded, “Monitoring patients at extreme risk with [total-body photography] and [sequential digital dermoscopy imaging] assisted with early diagnosis of primary melanoma. Hypervigilance for difficult-to-detect thick melanoma subtypes is crucial.”
Scott W. Menzies, MB, BS, of the Sydney Melanoma Diagnostic Centre, New South Wales, is the corresponding author for the JAMA Dermatology article.
The study was supported by grants from the Cancer Institute New South Wales. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
