Rethinking skin surveillance for high-risk melanoma patients

Rethinking skin surveillance for high-risk melanoma patients

18 March 2021

New research has provided evidence in favour of a structured skin surveillance program for high-risk melanoma patients.

Australia has the highest incidence of melanoma in the world and early detection of melanoma is associated with better survival, less morbidity from treatment and less cost to the healthcare system. However, there is no formal population screening program for melanoma due to the lack of evidence showing it reduces melanoma death rates in the general population.

However, in patients at very high risk of developing melanoma – such as those who have already had one or more primary melanomas and have additional risk factors – we know that close surveillance is important.

Research by Melanoma Institute Australia (MIA) and University of Sydney, published this week in JAMA Dermatology, has demonstrated that it is feasible for a structured surveillance program for high-risk patients to be implemented on a large scale in numerous settings, including dermatology clinics and primary care skin cancer clinics.

Clinicians at four different clinics in NSW closely examined the whole body of high-risk patients every six months using dermoscopy, total body photography and sequential digital dermoscopy imaging. They found that two-thirds of new melanomas were detected with the help of total body photography and digital dermoscopy monitoring.

“Using these technologies to closely monitor patients has demonstrated the importance of including them in rigorous surveillance of high-risk patients,” said Prof Pascale Guitera, Dermatologist at MIA, Director of the Sydney Melanoma Diagnostic Centre at Royal Prince Alfred Hospital, Professor of Dermatalogy at The University of Sydney and the study’s first author. “The use of these technologies not only assists clinicians with early detection of melanoma but helps to reduce unnecessary removal of benign lesions.”

The study demonstrated that the protocol devised by the researchers can be undertaken beyond a melanoma specialist centre, and that it can be effectively rolled out in dermatology clinics and primary care skin cancer clinics.

“This study, together with the increasing health system costs for melanoma treatment, demonstrates that it is cost-effective to undertake this structured surveillance for high-risk patients, providing impetus to scale up the program even further,” says senior author Prof Anne Cust, Epidemiologist at MIA and Professor of Cancer Epidemiology at The University of Sydney.

Researchers hope that this cost-effective model of care will be implemented on a national level across dermatology clinics and in primary care.

Publication:

Guitera P, Menzies SW, Coates E, Azzi A, Fernandez-Penas P, Lilleyman A, Badcock C, Schmid H, Watts CG, Collgros H, Liu R, van Kemenade C, Mann GJ, Cust AE. Efficiency of Detecting New Primary Melanoma Among Individuals Treated in a High-risk Clinic for Skin SurveillanceJAMA Dermatol. (ePub 17 March 2021)