Australian Surveillance Program for Individuals at High Risk of Aggressive Skin Cancer
Posted: Tuesday, April 6, 2021
According to findings presented in JAMA Dermatology, a surveillance program based on a previous single-center study for patients who are high risk for aggressive skin cancer such as melanoma should be implemented on a larger scale, including at primary care skin cancer clinics, because of its consistent and sustainable benefits. Pascale Guitera, MD, PhD, of The University of Sydney, Australia, and colleagues observed favorable long-term early detection and excision results for more than 10 years at a center in Australia and replicated these results at three other centers.
“The clinicians following the surveillance protocol included dermatology specialists, trained dedicated residents, and primary care physicians in hospital outpatient clinics and in a primary care skin cancer clinic,” the authors noted.
In this prospective cohort study, the authors recruited 593 people from four melanoma high-risk clinics in New South Wales, Australia, who were deemed to be at “very high” risk for melanoma. The enrolled patients received full-body examinations every 6 months via total-body photography and sequential digital dermoscopy imaging.
During the follow-up, physicians excised 1,513 lesions. Of those lesions, 171 were primary melanomas, of which 96% had a Breslow thickness of up to 1 mm. About two-thirds of the melanomas were found with the assistance of total-body photography or sequential digital dermoscopy imaging. The overall benign-to-malignant excision ratio was 0.8:1.0, and the benign melanocytic-to-melanoma excision ratio was 2.4:1.0. Both ratios were similar across all the centers.
The authors found that the risk of developing a new melanoma was 9% annually in the first 2 years of surveilance and increased with time, particularly for those participants with multiple primary melanomas. New melanomas were detected most often by a clinician with help from total-body photography (31.6%), followed by digital dermoscopy monitoring (29.2%).
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.