Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance

Abstract

Background/Objective Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. Methods Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly‐selected patients. Results 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8–1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very‐high‐risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. Conclusion Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease.

Reply to: Is photographic surveillance in melanoma diagnosis dispensable?

“…[1][2][3][4] The pin-point lesions can spread to form an annular pattern (Figure 2). [2][3][4] Often the pustules coalesce into larger vesicles, which can become secondarily infected. The disease can cause itch, but its appearance is most concerning for patients.…”

“…Although the disease is not infective, histopathology shows neutrophilic infiltrate and occasional eosinophils in the subcorneal layer. 1,2 The disease most commonly affects women between 50 and 70 years old. 1 The pustules are distributed symmetrically across the trunk, intertriginous and flexural regions of the proximal limbs (Figure 1).…”

“…1 The pustules are distributed symmetrically across the trunk, intertriginous and flexural regions of the proximal limbs (Figure 1). [1][2][3][4] The pin-point lesions can spread to form an annular pattern (Figure 2). [2][3][4] Often the pustules coalesce into larger vesicles, which can become secondarily infected.…”

A reply to ‘Evaluation of dynamic dermoscopic features of melanoma and benign naevi by sequential digital dermoscopic imaging and total body photography in a high‐risk Australian cohort’

“…TBP/SDDI compares unfavourably to usual surveillance with immediate excision. In Brown et al, 3 three dermatologists diagnosed 615 melanomas with an in situ to invasive ratio of 4.59:1. Less than 1% were >1 mm thick (3.4% in Nguyen et al).…”

“…This is typical of studies of TBP/SDDI where in situ to invasive ratios range from 0.59 to 2.17:1, with up to 8.2% of melanomas being >1 mm thick. 3 Monitoring over excision risks lesion progression, non-compliance and treatment delay.…”