Photographic cutaneous surveillance is a useful tool for the early detection of melanoma in high-risk patients. Not all new or changed pigmented lesions are melanomas, however. In this cohort study of patients at high risk for melanoma, Banky et al demonstrate that nevi are dynamic, and only a small proportion of new and changing nevi are melanomas. Baseline total body photography and dermoscopy were useful in reducing the high biopsy rates. New and changing lesions in patients older than 50 years were more likely to be melanomas.
Research suggests that behaviors that increase sun exposure are major contributors to the rising incidence of melanoma in the past 3 decades. The relationship between sunscreen use and melanoma risk remains controversial, with some studies suggesting that sunscreen use represents a risk factor rather than a protective factor for melanoma. In this randomized controlled intervention study at a French seaside resort, Dupuy et al demonstrate that the use of sunscreens with high sun-protection factor (SPF) did not increase the duration of sun exposure and also reduced the number of sunburns. These data suggest that public health recommendations should continue to promote high-SPF sunscreens as part of their sun-avoidance program.
Dermoscopy has been shown to improve the early diagnosis of melanoma, when lesions are still thin and surgical therapy is more likely to be curative. Although experienced clinicians tend to use overall dermoscopic pattern recognition without following specific algorithms, clinicians with less experience find several dermoscopic algorithms helpful in reaching a diagnosis. In this study of 61 nonexpert medical practitioners, Dolianitis et al demonstrate that the Menzies method showed the highest accuracy and sensitivity for melanoma diagnosis and was preferred by study participants.
Dermoscopic image of a level I superficial spreading melanoma.
Sentinel lymph node biopsy (SLNB) offers a powerful prognostic indicator for recurrence and survival in primary melanoma. In this retrospective analysis of their SLNB experience over an 8-year period, Berk et al confirm the prognostic value of SLNB and the validity of this technique for staging melanoma lesions thicker than 1.0 mm. Findings of SLNB were the strongest predictors of recurrence, and a low rate of regional nodal recurrence was recorded for cases with negative SLNB findings, demonstrating the reliability and reproducibility of this procedure.
Renal transplant recipients develop cutaneous malignancies such as squamous cell carcinomas more commonly than the general population. The risk of skin cancer in this population increases in proportion to the duration of immunosuppressive drug regimens as well as cumulative sun exposure. As graft survival outcomes have improved, a significant increase in immunosuppression-related skin cancers has been observed. In this single-observer study, Moloney et al demonstrate low compliance with sunscreen use both before and after transplantation. Reasons for not using sunscreens included the expense, lack of knowledge regarding the harmful effects of sun exposure, forgetting to apply the sunscreen, finding sunscreens impractical in a work environment, and finding sunscreens cosmetically unacceptable because of comedogenicity.
This Month in Archives of Dermatology. Arch Dermatol. 2005;141(8):939. doi:10.1001/archderm.141.8.939