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Editorial
March 17, 2021

Early Detection of Melanoma: Rethinking the Outcomes That Matter

Author Affiliations
  • 1Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Dermatol. 2021;157(5):511-513. doi:10.1001/jamadermatol.2020.5650

In this edition of JAMA Dermatology, Guitera et al1 report the outcomes from a structured surveillance program of total-body photography (TBP), sequential digital dermoscopy imaging (SSDI), and skin examinations every 6 months in a population at very high risk for melanoma. Of 593 patients, 113 (19%) had a new melanoma diagnosed during the median 2.8-year follow-up period. Most melanomas were in situ (117 of 171 [68%]), and 7 melanomas (4%) were thicker than 1 mm. Few melanomas (<10%) were detected by the patient. Rather, most melanomas were detected by the clinician using specialized imaging. At first glance, this is an exceptional level of melanoma detection and a testament to the value of intense surveillance augmented by technology. Given the resources required to achieve this level of care, including specialized software and physician time, it is important to consider how best to study the impact of this intense level of surveillance and determine when it is most beneficial and appropriate for use in clinical practice.

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    1 Comment for this article
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    We screen for breast cancer and bowel cancer, do we not?
    Andrew Enyvari, MD, MMed (Skin Cancer) | Skin Spot Clinic
    I fail to grasp the conclusions of this article. The authors appear less than convinced that early detection of melanomas , when they are at the in-situ stage, is of benefit. I don't see how anyone could argue the fact that thinner melanomas are less lethal than deeply invasive ones. The mortalitly rates for in-situ melanomas are far less than deeply invasive ones, and this has been demonstrated in numerous studies. I do full body photography and full body dermoscopy of high risk melanoma patients at my clinic. In the last five years, I have had one patient with an invasive melanoma, which was a superficially spreading hypomelanotic melanoma, 0.3mm Breslow depth. The rest of the melanomas that were detected in these patients on regular follow up were all in-situ. In comparison, I frequently see patients who are referred in to me from their community physicians with "just diagnosed" melanomas that are deeply invasive, Breslow depth of 2-7mm. A lot of these patients do poorly, and have metastatic disease at presentation. These patients suffer greatly and the costs to the medical system are high, with sentinel lymph node biopsies, PET scans, oncology and surgical consultations, and immunotherapy. There is a reason we screen high risk patients with mammograms and colonoscopies. It is to detect cancers early, so that we prevent advanced disease and its associated complications. Why should this approach not work in high risk melanoma patients?
    CONFLICT OF INTEREST: None Reported
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