Melanoma risk factors identify patients for long-term surveillance
MedWire News: Melanoma risk factors can identify patients who benefit from long-term surveillance with digital dermoscopy, German researchers suggest.
The team advises dermoscopy at 3-month intervals for patients with familial atypical mole and multiple melanoma (FAMMM) syndrome.
Follow-up at 6–12-month intervals is proposed for those with atypical mole syndrome (AMS), depending on additional risk factors.
The team from Georg-August University in Goettingen categorized 688 patients into three melanoma risk groups depending on combinations of risk factors. Participants included 461 with multiple nevi, 219 with AMS, and eight with FAMMM syndrome.
Patients were followed up for a mean of 44.3 months using clinical examination, dermoscopy, and, for atypical nevi, sequential digital dermoscopy.
Of 1219 excised lesions, 127 melanomas were confirmed by histopathologic examination. Although patients with AMS and FAMMM syndrome accounted for just 33.0% of participants, they developed 91.3% of the melanomas.
Multivariate regression analysis identified a greatly increased melanoma risk for patients with FAMMM, AMS, or previous melanoma compared with multiple nevi, with odds ratios of 37.11, 8.06, and 6.23, respectively.
Each digitally documented atypical lesion was associated with a significant 10% increase in melanoma risk.
Patients with higher melanoma risk had a higher percentage of melanomas detected by digital dermoscopy, at 50% in patients with FAMMM syndrome and 22% in those with AMS, and were more likely to develop multiple melanomas within shorter intervals.
The ratio of melanoma to benign results for lesions excised because of dynamic changes was 1:15 for AMS patients and 1:4 for FAMMM-syndrome patients.
Holger Haenssle and colleagues note that melanomas detected by digital dermoscopy were significantly thinner than those detected using other means, with a mean Breslow thickness of 0.41 versus 0.62.
Reporting in the Archives of Dermatology, they add: “Patients with multiple common nevi and no additional risk factors experienced no benefit from sequential digital dermoscopy.”
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By Anita Wilkinson