Oral Presentation ASPCR-ASDR Conference 2013

Detection of primary melanoma in individuals at extreme high risk: a prospective five-year follow-up study (#45)

E Coates 1 2 , F J Moloney 1 3 , P Guitera 1 3 4 , Nikolas K Haass 1 3 , K Ho 2 5 , R Khoury 3 , R O'Connell 6 , L Raudonikis 7 , G L Mann 4 8 , S W Menzies 1 3
  1. Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  2. Discipline of Dermatology, University of Sydney, Sydney, New South Wales, Australia
  3. Discipline of Dermatology, University of Sydney, Sydney, New South Wales, Australia
  4. Melanoma Institute Australia, North Sydney, NSW, Australia
  5. Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  6. Clinical Trials Centre, Unviersity of Sydney, Sydney, NSW, Australia
  7. Raudonikis Database Services, Mount Colah, NSW, Australia
  8. University of Sydney , Westmead Millennium Insitute, Westmead, NSW, Australia

Background

A small number of individuals have a disproportionately higher new melanoma risk. Although early detection is crucial, there is no clear consensus for optimal screening in this cohort.

Objectives

To determine the role of total body photography (TBP) and sequential digital dermoscopy imaging (SDDI) in detecting new primary melanoma in a high risk melanoma cohort over 5 years.

Methods

Individuals fulfilling ≥1 of the following criteria were included: (1) CDKN2A/CDK4 mutation; (2) ≥2 previous invasive melanomas; (3) ≥1 previous invasive melanoma with Dysplastic Naevus Syndrome or (4) ≥3 1st/2nd degree relatives with prior melanoma. 312 patients were screened including TBP at least 6-monthly over 5 years with short-term (~3 months) and long-term (≥6 months) SDDI used.

Results

77 primary melanomas were detected, 16 at baseline and 61 subsequently over a median follow-up time of 3.5 years. TBP detected 37.7% and SDDI 39.3%. Post-baseline median Breslow thickness was in-situ (IQR=In-situ-0.60mm), with five thick (>1mm) melanomas identified. The overall benign/malignant excision ratio was 1.6:1 and 4.2:1 for melanocytic lesions.

69% of non-baseline primary melanomas were detected within the first two years, with a cumulative new primary melanoma risk of 12.8% by year two and 18.7% by year four. The melanoma incidence during the last 3 follow-up years was 51% of that observed during the first 2 years (P=0.013).

Conclusions

Monitoring high risk patients with TBP and SDDI assisted with early primary melanoma identification. Use of these diagnostic techniques in this subpopulation is crucial to ensure optimal treatment and reduced associated mortality.