New recommendations on the use of noninvasive melanoma detection techniques in adults and children have been published, with the primary consensus-based recommendations appearing in the Journal of the American Academy of Dermatology.
A total of 13 committee members with experience in dermatology and oncology were recruited to evaluate 24 clinical scenarios regarding noninvasive melanoma detection techniques. Each scenario was rated on a 5-point Likert scale, ranging from “strongly agree” to “strongly disagree.” Rationales were provided from each committee member detailing their position on each recommendation. Consensus-based recommendations were made if ≥75% of the committee members agreed or strongly agreed with a scenario-based statement.
The second round of review led to the generation of 11 consensus statements. Approximately 91% of members strongly agreed on the use of total body photography for patients with familial atypical multiple mole melanoma syndrome. The majority of participants also agreed on the use of total body photography for adult patients with >50 nevi who also have a history of multiple cutaneous melanomas or amelanotic melanoma and/or a genetic syndrome predisposing them to cutaneous melanoma.
Committee members mostly agreed on recommending serial digital dermoscopic imaging for monitoring “ugly duckling” nevi with equivocal dermoscopic features. Approximately 80% of members also agreed on recommending reflectance confocal microscopy for assessment of dermoscopically equivocal pigmented lesions in either cosmetically sensitive areas or areas prone to slow or insufficient wound healing. Also, 70% of committee members recommended reflective confocal microscopy for assessment of dermoscopically equivocal pigmented lesions in pediatric patients or in patients who are reluctant to undergo biopsy.
In their conclusion, the researchers wrote that the recommendations are not designed to replace clinician judgment since they do not exhaust every potential indication for the discussed techniques. “The aforementioned techniques can help facilitate earlier diagnosis of melanoma and can spare patients unnecessary biopsies,” the researchers wrote.
Waldman RA, Grant-Kels JM, Curiel CN, et al. Consensus recommendations for the use of non-invasive melanoma detection techniques based on results of an international DELPHI process [published online September 26, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.046