Premalignant skin lesions are uncommon after targeted therapy and immunotherapy in treatment for melanoma, and are commonly identified during self-examination, according to study results published in the Journal of the European Academy of Dermatology and Venereology.
Current guidelines recommend dermatologic surveillance to screen for recurrence in patients who respond to targeted or immunotherapy, but do not specify the timing or frequency at which screenings should occur. The researchers aimed to determine the need for routine examination in patients after treatment for metastatic cutaneous melanoma.
A total of 121 patients (43.3% women) who had achieved 6 months of stable disease with targeted or immunotherapy, including complete remission, partial response, stable disease, and mixed response, were included in the study. Median follow-up time was 23.5 months (range, 10-65 months). Disease progression or recurrence occurred in 39.2% of patients, with a median time to progression of 15 months (range, 6-33 months). Of those who experienced disease progression, 15 patients (32%) died during follow-up, with a median time to death of 23 months (range, 11-41 months).
After remission, 62% of patients received regular skin examinations by a dermatologist. Premalignant nonmelanoma skin cancer occurred in 12.4% of patients, with a median time to detection of 9 months (range, 1-31 months). However, more than half (53.3%) of new lesions were discovered by the patient rather than the dermatologist. The most commonly occurring lesion was actinic keratosis, which occurred in 8 (53.3%) patients. These lesions were predominantly discovered during routine examination, with 75% identified by a dermatologist. Other lesions that occurred during follow-up were basal cell carcinoma in 4 (26.7%) patients, squamous cell carcinoma in situ in 1 patient (6.6%, metastasis in 1 (6.6%) patient, and lentigo maligna in 1 (6.6%) patient, and were almost exclusively identified during self-examination.
The researchers noted that the results of the study should be considered with regard to the small sample size.
Given that the majority of premalignant lesions were identified by patients themselves, the investigators concluded that “[t]he first dermatologic consultation after good response to [targeted therapy] and [immunotherapy] should consist of complete skin examination and most importantly, patients should be educated on skin malignancies and should receive instruction for self-examination.”
Huis In’t Veld EA, van Seventer IC, van Teeseling L, van Thienen JV, Crijns MB. Is routine skin examination in metastatic melanoma patients treated with immuno- or targeted therapy necessary? [published online December 3, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16128