Lesions which are not visible to patients may be detected later and subsequently have an advanced course.
Clinical Pearls
Suspicious lesions ultimately diagnosed as melanoma which were located on the scalp, plantar surface of the foot, and posterior aspect of the leg, calf, or arm were more likely to be a higher T-stage and have associated positive lymph nodes
Lesions which are not visible to patients may be detected later and subsequently have an advanced course
Discussion:
This retrospective review published by Everdell et al in the Journal of the American Academy of Dermatology investigated whether lesions suspicious for melanoma located in areas non-visible to patients have outcomes different from more visible lesions. The authors performed a retrospective analysis of all patients diagnosed with invasive melanoma at their institution from August 1, 2018 to November 1, 2021.
Specifically, the authors defined non-visible lesions as being located on the scalp, plantar surface of the foot, and posterior surface of the leg, calf, and arm. To categorize outcomes, they defined stages IA, IB, IIA, and IIA as low-risk while stages IIB, IIC, IIIB, IIIC, IIID, and IV were defined as high-risk.
With data from 382 patients, the authors recognized 201 (58%) had visible lesions and 181 (47%) had non-visible lesions. Interestingly, patients with non-visible lesions were found to be more likely to have T3 or T4 tumors when compared to patients with visible lesions (OR, 2.22; 95% CI, 1.38.3.57; P<.001). Additionally, 60% of all patients with positive lymph nodes in this study had nonvisible lesions, suggesting a more advanced course of disease. Similarly, 67% of patients diagnosed with high-risk stages had nonvisible lesions. Overall, this first of its kind study suggests non-visibility of lesions suspicious for melanoma may lead to later detection.
Comments