Total body photography and telemedicine may benefit patients with a history of melanoma

Tan, A., Greenwald, E., Bajaj, S., Belen, D., Sheridan, T., Stein, J.A., Liebman, T.N., Bowling, A., Polsky, D., 2022. Melanoma surveillance for high-risk patients via telemedicine: Examination of real-world data from an integrated store-and-forward total body photography and dermoscopy service. Journal of the American Academy of Dermatology 86, 191–192. doi:10.1016/j.jaad.2021.01.055

Total body photography and telemedicine may benefit patients with a history of melanoma.

Clinical Pearls

• This was a (preliminary) prognostic study analyzing the efficacy of store-and-forward (SAF) total body photography (TBP) as a means of remotely surveilling high-risk patients with a history of melanoma.

• Of 390 pigmented lesions that were remotely monitored and biopsies, 7% were melanomas, 2% were non-melanoma skin cancers (NMSCs).

• The overall benign to malignant ratio was 9.7:1 for pigmented lesions with a number-needed-to-biopsy of 13.4.

Discussion:

This study was a preliminary review of data regarding the use of store and forward (SAF) total body photography as a means of using teledermatology for melanoma surveillance for high-risk patients. (Self-)Referred patients had total body photography followed by clinical and dermoscopic imaging of suspicious pigmented lesions. Images were then reviewed remotely by a pigmented lesion expert followed by recommendations for annual reimaging and/or potential biopsy/excision for lesions suspicious (i.e., potential melanoma or non-melanoma skin cancer (NMSC)) or 3 month follow-up for less suspicious lesions.

Among 309 lesions remotely recommended for biopsy from 240 patients, 91% were benign, 7% were melanomas, and 2% were NMSCs with a benign:malignant ratio of 9.7:1 and number-needed-to-biopsy (NNB) of 13.4 to identify one melanoma. 57% of melanomas were identified on follow-up as “changed” lesions with 56% being invasive (Breslow thickness 0.18-0.94 mm). The authors note no direct comparison of lesion thickness at time of diagnosis could be done, but a median thickness of 0.22 mm was less than the median thickness from a recent Surveillance, Epidemiology, and End Results (SEER)-9 database study (median 0.58 mm)[1] and the current study found a similar NNB compared to another study of dermatologists (25.4)[2].

The study utilized proprietary protocol and received funding from MoleSafe, USA. A majority of patients reported no personal (69%) or family (68%) history of melanoma, and use of sunbeds (76%). A majority of patients referred for evaluation had more than 50 moles larger than 2 mm (80%), over 15 atypical nevi (52%), or had some (43%) to many (14%) sunburns in “early years”. These may limit the generalizability of study findings as well as ability to discern patients that may benefit most of the intervention, especially as the patient population most likely to benefit from increased surveillance scrutiny (i.e., patients with a history of melanoma) were not the majority of participants in this pilot report. It is also important to note that the authors do not include a follow-up period or an average time between initial imaging and biopsy.

Ultimately the authors note that while “no firm conclusions can be drawn regarding this service”, it may assist pigmented lesions experts interested in SAF teledermatology care for high-risk patients.

References

1. Shaikh WR, Dusza SW, Weinstock MA, Oliveria SA, Geller AC, Halpern AC. Melanoma Thickness and Survival Trends in the United States, 1989 to 2009. J Natl Cancer Inst. 2015 Nov 12;108(1):djv294. doi: 10.1093/jnci/djv294. PMID: 26563354; PMCID: PMC4857148.

2. Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK. Accuracy of skin cancer diagnosis by physician assistants compared with dermatologists in a large health care system. JAMA Dermatol. 2018;154:569-573.