Non-invasive Detection Modalities and Metastatic Risk Stratification for Melanoma: Where Are We Now?

By Pooja H. Rambhia, MD Candidate, Case Western Reserve University | 10 July 2017 | Prevention, Science, Treatment


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The dramatic increase in melanoma incidence over the last several decades has been the impetus for increased emphasis on prevention techniques, earlier detection, and more targeted therapies, namely immunotherapies. While dermatologists have advocated for patient education about irregular skin lesions in order to catch melanomas earlier, dermatologists ultimately play the largest role in the detection and excision of abnormal skin lesions via skin biopsy. However, visual recognition andassessment of pigmented skin lesions is limited to the eye of the dermatologist, and can be challenging for even the most experienced clinicians.

Studies have previously demonstrated that dermatologists’ sensitivity (ability to correctly identify those with disease) to early melanoma detection ranges from 70 - 80%, indicating that 20 - 30% of early melanomas initially go undetected.  Additional reports have investigated the number of skin biopsies needed to perform to correctly identify one melanoma. Findings from these studies have ranged from 8 for more experienced users to 30 for other health care providers.

This deficit in clinical detection of melanomas has inspired exploration of a new wave of non-invasive detection modalities that are visually oriented and/or genetically based. They range from non-invasive, computerized visual diagnostics that provides a recommendation as to whether to biopsy a pigmented lesion or not to patch biopsy tests that assesses for expression of specific genes.

Moving beyond detection efforts, other groups have aimed at developing non-invasive methods of more accurately predicting metastatic risk in primary cutaneous melanoma patients, and consequently provide closer follow-up care for higher risk patients. Treating or tracking higher-risk patients more aggressively may prevent their relapse, and ultimately impact melanoma management as it stands currently.

While still relatively early, technologies for detection and risk classification of melanoma have made significant headway in the last several years. These techniques may be advantageous not only for increasing the dermatologist’s accuracy of identifying malignant pigmented lesions, but also for helping avoid unnecessary skin biopsies. Namely, certain patient populations, those with issues with wound healing, those chronically on blood thinners, and those with suspicious lesions in cosmetically sensitive areas of the body, may stand to benefit the most from avoiding skin biopsies if deemed unnecessary. Further insights into the genetics of melanoma development may offer opportunities for optimization of various diagnostic, non-invasive melanoma detection modalities.

 

 


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