Early detection of melanoma: evaluating the combined use of total body photography and sequential digital dermoscopic imaging in a national health service setting

Early detection of thin, stage 1A melanoma is crucial in improving patient outcomes, but this can be clinically challenging in patients with multiple atypical naevi. We report an observational study evaluating the effectiveness of a UK-based clinical nurse specialist-led total body photography (TBP) and sequential digital dermoscopic imaging (SDDI) programme for patients at high risk of developing melanoma. In total, 1680 patients underwent 6890 TBP and SDDI sessions, with 345 excision biopsies of clinically suspicious melanocytic lesions being performed (5% of sessions); 21 pT1a and pT1b melanomas (6% of biopsies), 20 melanoma in situ (6% of biopsies) and 150 dysplastic naevi (43% of biopsies) were identified. Median (range) Breslow thickness was 0.5 (0.2-1) mm; 95% of melanomas had a Breslow thickness of < 0.8 mm without ulceration (pT1a) and the number needed to biopsy was 8.41. Our UK experience demonstrates that a nurse-led programme of TBP with SDDI can be a clinically effective strategy for detection of early melanoma and melanoma in situ.