AI08 Early detection of melanoma: evaluating the combined use of total-body photography and sequential digital dermoscopic imaging in a National Health Service setting

Abstract 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 the first observational study evaluating the effectiveness of a UK-based nurse-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 excisional biopsies of clinically suspicious naevi performed (5% of sessions). Twenty-one pT1a and pT1b melanomas (6.1% of biopsies), 20 melanomas in situ (MMis; 5.8% of biopsies) and 150 mildly to severely cytologically dysplastic naevi (43.5% of biopsies) were identified. The mean age at diagnosis was 57 years (range 27–91). The mean number of sessions completed per patient prior to diagnosis was 2.8 (range 1–9) for invasive melanoma and 3.8 (range 1–9) for MMis. The mean Breslow thickness was 0.52 mm (range 0.2–1). Overall, 95.2% of melanomas had a Breslow thickness < 0.8 mm without ulceration (pT1a), in comparison with 42% of melanomas diagnosed through the same National Health Service (NHS) trust’s 2-week-wait suspected skin cancer service. The number needed to biopsy (NNB) was 8.41 for melanoma, and 5.95 for melanoma, MMis and severely dysplastic naevi combined. These NNB rates were comparable with the 2-week-wait face-to-face consultant dermatologist-led service at the same NHS trust, which had an NNB of 9.6 (melanoma, MMis and severely dysplastic naevi combined), and also aligned with a recent meta-analysis of 14 studies that calculated an NNB of 9.6 for dermatologists internationally (Petty AJ, Ackerson B, Garza R et al. Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting. J Am Acad Dermatol 2020; 82: 1158). Our study demonstrates a nurse-led TBP and SDDI service is a viable and clinically effective strategy for detection of stage 0–1A melanoma. Further multicentre studies are warranted to examine its utility as an effective tool for the screening and surveillance of high-risk patients on a national scale.