02/09/11

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EXPERT ANALYSIS FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF DERMATOLOGY

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Private Practice Melanoma Screenings Reap Stellar Cure Rate

NEW ORLEANS - Serial screening of patients at high risk for melanoma is effective for detecting lesions, and appears to have prevented the development of aggressive advanced nodular melanoma.

For the past 19 years, Dr. Ronald N. Shore has been conducting serial screening on patients at high risk for melanoma, as many as 1,100 patients per year. He reported finding no metastases, recurrences, or deaths during this time period.

In addition, only one of his patients developed nodular melanoma, a phenomenon that Dr. Shore, who is in private practice in Rockville, Md., attributes to serial screening. The one patient who developed nodular melanoma failed to return for screening for 27 months.

Dr. Shore said that he believes the total absence of nodular melanoma for the first 17 years of his program is best explained by the program's detection of previously unrecognized early melanomas that he suspects have the potential to become nodular lesions.

He presented his most recent findings at the annual meeting of the American Academy of Dermatology.

He described finding what he termed "papular erythematous melanomas," which are distinct, amelanotic, red or pink, symmetrical lesions that closely resemble some of the recently described early nodular melanomas. The lesions were distinguished by their smaller size, lack of rapid growth, and radial growth phase histopathology.

The absence of classic ABCDE features may be another reason why the lesions had not been recognized, he said.

These findings raise the possibility that these lesions are recognizable precursors of nodular melanoma, he said. If the theory proves correct, "it reveals a way we can prevent development of nodular melanoma and by doing so, save lives," he added.

Dr. Shore noted that two prior studies have also reported 100% survival of screened patients at increased risk for melanoma: one led by Dr. Darrell S. Rigel, a professor of dermatology and dermatologic surgery at New York University Medical Center (Cancer 1989;63:386-9), and another more recent study led by Dr. Stephen Wang of the Memorial Sloan-Kettering Cancer Center in New York (J. Am. Acad. Dermatol. 2004;50:15-20). Dr. Shore pointed out that the studies share two common features: the use of serial screening, and performance of thorough examinations by dermatologists.

Analysis of 5 years of study data showed that 10 new cases of melanoma were detected in serially screened patients. The greatest Breslow depth was 0.15 mm; the lesions were all in radial growth phase; 70% were in men aged older than 50 years; and only 10% of the lesions were detected by patients.

The latter finding is one that Dr. Shore emphasized.

"Neither random screenings nor patient self-examinations can provide anywhere near the efficacy provided by serial professional examinations in the office setting," Dr. Shore said.

"Patients are very symptom oriented," he said, but early melanomas are mostly asymptomatic. In addition, "our records clearly show that some patients – especially men over 50 – are very poor at self-examination."

The study classified high-risk patients as those with significant past sun exposure and damage, especially multiple or severe sunburns; numerous or dysplastic nevi; actinic keratoses; any skin cancer; and family history of melanoma, especially in multiple blood relatives.

His practice has implemented a recall system, in which high-risk patients get reminders for their 6-month visit and continued follow-up reminders if they do not schedule an appointment.

Dr. Shore's findings are scheduled to appear in an upcoming issue of the Journal of Drugs in Dermatology.

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