Early Detection and Prognostic Assessment of Cutaneous Melanoma
Authors: Kashani-Sabet Mohammed , Leachman Sancy A. , Stein Jennifer A. , Arbiser Jack L. , Berry Elizabeth G. , Celebi Julide T. , Curiel-Lewandrowski Clara , Ferris Laura K. , Grant-Kels Jane M. , Grossman Douglas , Kulkarni Rajan P. , Marchetti Michael A. , Nelson Kelly C. , Polsky David , Seiverling Elizabeth V. , Swetter Susan M. , Tsao Hensin , Verdieck-Devlaeminck Alexandra , Wei Maria L. , Bar Anna , Bartlett Edmund K. , Bolognia Jean L. , Bowles Tawnya L. , Cha Kelly B. , Chu Emily Y. , Hartman Rebecca I. , Hawryluk Elena B. , Jampel Risa M. , Karapetyan Lilit , Kheterpal Meenal , Lawson David H. , Leming Philip D. , Liebman Tracey N. , Ming Michael E. , Sahni Debjani , Savory Stephanie A. , Shaikh Saba S. , Sober Arthur J. , Sondak Vernon K. , Spaccarelli Natalie , Usatine Richard P. , Venna Suraj , Kirkwood John M. 
Published: March 2023

Importance

Therapy for advanced melanoma has transformed during the past decade, but early detection and prognostic assessment of cutaneous melanoma (CM) remain paramount goals. Best practices for screening and use of pigmented lesion evaluation tools and gene expression profile (GEP) testing in CM remain to be defined.

Objective

To provide consensus recommendations on optimal screening practices and prebiopsy diagnostic, postbiopsy diagnostic, and prognostic assessment of CM.

Evidence Review

Case scenarios were interrogated using a modified Delphi consensus method. Melanoma panelists (n = 60) were invited to vote on hypothetical scenarios via an emailed survey (n = 42), which was followed by a consensus conference (n = 51) that reviewed the literature and the rationale for survey answers. Panelists participated in a follow-up survey for final recommendations on the scenarios (n = 45).

Findings

The panelists reached consensus (≥70% agreement) in supporting a risk-stratified approach to melanoma screening in clinical settings and public screening events, screening personnel recommendations (self/partner, primary care provider, general dermatologist, and pigmented lesion expert), screening intervals, and acceptable appointment wait times. Participants also reached consensus that visual and dermoscopic examination are sufficient for evaluation and follow-up of melanocytic skin lesions deemed innocuous. The panelists reached consensus on interpreting reflectance confocal microscopy and some but not all results from epidermal tape stripping, but they did not reach consensus on use of certain pigmented lesion evaluation tools, such as electrical impedance spectroscopy. Regarding GEP scores, the panelists reached consensus that a low-risk prognostic GEP score should not outweigh concerning histologic features when selecting patients to undergo sentinel lymph node biopsy but did not reach consensus on imaging recommendations in the setting of a high-risk prognostic GEP score and low-risk histology and/or negative nodal status.

Conclusions and Relevance

For this consensus statement, panelists reached consensus on aspects of a risk-stratified approach to melanoma screening and follow-up as well as use of visual examination and dermoscopy. These findings support a practical approach to diagnosing and evaluating CM. Panelists did not reach consensus on a clearly defined role for GEP testing in clinical decision-making, citing the need for additional studies to establish the clinical use of existing GEP assays.