Melanoma diagnosis benefits from recent clinical and pathologic advances

July 29, 2006

Diagnosis of melanoma has been advanced recently by breakthroughs in imaging techniques, but improving patient education offers a target for further increasing early detection, while molecular-based diagnostic methods represent the greatest hope for the future, said Jean L. Bolognia, M.D., at the plenary session of Academy '06.

Diagnosis of melanoma has been advanced recently by breakthroughs in imaging techniques, but improving patient education offers a target for further increasing early detection, while molecular-based diagnostic methods represent the greatest hope for the future, said Jean L. Bolognia, M.D., at the plenary session of Academy '06.

Discussing patient diagnosis, Dr. Bolognia told attendees that a recent study conducted to identify features patients find helpful in distinguishing between benign pigmented lesions and melanomas suggests a new emphasis for public education campaigns. In that study, two major criteria from the seven-point checklist - change in lesion size/development of a new lesion and change in color - were the most useful discriminators. None of the ABCD(E) rules helped discriminate between benign and malignant lesions. "Perhaps the ?E' in the ABCD(E) rules should stand for evolution, and I think this study draws attention to the fact that we need to incorporate the idea of change in our public education messages," says Dr. Bolognia, professor of dermatology, Yale University, New Haven, Conn.

In terms of physician diagnosis, Dr. Bolognia noted that despite the developments in digital imaging and total body photography, there remains no substitute for the "good old-fashioned" total body skin examination.

"Dermatologists who are not using routine total body photography and computer-assisted image analysis do not need to feel inadequate. My opinion is that total body photography is only indicated for the highest of the highest-risk group, and if you can answer 'few, if any' to the question, ?How many superficial pigmented spreading melanomas have you detected among returning patients that are more than 1 mm in depth?', then whatever you are doing is correct," she says.

In the area of pathologic diagnosis, a recent advance has been the description of consumption of the epidermis (COE) as a simple criterion for discriminating between melanoma and Spitz nevus. The investigators in that study defined COE as thinning of the epidermis with attenuation of the basal and suprabasal layer with loss of rete ridges in areas of direct contact with neoplastic melanocytes. However, molecular techniques are being looked to as the area of key diagnostic advances in the future. In that arena, Dr. Bolognia indicates that research is moving away from investigations of single monoclonal antibodies and toward the use of gene arrays and gene expression.

"These techniques will be important not only for diagnosis, but also have implications for prognosis and designing specific therapy," she says.