Dermatology World

Diagnosis: Melanoma

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What emerging tests and tech mean for dermatologists

By Diane Donofrio Angelucci, contributing writer, May 1, 2014

Early diagnosis of melanoma is critical in the battle against this deadly disease — with a 98-percent five-year survival rate if it is diagnosed and treated at an early minimally invasive stage, according to data from the government’s Surveillance, Epidemiology, and End Results Program (SEER). New technologies promise to help improve dermatologists’ efficiency and accuracy for early detection. Amid this promise, though, it is important for clinicians to recognize the strengths and limitations of available tests.

For example, if a molecular test provides negative results for a suspect lesion, the clinician must understand the sensitivity and specificity of the assay and how to incorporate a result in conjunction with the clinician’s clinical impression, said Pedram Gerami, MD, associate professor of dermatology and pathology and director of research at the Skin Cancer Institute of Northwestern University’s Feinberg School of Medicine.

Clinicians also need to understand how test results affect management. “They really need to know how to interpret the tests, the meaning of the tests, and the limitations,” Dr. Gerami said. “We have to keep up, or else other fields that are more in tune to the molecular era [tests], will take over the care of a lot of the patients that we currently manage.”

Identifying suspect lesions

“The gold standard for melanoma diagnosis is a full-skin examination and biopsy of suspicious lesions,” said Debjani Sahni, MD, assistant professor of dermatology and director of the cutaneous oncology program at Boston University School of Medicine. But detecting melanomas accurately, particularly early melanomas, remains a challenge for dermatologists, she said. “A lot of benign lesions get biopsied unnecessarily, causing morbidity to patients, who can end up with a lot of scars and be put at a psychological disadvantage. Moreover, early melanomas may still be missed on examination.”