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Melanoma: HELP
Articles by Scott W. Menzies
Based on 51 articles published since 2010
(Why 51 articles?)
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Between 2010 and 2020, S. W. Menzies wrote the following 51 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial On reducing the need to excise nevi. 2011

Menzies, Scott W. · ·Arch Dermatol · Pubmed #21242401.

ABSTRACT: -- No abstract --

2 Review Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. 2016

Kittler, Harald / Marghoob, Ashfaq A / Argenziano, Giuseppe / Carrera, Cristina / Curiel-Lewandrowski, Clara / Hofmann-Wellenhof, Rainer / Malvehy, Josep / Menzies, Scott / Puig, Susana / Rabinovitz, Harold / Stolz, Wilhelm / Saida, Toshiaki / Soyer, H Peter / Siegel, Eliot / Stoecker, William V / Scope, Alon / Tanaka, Masaru / Thomas, Luc / Tschandl, Philipp / Zalaudek, Iris / Halpern, Allan. ·Department of Dermatology, Medical University of Vienna, Vienna, Austria. Electronic address: harald.kittler@meduniwien.ac.at. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. · Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy. · Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Barcelona, Spain. · University of Arizona Cancer Center, Tucson, Arizona. · Department of Dermatology and Venerology, Nonmelanoma Skin Cancer Unit, Medical University of Graz, Graz, Austria. · Sydney Melanoma Diagnostic Center, Sydney Cancer Center, Royal Prince Alfred Hospital, Camperdown, Australia. · Skin and Cancer Associates, Plantation, Florida. · Department of Dermatology, Klinikum München, Munich, Germany. · Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan. · Dermatology Research Center, University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia. · University of Maryland Medical Center, Baltimore Department of Veterans Affairs Medical Center, Baltimore, Maryland. · Department of Dermatology, University of Missouri Health Sciences Center, Columbia, Missouri. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Dermatology, Keio University, Tokyo, Japan. · Service de Dermatologie, Center Hospitalier Universitaire de Lyon, Lyon, France. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. ·J Am Acad Dermatol · Pubmed #26896294.

ABSTRACT: BACKGROUND: Evolving dermoscopic terminology motivated us to initiate a new consensus. OBJECTIVE: We sought to establish a dictionary of standardized terms. METHODS: We reviewed the medical literature, conducted a survey, and convened a discussion among experts. RESULTS: Two competitive terminologies exist, a more metaphoric terminology that includes numerous terms and a descriptive terminology based on 5 basic terms. In a survey among members of the International Society of Dermoscopy (IDS) 23.5% (n = 201) participants preferentially use descriptive terminology, 20.1% (n = 172) use metaphoric terminology, and 484 (56.5%) use both. More participants who had been initially trained by metaphoric terminology prefer using descriptive terminology than vice versa (9.7% vs 2.6%, P < .001). Most new terms that were published since the last consensus conference in 2003 were unknown to the majority of the participants. There was uniform consensus that both terminologies are suitable, that metaphoric terms need definitions, that synonyms should be avoided, and that the creation of new metaphoric terms should be discouraged. The expert panel proposed a dictionary of standardized terms taking account of metaphoric and descriptive terms. LIMITATIONS: A consensus seeks a workable compromise but does not guarantee its implementation. CONCLUSION: The new consensus provides a revised framework of standardized terms to enhance the consistent use of dermoscopic terminology.

3 Review Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: a systematic review. 2015

Watts, C G / Dieng, M / Morton, R L / Mann, G J / Menzies, S W / Cust, A E. ·Cancer Epidemiology and Services Research (CESR), The University of Sydney, Australia. ·Br J Dermatol · Pubmed #25204572.

ABSTRACT: Understanding how individuals at high-risk of primary cutaneous melanoma are best identified, screened and followed up will help optimize melanoma prevention strategies and clinical management. We conducted a systematic review of international clinical practice guidelines and documented the quality of supporting evidence for recommendations for clinical management of individuals at high risk of melanoma. Guidelines published between January 2000 and July 2014 were identified from a systematic search of Medline, Embase and four guideline databases; 34 guidelines from 20 countries were included. High-risk characteristics that were consistently reported included many melanocytic naevi, dysplastic naevi, family history, large congenital naevi, and Fitzpatrick Type I and II skin types. Most guidelines identify risk factors and recommend that individuals at high risk of cutaneous melanoma be monitored, but only half of the guidelines provide recommendations for screening based on level of risk. There is disagreement in screening and follow-up recommendations for those with an increased risk of future melanoma. High-level evidence supports long-term screening of individuals at high risk and monitoring using dermoscopy. Evidence is low for defining screening intervals and duration of follow-up, and for skin self-examination, although education about skin self-examination is widely encouraged. Clinical practice guidelines would benefit from a dedicated section for identification, screening and follow-up of individuals at high risk of melanoma. Guidelines could be improved with clear definitions of multiple naevi, family history and frequency of follow-up. Research examining the benefits and costs of alternative management strategies for groups at high risk will enhance the quality of recommendations.

4 Review A clinico-dermoscopic approach for skin cancer screening: recommendations involving a survey of the International Dermoscopy Society. 2013

Argenziano, Giuseppe / Giacomel, Jason / Zalaudek, Iris / Blum, Andreas / Braun, Ralph P / Cabo, Horacio / Halpern, Allan / Hofmann-Wellenhof, Rainer / Malvehy, Josep / Marghoob, Ashfaq A / Menzies, Scott / Moscarella, Elvira / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold / Saida, Toshiaki / Seidenari, Stefania / Soyer, H Peter / Stolz, Wilhelm / Thomas, Luc / Kittler, Harald. ·Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, Reggio Emilia 42100, Italy. Electronic address: g.argenziano@gmail.com. ·Dermatol Clin · Pubmed #24075542.

ABSTRACT: Dermoscopy is useful for skin cancer screening, but a detailed approach is required that integrates this tool into a rational clinical work flow. To investigate clinician perceptions and behavior in approaching patients with skin tumors, a survey was launched by electronic mail through the International Dermoscopy Society. After 4 months, the responses were analyzed and significant findings calculated. Considering the current approach of study participants in examining patients for skin cancer, an up-to-date system of triage is presented in this review, which aims to promote an improved diagnostic accuracy and more timely management of skin malignancy.

5 Review Evidence-based dermoscopy. 2013

Menzies, Scott W. ·Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; Discipline of Dermatology, Sydney Medical School, The University of Sydney, NSW 2006, Australia. Electronic address: scott.menzies@sswahs.nsw.gov.au. ·Dermatol Clin · Pubmed #24075541.

ABSTRACT: Dermoscopy has been shown in meta-analyses to improve the diagnostic accuracy of melanoma unequivocally compared with naked eye examination and to reduce excision rates of benign melanocytic lesions in clinical trials. Sequential digital dermoscopy imaging (SDDI) allows the detection of dermoscopic featureless melanoma. When used in high-risk individuals or on individual suspicious melanocytic lesions, it has a gross impact for detecting melanoma in clinical practice, with a range of 34% to 61% of melanomas detected exclusively using SDDI in these patients. Furthermore, SDDI has been shown to reduce the excision of benign lesions when used in combination with dermoscopy.

6 Review Psycho-educational interventions for melanoma survivors: a systematic review. 2013

McLoone, Jordana / Menzies, Scott / Meiser, Bettina / Mann, Graham J / Kasparian, Nadine A. ·School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. ·Psychooncology · Pubmed #22933380.

ABSTRACT: OBJECTIVE: To systematically review psycho-educational interventions developed for melanoma survivors. METHODS: Electronic databases Medline, PsycINFO, Embase, and CINAHL were systematically searched using key words and subject headings for articles describing educational or psychological interventions designed specifically for people affected by melanoma. RESULTS: Twenty-seven articles, generated by 16 unique interventions, were included for detailed review. Overall, educational interventions showed increased patient satisfaction with clinical care and information provision, as well as increased frequency of skin self-examination, although accuracy and thoroughness of skin examination were seldom reported. Participation in psychological interventions was associated with decreases in anxiety, health-related distress, and melanoma recurrence rates, as well as positive changes in coping with illness. Programs, when implemented as part of routine clinical care, were found to be cost-effective. CONCLUSIONS: Interventions in this field vary widely, limiting the identification of 'active ingredients' for psychological or behavioral change. Future intervention studies should ensure sufficient information is provided to support program replication and comprehensive assessment of program outcomes.

7 Review Update on melanoma and non-melanoma skin cancer. Annual Skin Cancer Conference 2011, Hamilton Island, Australia, 5–6 August 2011. 2011

Zalaudek, Iris / Whiteman, David / Rosendahl, Cliff / Menzies, Scott W / Green, Adèle C / Hersey, Peter / Argenziano, Giuseppe. ·Department of Dermatology, Medical University of Graz, Graz, Austria. iris.zalaudek@meduni-graz.at ·Expert Rev Anticancer Ther · Pubmed #22117149.

ABSTRACT: In this article, we will summarize some of the highlights of the third annual conference on skin cancer, with special emphasis on the the recent advances regarding melanoma and non-melanoma skin cancer epidemiology, diagnosis and treatment. Topics were particularly addressed to a newly developing medical branch in Australia, namely that of Primary Care Skin Cancer Practitioners, and focused on strategies to improve primary and secondary prevention and early detection of melanoma and non-melanoma skin cancer using dermoscopy. Controversies related to skin cancer screening programs and recent progresses for treating advanced melanoma were additionally discussed. Yet, besides its scientific goals, the conference aimed also to encourage research originating in primary care and relevant to primary care.

8 Review State of the art of diagnostic technology for early-stage melanoma. 2011

Guitera, Pascale / Menzies, Scott W. ·Melanoma Institute Australia, Sydney, NSW, Australia. pascale.guitera@melanoma.org.au ·Expert Rev Anticancer Ther · Pubmed #21554047.

ABSTRACT: In the past few decades, rapid improvements in noninvasive optical technologies have revolutionized the diagnosis of early-stage melanoma. Current knowledge and limitations of these tools will be reviewed in this article. Dermoscopy has been recognized as the 'gold standard' in the screening phase. Digital dermoscopy monitoring and total-body photography are used to identify so-called 'featureless' melanoma only on the criteria of change over time. Automated instruments, as well as optical and nonmorphological methods, are still under development, and offer many opportunities to improve the speed and accuracy of the diagnosis of melanoma and/or to reduce the need for expertise. Despite a penetration depth limited to the upper dermis, the quasi-histological imaging achieved by in vivo reflectance confocal microscopy has been demonstrated to significantly aid diagnostic accuracy for selected melanocytic lesions. Future perspectives on diagnostic instrumentation will also be explored.

9 Review Key points in the dermoscopic diagnosis of hypomelanotic melanoma and nodular melanoma. 2011

Moloney, Fergal J / Menzies, Scott W. ·Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. fergal.moloney@sydney.edu.au ·J Dermatol · Pubmed #21175750.

ABSTRACT: Nodular melanoma (NM) and amelanotic/hypomelanotic melanoma (AHM) often present a challenge to the diagnosing clinician. A significant proportion of AHM are nodular in nature. Such tumors may lack features of asymmetry and altered peripheral pigmentation routinely observed in other melanoma subtypes. This lack of distinguishing clinical features can potentially result in delayed diagnosis or inappropriate treatment. This review highlights the key points in evaluating the range of lesions where AHM or NM are considered in the differential diagnosis and summarizes current evidence in relation to pigmented and vascular dermoscopic diagnostic criteria for both.

10 Article Methods of melanoma detection and of skin monitoring for individuals at high risk of melanoma: new Australian clinical practice. 2019

Adler, Nikki R / Kelly, John W / Guitera, Pascale / Menzies, Scott W / Chamberlain, Alex J / Fishburn, Paul / Button-Sloan, Alison E / Heal, Clinton / Soyer, H Peter / Thompson, John F. ·Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC. · Armadale Dermatology, Melbourne, VIC. · Melanoma Institute Australia, Sydney, NSW. · University of Sydney, Sydney, NSW. · Royal Prince Alfred Hospital, Sydney, NSW. · Sydney Melanoma Diagnostic Centre, University of Sydney, Sydney, NSW. · Victorian Melanoma Service, Alfred Health, Melbourne, VIC. · Glenferrie Dermatology, Melbourne, VIC. · Norwest Skin Cancer Centre, Sydney, NSW. · Melanoma Patients Australia, Brisbane, QLD. · MelanomaWA, Perth, WA. · Dermatology Research Centre, Diamantina Institute, University of Queensland, Brisbane, QLD. · Princess Alexandra Hospital, Brisbane, QLD. ·Med J Aust · Pubmed #30636296.

ABSTRACT: INTRODUCTION: The evidence-based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma-related mortality. MAIN RECOMMENDATIONS: Clinicians who perform skin examinations for the purpose of detecting skin cancer should be trained in and use dermoscopy. The use of short term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual melanocytic lesions of concern. The use of long term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual or multiple melanocytic lesions for routine surveillance of high risk patients. The use of total body photography should be considered in managing patients at increased risk for melanoma, particularly those with high naevus counts and dysplastic naevi. There is insufficient evidence to recommend the routine use of automated instruments for the clinical diagnosis of primary melanoma. MANAGEMENT OVERVIEW: Determining the relative indications for each diagnostic method and how each method should be introduced into the surveillance of a patient requires careful consideration and an individualised approach.

11 Article The steadily growing problem of lentigo maligna and lentigo maligna melanoma in Australia: Population-based data on diagnosis and management. 2019

Guitera, Pascale / Collgros, Helena / Madronio, Christine M / Goumas, Christopher / Mann, Graham J / Watts, Caroline G / Pereira, Amanda R / Armstrong, Bruce K / Drummond, Martin / Morton, Rachael L / Scolyer, Richard A / Menzies, Scott W / Thompson, John F / Cust, Anne E. ·Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia. · Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. · Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia. · Surveillance, Evaluation & Research Program, Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia. · Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · Discipline of Surgery, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. ·Australas J Dermatol · Pubmed #30302753.

ABSTRACT: BACKGROUND/OBJECTIVES: There are limited population-based data documenting the incidence and management of lentigo maligna (LM) and invasive lentigo maligna melanoma (LMM). We report the data on occurrence and management of LM and LMM in an Australian population. METHODS: Prospective collection of incidence and clinician-reported management of melanoma in situ (MIS; n = 450, capped) and localised invasive melanoma (n = 3251) notified to the New South Wales Cancer Registry over 12-months in 2006-2007. RESULTS: The estimated annual incidence of all MIS was 27.0 per 100 000 (LM 12.2, non-LM MIS 5.9 and unclassified MIS 9.0). Patients with LM or LMM were on average approximately 10 years older than those with other melanoma subtypes (P < 0.001). The head and neck was the location of 59% of LM, 44% of LMM and <20% of other melanoma subtypes (P < 0.001). The majority of LM and LMM were treated only by specialists. Diagnostic partial biopsies were more frequent for LM and LMM than for other melanoma subtypes, and primary care physicians were more likely than specialists to do a punch partial biopsy than a shave biopsy. The reported median definitive excision margin for LM was 5.0 mm compared with 7.2 mm for non-LM MIS (P = 0.001). CONCLUSIONS: In this Australian population, LM was twice as frequent as other types of MIS. Improved strategies for diagnosis and management are required.

12 Article A prospective observational study of pigmented naevi changes in psoriasis patients on biologic therapy. 2019

Choi, Seohee Deanne / D'Souza, Mario I / Menzies, Scott W / Weninger, Wolfgang. ·Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. · Sydney Local Health District Clinical Research Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Immune Imaging Program, Centenary Institute, Newtown, NSW, Australia. ·Australas J Dermatol · Pubmed #29797312.

ABSTRACT: BACKGROUND/OBJECTIVES: Patients on biologic therapy are thought to be at increased risk of developing non-melanoma skin cancers and melanomas. It is unknown whether biologic therapy alters the natural history of melanocytic naevi. Therefore, a prospective observational study was conducted to determine whether psoriasis patients on biologic therapy develop changes in naevi. METHODS: Clinical and dermoscopic assessment of all melanocytic naevi was performed in 45 psoriasis patients on biologic therapy versus a control cohort of 43 subjects, using sequential digital dermoscopic imaging and total body photography. The mean follow-up period was 1.5 years. RESULTS: The study and control patients had comparable age, gender, previous and family history of non-melanoma skin cancers and melanomas, as well as previous sun exposure and total number of naevi. The number of naevi with major dermoscopic changes was 3% in the study and 1.9% in the control group, with an adjusted incidence rate ratio of 1.45 (95% confidence interval 0.90-2.33; P = 0.125). The rate of minor changes was 15.9% in the study group versus 19.4% in the control (adjusted incidence rate ratio 0.77, 95% confidence interval 0.57-1.08; P = 0.14). There were six new dysplastic naevi in 4/45 biologic patients and four in 4/43 controls; however, the difference was not significant (relative risk 0.96, 95% confidence interval -0.12 to 0.12; P = 0.95). There were no melanomas in either group. CONCLUSION: Over a mean follow-up period of 1.5 years there was no evidence of significantly different changes in naevi or development of new dysplastic naevi in psoriasis patients on biologic treatment compared to controls.

13 Article 'Mind your Moles' study: protocol of a prospective cohort study of melanocytic naevi. 2018

Koh, Uyen / Janda, Monika / Aitken, Joanne F / Duffy, David L / Menzies, Scott / Sturm, Richard A / Schaider, Helmut / Betz-Stablein, Brigid / Prow, Tarl / Soyer, H Peter / Green, Adele C. ·Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia. · School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. · Australian Childhood Cancer Registry, Cancer Council Queensland, Brisbane, Queensland, Australia. · Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia. · Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia. · School of Public Health, University of Queensland, Brisbane, Queensland, Australia. · Genetic Epidemiology, Molecular Epidemiology and Neurogenetics Laboratories, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. · Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia. · Sydney Medical School (Discipline of Dermatology), The University of Sydney, Sydney, New South Wales, Australia. · Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia. · Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. · Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia. · Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia. · CRUK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK. ·BMJ Open · Pubmed #30232117.

ABSTRACT: INTRODUCTION: Having many melanocytic naevi or 'moles' on the skin is the strongest predictor of melanoma; thus, much can be learnt from investigating naevi in the general population. We aim to improve the understanding of the epidemiology and biology of naevi by conducting a 3-year prospective study of melanocytic naevi in adults. METHODS AND ANALYSIS: This is a population-based cohort study of melanocytic naevi in 200 adults aged 20-69 years recruited via the Australian electoral roll. At baseline, participants will complete a questionnaire on their sun behaviour and health and undergo a clinical examination. Three-dimensional (3D) total-body photography will be used to record the images of skin lesions. Pigmented naevi will be analysed in terms of number, diameter, colour and border irregularity using automated analysis software (excluding scalp, beneath underwear and soles of feet). All naevi ≥5 mm will be recorded using the integrated dermoscopy photographic system. A saliva sample will be obtained at baseline for genomic DNA analysis of pigmentation, naevus and melanoma-associated genes using the Illumina HumanCoreExome platform. The sun behaviour and health follow-up questionnaire, clinical examination and 3D total-body photography will be repeated every 6 months for 3 years. The first 50 participants will also undergo manual counts of naevi ≥2 mm and ≥5 mm at baseline, 6-month and 12-month follow-ups. Microbiopsy and excision of naevi of research interest is planned to commence at the 18-month time point among those who agree to donate samples for detailed histopathological and molecular assessment. ETHICS AND DISSEMINATION: This study was approved by the Metro South Health Human Research Ethics Committee in April 2016 (approval number: HREC/16/QPAH/125). The findings will be disseminated through peer-reviewed and non-peer-reviewed publications and presentations at conferences.

14 Article Clinical Perspective of 3D Total Body Photography for Early Detection and Screening of Melanoma. 2018

Rayner, Jenna E / Laino, Antonia M / Nufer, Kaitlin L / Adams, Laura / Raphael, Anthony P / Menzies, Scott W / Soyer, H Peter. ·Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia. · Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. ·Front Med (Lausanne) · Pubmed #29911103.

ABSTRACT: Melanoma incidence continues to increase across many populations globally and there is significant mortality associated with advanced disease. However, if detected early, patients have a very promising prognosis. The methods that have been utilized for early detection include clinician and patient skin examinations, dermoscopy (static and sequential imaging), and total body photography via 2D imaging. Total body photography has recently witnessed an evolution from 2D imaging with the ability to now create a 3D representation of the patient linked with dermoscopy images of individual lesions. 3D total body photography is a particularly beneficial screening tool for patients at high risk due to their personal or family history or those with multiple dysplastic naevi-the latter can make monitoring especially difficult without the assistance of technology. In this perspective, we discuss clinical examples utilizing 3D total body photography, associated advantages and limitations, and future directions of the technology. The optimal system for melanoma screening should improve diagnostic accuracy, be time and cost efficient, and accessible to patients across all demographic and socioeconomic groups. 3D total body photography has the potential to address these criteria and, most importantly, optimize crucial early detection.

15 Article A National Budget Impact Analysis of a Specialised Surveillance Programme for Individuals at Very High Risk of Melanoma in Australia. 2018

Watts, Caroline G / Wortley, Sally / Norris, Sarah / Menzies, Scott W / Guitera, Pascale / Askie, Lisa / Mann, Graham J / Morton, Rachael L / Cust, Anne E. ·Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia. caroline.watts@sydney.edu.au. · Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. caroline.watts@sydney.edu.au. · Sydney School of Public Health, The University of Sydney, The Lifehouse, Level 6-North, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia. · Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW, Australia. · Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Dermatology Department, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia. ·Appl Health Econ Health Policy · Pubmed #29305821.

ABSTRACT: BACKGROUND: Specialised surveillance using total body photography and digital dermoscopy to monitor people at very high risk of developing a second or subsequent melanoma has been reported as cost effective. OBJECTIVES: We aimed to estimate the 5-year healthcare budget impact of providing specialised surveillance for people at very high risk of subsequent melanoma from the perspective of the Australian healthcare system. METHODS: A budget impact model was constructed to assess the costs of monitoring and potential savings compared with current routine care based on identification of patients at the time of a melanoma diagnosis. We used data from a published cost-effectiveness analysis of specialised surveillance, and Cancer Registry data, to estimate the patient population and healthcare costs for 2017-2021. RESULTS: When all eligible patients, estimated at 18% of patients with melanoma diagnosed annually in Australia, received specialised surveillance rather than routine care, the cumulative 5-year cost was estimated at $93.5 million Australian dollars ($AU) ($US 64 million) for specialised surveillance compared with $AU 120.7 million ($US 82.7 million) for routine care, delivering savings of $AU 27.2 million ($US 18.6 million). With a staggered introduction of 60% of eligible patients accessing surveillance in year 1, increasing to 90% in years 4 and 5, the cumulative cost over 5 years was estimated at $AU 98.1 million ($US 67.2 million), amounting to savings of $AU 22.6 million ($US 15.5 million) compared with routine care. CONCLUSIONS: Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.

16 Article Follow-Up Recommendations after Diagnosis of Primary Cutaneous Melanoma: A Population-Based Study in New South Wales, Australia. 2018

Read, Rebecca L / Madronio, Christine M / Cust, Anne E / Goumas, Chris / Watts, Caroline G / Menzies, Scott / Curtin, Austin M / Mann, Graham / Thompson, John F / Morton, Rachael L. ·Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. · Calvary Health Care, Bruce, ACT, Australia. · Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia. · Sydney Medical School, The University of Sydney and the Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Department of Surgery, The University of Sydney, Camperdown, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia. rachael.morton@ctc.usyd.edu.au. · NHMRC Clinical Trials Centre, The University of Sydney, Level 6, Medical Foundation Building92-94 Parramatta Road, Camperdown, NSW, Australia. rachael.morton@ctc.usyd.edu.au. ·Ann Surg Oncol · Pubmed #29299710.

ABSTRACT: BACKGROUND: Follow-up practices after diagnosis and treatment of primary cutaneous melanoma vary considerably. We aimed to determine factors associated with recommendations for follow-up setting, frequency, skin surveillance, and concordance with clinical guidelines. METHODS: The population-based Melanoma Patterns of Care study documented clinicians' recommendations for follow-up for 2148 patients diagnosed with primary cutaneous melanoma over a 12-month period (2006/2007) in New South Wales, Australia. Multivariate log binomial regression models adjusted for patient and lesion characteristics were used to examine factors associated with follow-up practices. RESULTS: Of 2158 melanomas, Breslow thickness was < 1 mm for 57% and ≥ 1 mm for 30%, while in situ melanomas accounted for 13%. Follow-up was recommended for 2063 patients (96%). On multivariate analysis, factors associated with a recommendation for follow-up at a specialist center were Breslow thickness ≥ 1 mm [prevalence ratio (PR) 1.05, 95% confidence interval (CI) 1.01-1.09] and initial treatment at a specialist center (PR 1.12, 95% CI 1.08-1.16). Longer follow-up intervals of > 3 months were more likely to be recommended for females, less likely for people living in rural compared with urban areas, and less likely for thicker (≥ 1 mm) melanomas compared with in situ melanomas. Skin self-examination was encouraged in 84% of consultations and was less likely to be recommended for patients ≥ 70 years (PR 0.88, 95% CI 0.84-0.93) and for those with thicker (≥ 1 mm) melanomas (PR 0.92, 95% CI 0.86-0.99). Only 1% of patients were referred for psychological care. CONCLUSIONS: Follow-up recommendations were generally consistent with Australian national guidelines for management of melanoma, however some variations could be targeted to improve patient outcomes.

17 Article Sensitivity of Preference-Based Quality-of-Life Measures for Economic Evaluations in Early-Stage Melanoma. 2018

Dieng, Mbathio / Kasparian, Nadine A / Cust, Anne E / Costa, Daniel S J / Tran, Anh / Butow, Phyllis N / Menzies, Scott W / Mann, Graham J / Morton, Rachael L. ·National Health and Medical Research Council (NHMRC) Clinical Trial Centre, The University of Sydney, Camperdown, Australia. · Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Australia. · Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia. · Melanoma Institute Australia, University of Sydney, North Sydney, Australia. · Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, Australia. · Sydney Medical School, University of Sydney, Australia. · Psycho-oncology Co-operative Research Group, School of Psychology, University of Sydney, Sydney, Australia. · Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia. · The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Australia. ·JAMA Dermatol · Pubmed #29188268.

ABSTRACT: Importance: The diagnosis of a life-threatening disease like melanoma can affect all aspects of a person's life, including health-related quality of life (HRQOL) and psychological aspects of melanoma such as fear of cancer recurrence (FCR). Economic evaluations of psychological interventions require preference-based (utility) instruments that are sensitive to changes in well-being and HRQOL; however, very few studies have evaluated the sensitivity of these instruments when used for people with melanoma. Objective: To compare utility scores from the multiple-attribute instrument Assessment of Quality of Life-8-Dimension Scale (AQoL-8D) with the mapped utility scores of the Functional Assessment of Cancer Therapy-Melanoma (FACT-M) and to investigate the sensitivity of both instruments in identifying the influence of FCR on HRQOL. Design, Setting, and Participants: This assessment of data from a randomized clinical trial of a psychoeducational intervention to reduce FCR, conducted at 3 high-risk melanoma clinics in Australia, evaluated 164 patients with early-stage melanoma and a high risk of developing a second primary melanoma. Main Outcomes and Measures: The FACT-M and AQoL-8D were used to assess HRQOL and FCR among the study participants. Concurrent validity was assessed by comparing the total and subdomain scores of the 2 instruments, and the strength of associations was assessed using Pearson correlation coefficient. Convergent validity was assessed by comparing participants' HRQOL, demographic, and clinical characteristics using the χ2 test and F statistic. Both the FACT-M and AQoL-8D utilities were regressed on FCR Inventory (FCRI) severity scores to estimate the effect of elevated FCR on HRQOL. Results: A total of 164 participants completed the baseline questionnaires, but only 163 met all inclusion criteria and underwent the full analysis: 72 were women; 91 were men; and mean (SD) age was 58.2 (12.1) years. Both the AQoL-8D and FACT-M instruments showed good concurrent validity and could differentiate between relevant subgroups including level of FCRI severity. The AQoL-8D and FACT-M utilities were strongly correlated (r2 = 0.57). Respondents had a mean (SD) AQoL-8D utility of 0.77 (0.2), and a mean (SD) FACT-M utility score of 0.76 (0.07). High levels of FCRI severity were associated with a decrease in utility of 0.12 (95% CI, -0.19 to -0.05) as measured by AQoL-8D, and a decrease of 0.03 (95% CI, -0.05 to -0.01) as measured by the FACT-M. Conclusions and Relevance: For economic evaluations of psychological interventions in melanoma, the AQoL-8D and FACT-M are valid measures of utility; however, the AQoL-8D demonstrates greater sensitivity to FCRI severity. Our results suggest a significant association between FCR and HRQOL.

18 Article Punch 'scoring': a technique that facilitates melanoma diagnosis of clinically suspicious pigmented lesions. 2018

Grogan, Judith / Cooper, Caroline L / Dodds, Tristan J / Guitera, Pascale / Menzies, Scott W / Scolyer, Richard A. ·Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. · Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia. ·Histopathology · Pubmed #28796900.

ABSTRACT: AIMS: Early recognition and accurate diagnosis underpins melanoma survival. Identifying early melanomas arising in association with pre-existing lesions is often challenging. Clinically suspicious foci, however small, must be identified and examined histologically. This study assessed the accuracy of punch biopsy 'scoring' of suspicious foci in excised atypical pigmented skin lesions to identify early melanomas. METHODS AND RESULTS: Forty-one excised pigmented skin lesions with a clinically/dermoscopically focal area of concern for melanoma, with the suspicious focus marked prior to excision with a punch biopsy 'score' (a partial incision into the skin surface), were analysed. Melanoma was diagnosed in nine of 41 cases (22%). In eight of nine cases (89%) the melanoma was associated with a naevus, and in seven of nine (88%) cases the melanoma was identified preferentially by the scored focus. In six of nine cases (67%), the melanoma was entirely encompassed by the scored focus. In one case of melanoma in situ, the diagnostic material was identified only on further levelling through the scored focus. In 28 of 32 of non-melanoma cases (88%), the scored focus identified either diagnostic features of a particular lesion or pathological features that correlated with the clinical impression of change/atypia including altered architecture or distribution of pigmentation, features of irritation or regression. CONCLUSIONS: The 'punch scoring technique' allows direct clinicopathological correlation and facilitates early melanoma diagnosis by focusing attention on clinically suspicious areas. Furthermore, it does not require special expertise in ex-vivo clinical techniques for implementation. Nevertheless, in some cases examination of the lesion beyond the scored focus is also necessary to make a diagnosis of melanoma.

19 Article Psychoeducational intervention for people at high risk of developing another melanoma: a pilot randomised controlled trial. 2017

Dieng, Mbathio / Kasparian, N A / Mireskandari, Shab / Butow, Phyllis / Costa, Daniel / Morton, Rachael / Mann, Graham / Menzies, Scott / Cust, Anne. ·Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia. · NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia. · Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Sydney, Australia. · Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia. · Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia. · Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia. · Melanoma Institute Australia, The University of Sydney, North Sydney, Australia. · Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, Australia. · The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia. ·BMJ Open · Pubmed #29018064.

ABSTRACT: INTRODUCTION: Information and psychological needs have been reported as one of the greatest areas of unmet needs for patients with melanoma. To respond to these needs, we developed the METHODS: Twenty-four adults (14 men, 10 women, mean age: 58 years, SD: 12.2) at high risk of developing a subsequent primary melanoma were recruited and randomly assigned 1:1 to the intervention (a psychoeducational booklet, a Cancer Council booklet on melanoma and up to five telephone-based sessions with a psychologist) or usual care (Cancer Council booklet only). Acceptability, feasibility, fear of cancer recurrence and secondary psychosocial outcomes were assessed at baseline, 1 and 6 months. RESULTS: Satisfaction and perceived benefits were rated highly for all intervention components, particularly the telephone-based psychology sessions (mean satisfaction and benefits: both 9.27 out of 10, SD=2.41). The quality of information and support provided throughout the trial was rated as 'high' by the intervention group, with a mean score of 4.6 out of a possible 5 (SD=0.9) and 4.2 (SD=1.2) for the control group. CONCLUSIONS: The intervention was feasible and acceptable for improving psychological adjustment. Timely access to effective, evidence-based, psychological care is a recognised need for people with melanoma. The intervention is designed to directly address this need in a way that is feasible in a clinical setting, acceptable to patients and health professionals. TRIAL REGISTRATION NUMBER: The trial was registered with the Australian and New Zealand Clinical Trials Registry on 19/03/2013 (Registration Number: ACTRN12613000304730).

20 Article Accuracy of dermatoscopy for the diagnosis of nonpigmented cancers of the skin. 2017

Sinz, Christoph / Tschandl, Philipp / Rosendahl, Cliff / Akay, Bengu Nisa / Argenziano, Giuseppe / Blum, Andreas / Braun, Ralph P / Cabo, Horacio / Gourhant, Jean-Yves / Kreusch, Juergen / Lallas, Aimilios / Lapins, Jan / Marghoob, Ashfaq A / Menzies, Scott W / Paoli, John / Rabinovitz, Harold S / Rinner, Christoph / Scope, Alon / Soyer, H Peter / Thomas, Luc / Zalaudek, Iris / Kittler, Harald. ·Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. · Faculty of Medicine, The University of Queensland, Brisbane, Australia; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. · Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey. · Dermatology Unit, University of Campania, Naples, Italy. · Public, Private and Teaching Practice of Dermatology, Konstanz, Germany. · Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. · Department of Dermatology, Instituto de Investigaciones Médicas "A. Lanari," University of Buenos Aires, Buenos Aires, Argentina. · Centre de Dermatologie, Nemours, France. · Private Dermatology Practice, Lübeck, Germany. · First Department of Dermatology, Aristotle University, Thessaloniki, Greece. · Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden. · Memorial Sloan Kettering Cancer Center, Hauppauge, New York. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Discipline of Dermatology, University of Sydney, Sydney, Australia. · Department of Dermatology and Venereology, Sahlgrenska University Hospital, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. · Skin and Cancer Associates, Plantation, Florida. · Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. · Department of Dermatology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia. · Department of Dermatology, Centre Hospitalier Lyon Sud, Lyon 1 University, Lyons Cancer Research Center, Lyon, France. · Department of Dermatology, Medical University of Graz, Graz, Austria. · Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria. Electronic address: harald.kittler@meduniwien.ac.at. ·J Am Acad Dermatol · Pubmed #28941871.

ABSTRACT: BACKGROUND: Nonpigmented skin cancer is common, and diagnosis with the unaided eye is error prone. OBJECTIVE: To investigate whether dermatoscopy improves the diagnostic accuracy for nonpigmented (amelanotic) cutaneous neoplasms. METHODS: We collected a sample of 2072 benign and malignant neoplastic lesions and inflammatory conditions and presented close-up images taken with and without dermatoscopy to 95 examiners with different levels of experience. RESULTS: The area under the curve was significantly higher with than without dermatoscopy (0.68 vs 0.64, P < .001). Among 51 possible diagnoses, the correct diagnosis was selected in 33.1% of cases with and 26.4% of cases without dermatoscopy (P < .001). For experts, the frequencies of correct specific diagnoses of a malignant lesion improved from 40.2% without to 51.3% with dermatoscopy. For all malignant neoplasms combined, the frequencies of appropriate management strategies increased from 78.1% without to 82.5% with dermatoscopy. LIMITATIONS: The study deviated from a real-life clinical setting and was potentially affected by verification and selection bias. CONCLUSIONS: Dermatoscopy improves the diagnosis and management of nonpigmented skin cancer and should be used as an adjunct to examination with the unaided eye.

21 Article In Vivo Reflectance Confocal Microscopy for the Diagnosis of Melanoma and Melanotic Macules of the Lip. 2017

Uribe, Pablo / Collgros, Helena / Scolyer, Richard A / Menzies, Scott W / Guitera, Pascale. ·Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia. · Melanoma Institute Australia, Sydney, New South Wales, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia. · The University of Sydney, Sydney, New South Wales, Australia. ·JAMA Dermatol · Pubmed #28467525.

ABSTRACT: Importance: Benign melanotic macules (MAC) are the most frequent cause of lip pigmentation and sometimes difficult to differentiate from lip melanoma (MEL). Objectives: To report in vivo reflectance confocal microscopy (RCM) features of normal lips of different phototypes and to identify features that assist in distinguishing MEL from MAC using dermoscopy and RCM. Design, Setting, and Participants: For this retrospective observational study, 2 groups of patients from 2 tertiary referral centers for melanoma (Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia) were recruited between June 2007 and January 2015. Group 1 included patients with normal lips and different phototypes, and Group 2 consisted of patients with MAC and MEL; RCM and dermoscopy were used for lips analysis. Main Outcomes and Measures: Overall, 92 RCM features were correlated with clinical history, dermoscopic images, and histopathology in all patients with MEL and 5 patients with MAC. Results: Images from the vermillion and/or mucosal part of the lip were recorded from 10 patients with clinically normal lips (mean [SD] age, 34.5 [6.1] years), 16 patients with MAC (mean [SD] age, 49.6 [17.9] years), and 5 patients with 6 cases of MEL (1 patient had a recurrent lesion; mean [SD] age, 56.2 [15.5] years). In normal lips, the draped pattern-a previously described MAC RCM feature-was identified in all cases. In MEL, the following findings were frequent and significantly different from MAC: epidermal disarray; pagetoid infiltration of dendritic and/or round cells; a nonspecific architectural pattern at the dermoepidermal junction (DEJ); nonhomogenously distributed papillae; continuous (lentiginous) proliferation of cells with marked atypia at the DEJ, especially in interpapillary spaces; a higher number of dendritic cells (especially roundish); and atypical round cells at the DEJ. The cellular body area of dendritic cells was about the double in MEL compared with MAC. An RCM lip algorithm was developed that provided 100% sensitivity and 88% specificity for the diagnosis of MEL of the vermillion and mucosal part of the lip. With dermoscopy, MAC were correctly classified as benign in 13 of 16 cases (81%) and MEL were classified as equivocal or malignant in 5 of 6 cases (83%). Conclusions and Relevance: Reflectance confocal microscopy can assist in the differential diagnosis of lip MEL and MAC. An RCM Lip Score that we developed based on study results is proposed and needs to be validated on an independent data set.

22 Article Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions. 2017

Rocha, L / Menzies, S W / Lo, S / Avramidis, M / Khoury, R / Jackett, L / Guitera, P. ·Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · The University of Sydney, Sydney Medical School, Discipline of Dermatology, Camperdown, NSW, Australia. · Melanoma Institute Australia, North Sydney, NSW, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia. · Discipline of Dermatology, University of Sydney and Sydney Melanoma Diagnostic Centre, Camperdown, NSW, Australia. ·Br J Dermatol · Pubmed #28421597.

ABSTRACT: BACKGROUND: Electrical impedance spectroscopy (EIS) is a noninvasive diagnostic technique that measures tissue impedance. OBJECTIVES: To evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI). METHODS: Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). EIS measurement was performed at the first visit following dermoscopic photography. Normally, an EIS score of ≥ 4 is considered positive; however, this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥ 7 the lesion was excised immediately owing to the high risk of melanoma. Lesions with a score < 7 were monitored with standard SDDI over a 3-month period. RESULTS: From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83·1% [95% confidence interval (CI) 76·3-88·7]. Five of the six melanomas found in this study had an EIS score ≥ 7, with a sensitivity for melanoma diagnosis of 83·3% (95% CI 35·9-99·6). When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS = 6) giving a sensitivity for the diagnosis of melanoma overall of 100% (95% CI 54·1-100; six of six malignant melanomas excised) and a specificity of 69·5% (95% CI 61·5-76·6; 107 of 154 benign lesions not excised). CONCLUSIONS: If utilizing a protocol where an EIS score ≤ 3 requires no SDDI and ≥ 7 requires immediate excision, it reduced the need for SDDI by 46·9% (n = 75/160; 95% CI 39·0-54·9).

23 Article Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma. 2017

Watts, Caroline G / Cust, Anne E / Menzies, Scott W / Mann, Graham J / Morton, Rachael L. ·Caroline G. Watts, Sydney School of Public Health, The University of Sydney · Anne E. Cust, Sydney School of Public Health, The University of Sydney, and Melanoma Institute Australia, The University of Sydney · Graham J. Mann, Melanoma Institute Australia, The University of Sydney, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney · Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney, and Melanoma Institute Australia, The University of Sydney · and Scott W. Menzies, Discipline of Dermatology, University of Sydney, and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. ·J Clin Oncol · Pubmed #28034073.

ABSTRACT: Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective. A high-risk standard care cohort was obtained using linked population data, comprising the Sax Institute's 45 and Up cohort study, linked to Medicare Benefits Schedule claims data, the cancer registry, and hospital admissions data. Benefits were measured in quality-adjusted life-years gained. Sensitivity analyses were undertaken for all model parameters. Results Specialized surveillance through the High Risk Clinic was both less expensive and more effective than standard care. The mean saving was A$6,828 (95% CI, $5,564 to $8,092) per patient, and the mean quality-adjusted life-year gain was 0.31 (95% CI, 0.27 to 0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). The results were robust when tested in sensitivity analyses. Conclusion Specialized surveillance was a cost-effective strategy for the management of individuals at high risk of melanoma. There were also fewer invasive procedures in specialized surveillance compared with standard care in the community.

24 Article Clinical Features Associated With Individuals at Higher Risk of Melanoma: A Population-Based Study. 2017

Watts, Caroline G / Madronio, Christine / Morton, Rachael L / Goumas, Chris / Armstrong, Bruce K / Curtin, Austin / Menzies, Scott W / Mann, Graham J / Thompson, John F / Cust, Anne E. ·Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. · NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. · School of Public Health, Rural Health Northern Rivers, Lismore, NSW, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and the Discipline of Dermatology, The University of Sydney, Sydney, NSW, Australia. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia6Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia. · Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia3Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. ·JAMA Dermatol · Pubmed #27829101.

ABSTRACT: Importance: The identification of a subgroup at higher risk of melanoma may assist in early diagnosis. Objective: To characterize melanoma patients and the clinical features associated with their melanomas according to patient risk factors: many nevi, history of previous melanoma, and family history of melanoma, to assist with improving the identification and treatment of a higher-risk subgroup. Design, Setting, and Participants: The Melanoma Patterns of Care study was a population-based observational study of physicians' reported treatment of 2727 patients diagnosed with an in situ or invasive primary melanoma over a 12-month period from October 2006 to 2007 conducted in New South Wales. Our analysis of these data took place from 2015 to 2016. Main Outcomes and Measures: Age at diagnosis and body site of melanoma. Results: Of the 2727 patients with melanoma included, 1052 (39%) were defined as higher risk owing to a family history of melanoma, multiple primary melanomas, or many nevi. Compared with patients with melanoma who were at lower risk (ie, without any of these risk factors), the higher-risk group had a younger mean age at diagnosis (62 vs 65 years, P < .001), but this differed by risk factor (56 years for patients with a family history, 59 years for those with many nevi, and 69 years for those with a previous melanoma). These age differences were consistent across all body sites. Among higher-risk patients, those with many nevi were more likely to have melanoma on the trunk (41% vs 29%, P < .001), those with a family history of melanoma were more likely to have melanomas on the limbs (57% vs 42%, P < .001), and those with a personal history were more likely to have melanoma on the head and neck (21% vs 15%, P = .003). Conclusions and Relevance: These findings suggest that a person's risk factor status could be used to tailor surveillance programs and education about skin self-examination.

25 Article Diagnosis and clinical management of melanoma patients at higher risk of a new primary melanoma: A population-based study in New South Wales, Australia. 2017

Watts, Caroline G / Madronio, Christine M / Morton, Rachael L / Goumas, Chris / Armstrong, Bruce K / Curtin, Austin / Menzies, Scott W / Mann, Graham J / Thompson, John F / Cust, Anne E. ·Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia. · NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia. · Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia. · School of Public Health, Rural Health Northern Rivers, Lismore, New South Wales, Australia. · Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · Discipline of Dermatology, University of Sydney, Sydney, New South Wales, Australia. · Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia. ·Australas J Dermatol · Pubmed #27477217.

ABSTRACT: BACKGROUND/OBJECTIVES: To describe the method of diagnosis, clinical management and adherence to clinical practice guidelines for melanoma patients at high risk of a subsequent primary melanoma, and compare this with melanoma patients at lower risk. METHODS: The Melanoma Patterns of Care study was a population-based, observational study based on doctors' reported clinical management of melanoma patients in New South Wales, Australia, diagnosed with in situ or invasive melanoma over a 12-month period from October 2006. Of 2605 patients with localised melanoma, 1019 (39%) were defined as at higher risk due to the presence of one or more of the following factors: a family history of melanoma (11%), multiple primary melanomas (17%), or many naevi (24%). RESULTS: Compared to patients at lower risk, high risk patients were more likely to receive their initial care from a primary care physician (56% vs 50%, P = 0.002), have their melanoma detected during a routine skin check (40% vs 33%, P < 0.001), have their lesion assessed with dermoscopy (63% vs 56%, P = 0.002), and be encouraged to have skin surveillance (84% vs 77%, P < 0.001) and skin self-examination (87% vs 83%, P = 0.03). Higher socioeconomic status and urban residence were associated with patients at higher risk receiving initial treatment from a specialist doctor. CONCLUSIONS: Clinical management of higher risk patients was more likely to conform to clinical practice guidelines for diagnosis and skin surveillance than to melanoma patients at lower risk.

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