Melanomas Detected in a Follow-up Program Compared With Melanomas Referred to a Melanoma Unit

Objective: To compare melanomas diagnosed in patients included in follow-up programs with melanomas diagnosed in patients referred to a melanoma unit. Design: Retrospective analysis of 215 consecutive melanomas diagnosed between 2007 and 2008. Setting: Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain. Patients: The study included 201 patients (105 men and 96 women), 40 of whom were included in a follow-up program in our unit and 161 of whom were referred for evaluation. Main Outcome Measures: Clinical (ABCD algorithm), dermoscopic (ABCD rule of dermoscopy), and main histologic characteristics were evaluated in both groups. Results: Most melanomas diagnosed in follow-up did not fulfill some of the ABCD criteria, and only 12.0% fulfilled all 4 ABCD criteria, in contrast with 63.6% of the melanomas referred for evaluation (P< .001). The total dermoscopy score was lower in melanomas diagnosed in follow-up (5.04 vs. 6.39, P<.01), and 36% were mis-classified as benign in this group according to the total dermoscopy score. Seventy percent of melanomas diagnosed in follow-up were in situ; among invasive melanomas, the Breslow index was significantly lower in the group of melanomas diagnosed in follow-up, with a mean (range) of 0.55 (0.25-0.90) mm vs 1.72 (0.25-13.00) mm (P<.001). Conclusions: The inclusion of patients who are at high risk for melanoma in follow-up programs allows the detection of melanomas in early stages, with good prognosis, even in the absence of clinical and dermoscopic features of melanoma. In the general population without specific surveillance, melanoma continues to be diagnosed at more advanced stages.