NEW YORK — A presenter at the HemOnc Today Melanoma and Cutaneous Malignancies meeting reviewed new technologies for detecting early melanoma and their practical use in Germany.
Axel Hauschild, MD, of the department of dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Germany, reviewed sequential digital dermoscopy and computer-assisted systems for detecting melanoma.
In Germany, the current realistic ratio of benign to malignant melanomas that are biopsied is 24:1 for dermatologists, he said. Eighty-nine percent of Germans have public insurance, and due to a reimbursement system that favors private insurance, most lesions excised involve private insurance.
One in five German dermatologists in private practice use sequential digital dermoscopy, according to Hauschild.
In a 2010 study by Haenssle HA and colleagues published in Archives of Dermatology, researchers evaluated 688 patients with high melanoma risk by naked eye, dermoscopy and sequential dermoscopy evaluations (mean follow-up: 44.3 months), uncovering a 22% risk of melanoma development for patients with atypical mole syndrome, according to Hauschild. However, according to new German guidelines, sequential dermoscopy is only useful in patients with high melanoma risk or multiple nevi or a few other patients with atypical moles, he said.
“The question is, how can we overcome unnecessary excisions of benign nevi?” Hauschild said.
Hauschild reported that even when most nevi are removed from a patient with many nevi, it does not necessarily prevent the patients from developing melanoma.
“We need something more than routine evaluations for this sort of [high-risk] patient,” he said.
Hauschild also discussed MelaFind multispectral digital dermoscopy. Study findings reported MelaFind correctly identified 172 of 175 melanomas; however, the number of false-positives found during removal of moles was a problem for the reimbursement system in Germany, Hauschild reported.
In research he conducted in 2012 on MelaFind, Hauschild found American dermatologists incorporated MelaFind more often than German dermatologists when deciding on excision of pigmented lesions.
He also discussed Nevisense electrical impedance spectroscopy, a non-invasive method for early detection of malignant melanoma that was recently introduced in Europe. Acceptance of Nevisense and MelaFind is very low among German dermatologists, according to Hauschild.
In his summary of automated diagnosis of melanoma, Hauschild found videodermoscopy is the “gold standard.” He also reported most cellphone apps were not ready for use in dermatologists’ standard routine for detecting melanoma.
Hauschild reported that many procedures under German public health insurance must be paid out of pocket by patients, with a cost of €18 to €44 for dermoscopy and videodermosopy. MelaFind and Nevisense treatments also are out-of-pocket expenses for publically insured patients in Germany, at a rate of €90 to €120.
Hauschild concluded that, although the devices have a good rate for sensitivity for detecting melanoma, he questioned whether they were leading to reduced excision rates in Germany. – by Bruce Thiel
Hauschild A. The current state of automated diagnosis in early melanoma in Europe. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies. April 10-11, 2015; New York.
Disclosure: Hauschild reports receiving consultancy and speaker’s fees from Almirall Hermal, BMS, Boehringer Ingelheim, Celgene, Eisai, GSK, IGEA, La Roche-Posay, MEDA Pharma, MelaSciences, MSD, Novartis, Roche, SciBase, SOBI and Spiring.