P56: A systematic review and meta-analysis of total body photography for the diagnosis of cutaneous melanoma in adults
A. Ji-Xu, 1 J. Dinnes2 and R. Matin1
1Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; and 2Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
Early detection of melanoma is essential to reduce mortality. Total body photography (TBP) can facilitate the detection of melanoma in high-risk individuals (Truong A, Strazzulla L, March J et al. Reduction in nevus biopsies in patients monitored by total body photography. J Am Acad Dermatol 2016; 75: 135–43; Lallas A, Apalla Z, Kyrgidis A et al. Second primary melanomas in a cohort of 977 melanoma patients within the first 5 years of monitoring. J Am Acad Dermatol 2020; 82: 398–406). However, the accuracy of TBP in diagnosing melanoma remains unclear. Our aim was to conduct a systematic review to determine the diagnostic accuracy of TBP for the detection of melanoma in adults. MEDLINE, Embase, the Cochrane Library and the Centre for Reviews databases were searched from inception to 26 May 2020. Studies using TBP to diagnose melanoma with at least one follow-up appointment were eligible if they provided data to calculate at least one diagnostic accuracy measure. Two authors independently screened articles, extracted data and assessed quality. Disagreements were resolved by a third reviewer. Ten studies were included, comprising 41 703 patients who underwent TBP and 6203 biopsies. Melanoma in situ (MIS) was diagnosed in 315 (5·1%) lesions and invasive melanoma in 187 (3·0%) lesions biopsied. Summary estimates for TBP in diagnosing melanoma were calculated: mean percentage of biopsies positive for MIS or melanoma was 16% (95% confidence interval 11–20); number needed to biopsy (NNB) was 8·6 (range 2·3–19·6); naevus : melanoma ratio was 7·6 (range 1·3–18·6); and the MIS : melanoma ratio was 1·7 (range 1·0–3·5). Regression analysis showed a negative correlation between NNB and MIS : melanoma ratio. Available data regarding the diagnostic accuracy of TBP are heterogeneous owing to variability in the risk profile of cohorts and TBP protocols. Best current estimates suggest that TBP to diagnose melanoma has an acceptable NNB in high-risk patients. However, prospective diagnostic test accuracy studies are needed to gauge accurately the diagnostic accuracy of TBP.
