"This is going to have clinical impact down the line," Dr. Tsao noted. "Many of these [older] people have melanomas on the head and neck, which appear to have a worse prognosis." These tumors are thick, often nodular in subtype and with a lot of negative features in the pathology report. "We don’t really understand this phenotype – it may be the tumor, it may be the host, it may be the chronically sun-damaged skin surface."
However, "the question is how you get that group to be potentially screened – and how screening within this group is going to impact mortality," he noted. "We’re still optimistic that with proper screening, we can make a difference in mortality."
Dr. Tsao uses the mnemonic MENN (male, elderly, neck/scalp/trunk, nodular type melanoma) to thoroughly check for melanomas in this patient population, regardless of the reason for presentation.
Melanoma Registries
"One of the ways that we can study the burden of a skin disease is by having nationalized records. It doesn’t exist for most other skin diseases," said Dr. Tsao. "Still, most dermatologists in practice don’t think about registering their melanomas, even though this is one of the most codified disorders in all of dermatology ... maybe this is something that we need to work on ... the only way that we can make progress toward documenting the burden of skin disease is that we document the burden of skin disease."
There are likely a large number of melanomas that are diagnosed in the community and the question is whether those are getting recorded in a registry. "In most large hospitals or tertiary care centers, cancers undergo registration. But this may not be the case in private practice," Dr. Tsao said. "If we’re underestimating the burden of melanoma, then in some ways we’re shortchanging ourselves. Given the long-range surveillance, dermatologists are becoming the primary caretakers of melanoma patients in this country in terms of sheer volume ... dermatologists have an opportunity to detect at an early stage and to deflect these patients away from advanced disease."