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Background: Recommendations for surveillance imaging for resected melanoma vary considerably. This study examined the utility of imaging in patients with a high‐risk primary melanoma undergoing a protocolized imaging schedule. Methods: This retrospective study involved data collection regarding imaging, recurrence, and outcome characteristics for patients referred to the Victorian Melanoma Service from January 2016–April 2020 and managed for resected stage IIC or III melanoma. Patients with a T4b tumor who did not undergo a sentinel lymph node biopsy were included (T4bNX). Recurrences were "clinically detected" if they were primarily detected by patient symptoms or physical examination, or 'imaging‐detected' if the patient was asymptomatic. Cox regression models including time‐varying co‐variates were used to assess the impact of imaging‐detected versus clinically‐detected recurrence on overall survival. Results: Over a median follow‐up time of 2.7 years, 199 patients underwent surveillance imaging (T4bNX:22, IIC:33, IIIA:22, IIIB:60, IIIC:61, IIID:1), and 44% (n = 88) experienced disease recurrence. Imaging detected over half (53%) of all recurrences. In adjusted analyses, mortality risk was reduced after an imaging‐detected compared to clinically‐detected recurrence at any given time from the start of surveillance (hazard ratio 0.25, 95% confidence interval 0.10–0.66, p =.005). Conclusion: Our study indicates that routine imaging in the early follow‐up period of resected T4bNX, stage IIC and III melanoma plays an important role in the detection of asymptomatic recurrences. Imaging‐detected recurrence may be associated with a survival benefit and studies with more prolonged follow‐up are required to confirm these findings. [ABSTRACT FROM AUTHOR]

It is well recognized that randomized controlled trials (RCTs) are a powerful tool to investigate causal relationships, and are considered the gold standard level of research evidence. However, RCTs can be expensive and time‐consuming, and when they employ strict eligibility criteria, it results in an unrepresentative population and limited external validity. Recently, the registry‐based randomized clinical trial (RRCT) has emerged as an alternative trial design. Utilizing registries to underpin such studies, RRCTs can have advantages including rapid recruitment, and enhanced generalizability. In Australia, legislated mandatory reporting of cancer diagnoses means that jurisdictional cancer registries are a rich source of systematically collected patient details, representing sound platforms for comprehensive data capture that can serve as a key tool for further research. We review the roles of cancer registries in Australia, discuss important considerations relevant to the design of RRCTs, and outline the opportunities provided by cancer registries to strengthen cancer research. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to determine the frequency and concordance of BRAF and NRAS mutation in tumours arising in patients with multiple primary melanoma (MPM). Patients with MPM managed at one of three tertiary referral centres in Melbourne, Australia, from 2010 to 2015 were included. Incident and subsequent melanomas underwent mutation testing. Cohen's kappa (κ) coefficient assessed agreement between incident and subsequent primary melanomas for both BRAF and NRAS mutation status (mutant versus wild‐type). Mutation testing of at least two primary tumours from 64 patients was conducted. There was poor agreement for both BRAF and NRAS mutation status between incident and subsequent melanomas (κ = 0.10, 95% CI −0.10 to 0.42; κ = 0.06, 95% CI −0.10 to 0.57, respectively). In view of the low concordance in BRAF mutation status between incident and subsequent melanomas, mutational analysis of metastatic tissue, rather than of a primary melanoma, in patients with MPM should be used to guide targeted therapy. [ABSTRACT FROM AUTHOR]

(b) A dark, irregularly pigmented, ovoid-shaped lesion was seen in the nail matrix after reflection of the proximal nail fold and partial nail plate avulsion. gl After reflection of the proximal nail fold and partial nail plate avulsion, a dark irregularly pigmented black-grey, ovoid-shaped lesion was seen in the nail matrix (Fig. b). The diagnosis of a nail matrix blue naevus was established. Subungual blue naevi are exceedingly rare with approximately ten cases reported in the literature to date.[2] The most important differential diagnosis of subungual blue naevus is subungual melanoma. [Extracted from the article]