Original Title: Tratamiento quirúrgico de lesiones melanocíticas benignas para la prevención del melanoma

Authors' objectives: A systematic literature review to collect the available scientific evidence on the surgical treatment of benign melanocytic lesions as a melanoma prevention method.

Authors' results and conclusions: RESULTS: Twenty-two primary studies (thirteen on acquired lesions and nine on congenital lesions), one of them is a clinical trial and other an economic evaluation, while the rest are observational studies without control group nor cohorts. Also, we included eleven clinical practice guidelines. The effectiveness outcome of melanoma identification in acquired lesions was the ratio of number of excisions needed to discover one melanoma. This indicator depends on several factors such as the criteria for suspicion, the expertise and experience of the doctor or the pressure made by the patient. Variations also exist regarding patient characteristics such as age, gender or socio-economic level. The effectiveness can be improved with the use of screening techniques and educational programs for physicians. Regarding the congenital lesions, the studies of case series confirmed that the observation during the whole life of the patient without any surgery is a valid therapeutic option. The clinical practice guidelines agree on the importance of early detection, recommending ABCDE criteria or 7 point check list and dermoscopic examination to identify correctly the suspicion for melanoma. A suspicious lesion should be referred urgently to a dermatologist, who after confirming suspected lesion performs a deep excisional biopsy with little margin. It is not recommended to perform excisions in primary care. CONCLUSIONS: Early diagnosis of melanoma by detection of suspicious melanocytic lesions is essential. Primary studies demonstrate through several indicators that there are factors that increase the proportion of LM treated unnecessarily. The clinical practice guidelines of several countries agree on the criteria for identifying suspected melanocytic lesion. It is not recommend prophylactic excisions without suspicion nor perform surgeries in primary care, but referral clinically suspicious lesions urgently to specialist in dermatology.

Authors' methods: A systematic review of primary studies on the effectiveness, costs and safety of surgery of melanocytic lesions as a melanoma prevention was conducted. Clinical practice guidelines published internationally were also revised to compare the management of melanocytic lesions in different socioeconomic and healthcare environments.

Project Status: Completed

Year Published: 2014

URL for published report: https://sescs.es/tratamiento-quirurgico-de-lesiones-melanociticas-benignas-para-la-prevencion-del-melanoma/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es