PDF(Pubmed)
Abstract：
Therapy for advanced melanoma has transformed during the past decade, but early detection and prognostic assessment of cutaneous melanoma (CM) remain paramount goals. Best practices for screening and use of pigmented lesion evaluation tools and gene expression profile (GEP) testing in CM remain to be defined.
To provide consensus recommendations on optimal screening practices and prebiopsy diagnostic, postbiopsy diagnostic, and prognostic assessment of CM.
Case scenarios were interrogated using a modified Delphi consensus method. Melanoma panelists (n = 60) were invited to vote on hypothetical scenarios via an emailed survey (n = 42), which was followed by a consensus conference (n = 51) that reviewed the literature and the rationale for survey answers. Panelists participated in a follow-up survey for final recommendations on the scenarios (n = 45).
The panelists reached consensus (≥70% agreement) in supporting a risk-stratified approach to melanoma screening in clinical settings and public screening events, screening personnel recommendations (self/partner, primary care provider, general dermatologist, and pigmented lesion expert), screening intervals, and acceptable appointment wait times. Participants also reached consensus that visual and dermoscopic examination are sufficient for evaluation and follow-up of melanocytic skin lesions deemed innocuous. The panelists reached consensus on interpreting reflectance confocal microscopy and some but not all results from epidermal tape stripping, but they did not reach consensus on use of certain pigmented lesion evaluation tools, such as electrical impedance spectroscopy. Regarding GEP scores, the panelists reached consensus that a low-risk prognostic GEP score should not outweigh concerning histologic features when selecting patients to undergo sentinel lymph node biopsy but did not reach consensus on imaging recommendations in the setting of a high-risk prognostic GEP score and low-risk histology and/or negative nodal status.
For this consensus statement, panelists reached consensus on aspects of a risk-stratified approach to melanoma screening and follow-up as well as use of visual examination and dermoscopy. These findings support a practical approach to diagnosing and evaluating CM. Panelists did not reach consensus on a clearly defined role for GEP testing in clinical decision-making, citing the need for additional studies to establish the clinical use of existing GEP assays.
To provide consensus recommendations on optimal screening practices and prebiopsy diagnostic, postbiopsy diagnostic, and prognostic assessment of CM.
Case scenarios were interrogated using a modified Delphi consensus method. Melanoma panelists (n = 60) were invited to vote on hypothetical scenarios via an emailed survey (n = 42), which was followed by a consensus conference (n = 51) that reviewed the literature and the rationale for survey answers. Panelists participated in a follow-up survey for final recommendations on the scenarios (n = 45).
The panelists reached consensus (≥70% agreement) in supporting a risk-stratified approach to melanoma screening in clinical settings and public screening events, screening personnel recommendations (self/partner, primary care provider, general dermatologist, and pigmented lesion expert), screening intervals, and acceptable appointment wait times. Participants also reached consensus that visual and dermoscopic examination are sufficient for evaluation and follow-up of melanocytic skin lesions deemed innocuous. The panelists reached consensus on interpreting reflectance confocal microscopy and some but not all results from epidermal tape stripping, but they did not reach consensus on use of certain pigmented lesion evaluation tools, such as electrical impedance spectroscopy. Regarding GEP scores, the panelists reached consensus that a low-risk prognostic GEP score should not outweigh concerning histologic features when selecting patients to undergo sentinel lymph node biopsy but did not reach consensus on imaging recommendations in the setting of a high-risk prognostic GEP score and low-risk histology and/or negative nodal status.
For this consensus statement, panelists reached consensus on aspects of a risk-stratified approach to melanoma screening and follow-up as well as use of visual examination and dermoscopy. These findings support a practical approach to diagnosing and evaluating CM. Panelists did not reach consensus on a clearly defined role for GEP testing in clinical decision-making, citing the need for additional studies to establish the clinical use of existing GEP assays.
摘要：
未经证实：晚期黑色素瘤的治疗在过去十年中发生了变化，但皮肤黑色素瘤(CM)的早期发现和预后评估仍是首要目标.在CM中筛选和使用色素病变评估工具和基因表达谱（GEP）测试的最佳实践仍有待定义。
UNASSIGNED：为提供关于最佳筛查方法和活检前诊断的共识建议，活检后诊断，和CM的预后评估。
UNASSIGNED：使用改进的德尔菲共识方法询问案例场景。黑色素瘤小组成员(n=60)被邀请通过电子邮件调查(n=42)对假设情况进行投票，随后是一个共识会议(n=51)，回顾了文献和调查答案的理由。小组成员参加了对方案的最终建议的后续调查(n=45)。
UNASSIGNED：小组成员在支持临床环境和公共筛查事件中黑色素瘤筛查的风险分层方法方面达成共识（≥70％的共识），筛选人员建议(自我/合作伙伴，初级保健提供者，普通皮肤科医生,和色素性病变专家)，筛选间隔,和可接受的预约等待时间。参与者还达成共识，即视觉和皮肤镜检查足以评估和随访被认为无害的黑素细胞皮肤病变。小组成员就解释反射共聚焦显微镜和表皮胶带剥离的部分但并非全部结果达成共识，但是他们在使用某些色素性病变评估工具方面没有达成共识，如电阻抗谱。关于GEP分数，小组成员达成共识,即在选择接受前哨淋巴结活检的患者时,低危预后GEP评分不应超过组织学特征,但在高危预后GEP评分和低危组织学和/或淋巴结阴性的情况下,对影像学建议未达成共识.
未经评估：对于本共识声明，小组成员就黑色素瘤筛查和随访的风险分层方法以及目视检查和皮肤镜检查的使用达成共识.这些发现支持了诊断和评估CM的实用方法。小组成员未就GEP检测在临床决策中的明确作用达成共识。指出需要进行更多研究以建立现有GEP测定的临床用途。
UNASSIGNED：为提供关于最佳筛查方法和活检前诊断的共识建议，活检后诊断，和CM的预后评估。
UNASSIGNED：使用改进的德尔菲共识方法询问案例场景。黑色素瘤小组成员(n=60)被邀请通过电子邮件调查(n=42)对假设情况进行投票，随后是一个共识会议(n=51)，回顾了文献和调查答案的理由。小组成员参加了对方案的最终建议的后续调查(n=45)。
UNASSIGNED：小组成员在支持临床环境和公共筛查事件中黑色素瘤筛查的风险分层方法方面达成共识（≥70％的共识），筛选人员建议(自我/合作伙伴，初级保健提供者，普通皮肤科医生,和色素性病变专家)，筛选间隔,和可接受的预约等待时间。参与者还达成共识，即视觉和皮肤镜检查足以评估和随访被认为无害的黑素细胞皮肤病变。小组成员就解释反射共聚焦显微镜和表皮胶带剥离的部分但并非全部结果达成共识，但是他们在使用某些色素性病变评估工具方面没有达成共识，如电阻抗谱。关于GEP分数，小组成员达成共识,即在选择接受前哨淋巴结活检的患者时,低危预后GEP评分不应超过组织学特征,但在高危预后GEP评分和低危组织学和/或淋巴结阴性的情况下,对影像学建议未达成共识.
未经评估：对于本共识声明，小组成员就黑色素瘤筛查和随访的风险分层方法以及目视检查和皮肤镜检查的使用达成共识.这些发现支持了诊断和评估CM的实用方法。小组成员未就GEP检测在临床决策中的明确作用达成共识。指出需要进行更多研究以建立现有GEP测定的临床用途。
