Cutaneous Melanoma Systematic Diagnostic Workflows and Integrated Reflectance Confocal Microscopy Assessed with a Retrospective, Comparative Longitudinal (2009–2018) Study

SIMPLE SUMMARY: A retrospective study (2009–2018), where the integration of education, a diagnostic-therapeutical workflow (with centralized and immediate assessment of suspicious lesions) and high-performance technology in a single province, seems to improve melanoma detection accuracy, as measured by the number needed to excise. From 40,832 lesions excised there was 279% increase number of melanoma excised. A systemic diagnostic-therapeutical workflow including reflectance confocal micrscopy (RCM) was described. The impact was assessed with the number of lesions needed to excise (NNE) according to excision location: reference hospital (DP) or other (NDP), NNE decreased almost 3-fold at DP and by half at NDP. Aggressive melanoma detection remained unchanged over the study period. Hypothetical cost analyses estimated health service savings. ABSTRACT: Background: The increasing global burden of melanoma demands efficient health services. Accurate early melanoma diagnosis improves prognosis. Objectives: To assess melanoma prevention strategies and a systematic diagnostic-therapeutical workflow (improved patient access and high-performance technology integration) and estimate cost savings. Methods: Retrospective analysis of epidemiological data of an entire province over a 10-year period of all excised lesions suspicious for melanoma (melanoma or benign), registered according to excision location: reference hospital (DP) or other (NDP). A systematic diagnostic-therapeutical workflow, including direct patient access, primary care physician education and high-performance technology (reflectance confocal microscopy (RCM)) integration, was implemented. Impact was assessed with the number of lesions needed to excise (NNE). Results: From 40,832 suspicious lesions excised, 7.5% (n = 3054) were melanoma. There was a 279% increase in the number of melanomas excised (n = 203 (2009) to n = 567 (2018)). Identification precision improved more than 100% (5.1% in 2009 to 12.0% in 2018). After RCM implementation, NNE decreased almost 3-fold at DP and by half at NDP. Overall NNE for DP was significantly lower (NNE = 8) than for NDP (NNE = 20), p < 0.001. Cost savings amounted to EUR 1,476,392.00. Conclusions: Melanoma prevention strategies combined with systematic diagnostic-therapeutical workflow reduced the ratio of nevi excised to identify each melanoma. Total costs may be reduced by as much as 37%.