In this video blog, Rebecca Hartman, MD, discusses highlights from her lecture, Melanoma Updates 2024, on July 26, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.
In this video
Dr. Hartman is confident that physical blockers, zinc and titanium, are safe, including the nanoparticle formulations, since there's no data suggesting penetration or concern. For chemical sunscreens she has no safety data except for oxybenzone, which has been shown to be an endocrine disruptor, and she notes that heavy application does lead to blood absorption, so more studies are needed. She points to a randomized controlled trial in Australia showing a reduction in melanoma with regular sunscreen use.
On dysplastic nevi, she frames her goal as biopsying melanomas, not dysplastic nevi, though some will inevitably be sampled along the way. She favors a scoop-shave saucerization to remove the whole lesion for both diagnosis and treatment, then tailors next steps to severity: for mild or moderate lesions with positive margins but no repigmentation, she clinically monitors; for severely dysplastic nevi she often recommends a 2-3 mm re-excision given the gray zone with melanoma in situ. She applies the same scoop-shave approach (roughly a 2 mm peripheral margin, at least a millimeter of depth) to suspected melanomas, using scouting biopsies or upfront narrow excision for larger lesions, and she uses total body photography to cut unnecessary biopsies in high-nevus-count patients and to catch evolving early melanomas.
- Physical-blocker sunscreens (zinc, titanium), including nanoparticles, are safe; among chemical agents only oxybenzone has data as an endocrine disruptor, and heavy application does result in blood absorption.
- The goal is to biopsy melanomas, not dysplastic nevi — use scoop-shave saucerization to remove the whole lesion; mild/moderate DN with positive margins and no repigmentation can just be monitored.
- Severely dysplastic nevi warrant a 2-3 mm re-excision even with negative margins because of the gray zone with melanoma in situ; go back in if margins are positive.
- Preferred biopsy for suspected melanoma is a tangential scoop-shave with about a 2 mm peripheral margin and at least 1 mm of depth to inform sentinel node decisions; use scouting biopsies or narrow excision for larger lesions.
- Total body photography reduces unnecessary biopsies in patients with many moles and helps detect evolution in early, tricky melanomas.
