Optimising personalised melanoma care: A national e-Delphi consensus survey exploring expert perspectives on the use of a novel prognostic biomarker for early-stage cutaneous malignant melanoma.

Abstract

Cutaneous malignant melanoma (cMM) incidence continues to rise. AJCC staging provides broad prognostic estimates, potentially leading to overtreatment in early-stage disease. AMBLor™ is a validated IHC-based biomarker that identifies non-ulcerated AJCC stage I/II cMM at lower risk of progression. To obtain consensus on clinical and service challenges in early-stage cMM care and how AMBLor™ could be integrated into decision-making at critical points in the care pathway. A four-round modified e-Delphi survey was conducted. Twenty-five UK skin specialist MDT consultants participated in Round 1, with 15 completing all rounds. Rounds 1-2 explored challenges and potential biomarker use cases; Rounds 3-4 assessed the impact of an AMBLor™ low-risk result on key management scenarios including SLNB, adjuvant therapy, imaging, and follow-up. Consensus was defined as strong (≥75%) or moderate (50-74%) agreement. Strong consensus emerged for biomarker utility in: targeting radiological surveillance to higher-risk patients (100%), reducing follow-up for lower-risk patients (100%), prioritising adjuvant therapy for highest-risk cases (95%), and improving SLNB selection (91%). With an AMBLor™ low-risk result, moderate consensus supported not offering SLNB for pT1b melanoma (66%), not offering adjuvant therapy for stage IIB melanoma (72%) and reducing intensity of both CT surveillance for stage IIB melanoma (50%) and clinical surveillance for stages IA-IIA (50-56%). The e-DAM study demonstrates expert consensus that AMBLor™ could augment clinical decision making at key junctures in the cMM care pathway by refining SLNB selection, rationalising adjuvant therapy and imaging, and reducing follow-up burdens - enhancing personalised care, whilst alleviating service pressures.