Melanoma management in 2025: from prevention campaigns to high-risk surveillance

Prevention campaigns, imaging tools and sentinel node biopsy: EADV 2025 highlighted how melanoma management evolves across the entire patient journey.

Screening and prevention campaigns: are they delivering?

The GLOBOCAN 2022 data indicated that melanoma was the 17th most common cancer. An estimated 331.722 people were diagnosed with melanoma globally and approximately 58.667 died from this disease. During EADV 2025 Prof. Veronique del Marmol (Brussels, Belgium) reflected on the impact of two decades of melanoma awareness and screening initiatives, including the EuroMelanoma campaign. The message was nuanced: these campaigns have undoubtedly improved public knowledge, facilitated earlier diagnoses and collected invaluable epidemiological data across Europe. Yet their reach is uneven.

Participation varies considerably among countries, with coverage gaps in rural areas and among older men (groups that paradoxically carry the highest risk). The COVID-19 pandemic further reduced participation, and restoring pre-pandemic engagement has proved difficult.

The Australian example remains instructive: the long-standing “Slip-Slop-Slap” campaign successfully reduced melanoma incidence among younger cohorts, demonstrating that sustained investment in education can alter epidemiology. In Europe, the challenge is to adapt messages to culturally diverse populations and to sustain behaviour change over time. As Del Marmol stressed, prevention campaigns are effective but far from sufficient: dermatologists must advocate for targeted communication strategies, integration of self-examination tools, and partnerships with primary care to reach under-served groups.

Campaigns must evolve from isolated events to continuous, multi-channel communication adapted to modern lifestyles.

Total body and lesion-directed imaging

Prof. Danica Tiodorovic (Nis, Serbia) addressed how imaging can refine melanoma detection in clinical practice. Dermoscopy is now considered the standard of care, significantly increasing sensitivity and specificity compared to naked-eye examination.

For high-risk individuals - patients with multiple or atypical nevi, or with strong family histories - total body photography combined with sequential dermoscopy can capture subtle changes over time, providing reassurance when stable and prompting action when new or evolving lesions appear. More sophisticated tools such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) allow quasi-histological evaluation in vivo, helping to avoid unnecessary biopsies.

However, these technologies require specialised expertise, are time-consuming and carry substantial costs. Tiodorovic concluded that while dermoscopy should be universal, advanced imaging should be concentrated in referral centres and carefully selected patients, where its impact on early detection and reduction of unnecessary excisions justifies the investment. For dermatologists, knowing when to refer a patient for high-end imaging is as important as mastering dermoscopy itself.

Sentinel lymph node biopsy: is it still useful?

The session then shifted to the surgical domain. Prof. Eduardo Nagore (Valencia, Spain) examined the controversial role of sentinel lymph node biopsy (SLNB) in melanoma staging and management.
SLNB remains the most accurate method for assessing regional nodal status and retains prognostic value, especially in stage IB–IIA disease. It helps identify patients with worse prognosis and ensures eligibility for clinical trials. However, evidence consistently shows that SLNB does not improve overall survival, raising questions about its therapeutic role.

The landscape is changing with the advent of effective adjuvant therapies. In stage IIB–IIC, adjuvant immunotherapy with agents such as pembrolizumab or nivolumab is now recommended regardless of sentinel node status. In these settings, the value of SLNB becomes primarily prognostic, rather than therapeutic or decision-making for systemic therapy.

Nagore highlighted the need to balance benefits (accurate staging and stratification) against potential harms, including surgical complications, lymphedema and costs. Importantly, dermatologists should discuss openly with patients that a positive sentinel node will not necessarily alter access to systemic therapy but may still inform prognosis. Future directions may lie in predictive nomograms and molecular biomarkers to stratify nodal risk, but these remain investigational. For now, SLNB remains part of guidelines but requires individualised discussion.

Identifying high-risk groups

In the final lecture, Prof. Ana-Maria Forsea (Bucharest, Romania) explored how to define and detect patients at highest risk of melanoma. Traditional risk factors are well established: fair phototype, history of sunburns, >100 nevi, atypical nevi, family history and immunosuppression. Yet Forsea argued that risk stratification must evolve beyond simple checklists.

Genetic predisposition is gaining traction. Variants of MC1R, the so-called “red-hair gene”, roughly double the risk of melanoma. Emerging polygenic risk scores and digital risk calculators may in future help tailor surveillance strategies, though their clinical utility is not yet validated. Importantly, not all risks are equal: the likelihood of developing melanoma differs from the likelihood of developing an aggressive subtype, such as nodular melanoma.

Digital tools - apps, patient questionnaires, AI-assisted image analysis - are under development to support both self-examination and physician risk assessment. Until validated, however, Forsea emphasised that the cornerstone remains patient education and clinician vigilance, ensuring that high-risk groups receive closer follow-up and earlier intervention.

A broader view: melanoma care in transition

Taken together, the session painted melanoma management as a field in transition. Prevention campaigns and self-examination remain fundamental but require modernisation to reach under-served populations. Imaging technologies promise more accurate and less invasive diagnosis, though cost and expertise limit universal adoption. Sentinel lymph node biopsy retains prognostic importance but is losing therapeutic weight in the era of adjuvant immunotherapy. Identifying high-risk groups with refined tools may soon guide more personalised surveillance strategies.

For dermatologists, the message is clear: melanoma care is shifting from a one-size-fits-all approach to a layered strategy of prevention, precision diagnostics and tailored surveillance. Clinical practice is no longer just about excising suspicious lesions but about coordinating a continuum of education, technology and multidisciplinary care. The session reminded the audience that dermatologists are uniquely positioned to bridge population-level prevention, individualised risk assessment and integration of systemic therapies once needed.

Sources and further reading
  1. Del Marmol V. Screening and prevention campaigns: are they delivering? Melanoma session (Session ID D2T05.1A), EADV Congress 2025, Paris/Virtual, 18 Sept 2025, 08:30–08:50 CEST.
  2. Tiodorovic D. Total body and lesion-directed imaging. Melanoma session (Session ID D2T05.1B), EADV Congress 2025, Paris/Virtual, 18 Sept 2025, 08:50–09:10 CEST.
  3. Nagore E. Sentinel lymph node biopsy: is it still useful? Melanoma session (Session ID D2T05.1C), EADV Congress 2025, Paris/Virtual, 18 Sept 2025, 09:10–09:30 CEST.
  4. Forsea AM. Identifying high risk groups. Melanoma session (Session ID D2T05.1D), EADV Congress 2025, Paris/Virtual, 18 Sept 2025, 09:30–09:50 CEST.
  5. Del Marmol V, Suppa M, Stratigos AJ, Forsea AM. Prevention and screening of melanoma in Europe: 20 years of the Euromelanoma campaign. J Eur Acad Dermatol Venereol. 2022;36(Suppl 6):5–11. doi:10.1111/jdv.18195.
  6. Allard-Coutu A, Dobson V, Schmitz E, Shah H, Nessim C. The evolution of the sentinel node biopsy in melanoma. Life (Basel). 2023;13(2):489. doi:10.3390/life13020489.