Background:
Melanoma prognosis is strongly dependent on stage at diagnosis, yet access to timely dermatological assessment and longitudinal surveillance remains limited in low- and middle-income countries (LMICs). While population-wide screening remains controversial, targeted surveillance of individuals at increased risk represents a promising prevention and early interception strategy, particularly when supported by affordable technologies and structured follow-up protocols.
Objectives:
To implement and evaluate a risk-based longitudinal surveillance cohort of individuals at increased risk of developing melanoma, using structured follow-up protocols and a low-cost total body mapping technology within a public health setting.
Methods:
This prospective cohort study is conducted by the Melanoma Research Group of Barretos Cancer Hospital (Brazil). Individuals previously identified as potentially at risk for melanoma were invited for information validation and risk assessment using a validated scale (SAMScore). First-degree relatives of patients diagnosed with melanoma and followed at the institution’s skin cancer prevention unit were also invited to participate. Participants are stratified into low-, moderate-, and high-risk groups and enrolled in structured follow-up according to risk level, with annual or semiannual dermatological evaluations. Longitudinal monitoring includes education on skin self-examination, periodic telemedicine consultations, administration of questionnaires and assessment scales, and total body mapping using a low-cost imaging device developed in this study. Health economic analyses, including budget impact and cost-effectiveness assessments, are conducted to support implementation and scalability.
Results / Expected results
Information validation has been completed, the imaging device has been pilot-tested, and cohort enrollment is ongoing. The study is expected to support earlier detection of malignant skin lesions among high-risk individuals, improve longitudinal documentation of melanocytic lesions, and demonstrate the feasibility of integrating structured surveillance and low-cost imaging technologies into public health services.
Conclusions / Implications:
Risk-based longitudinal surveillance using affordable total body mapping and telemedicine support represents a feasible and scalable strategy for melanoma prevention and early interception in LMICs. This model addresses barriers related to specialist access and cost, and provides actionable evidence to inform public health strategies for targeted skin cancer surveillance.

EXECUTION STEPS (WORKFLOW)