P51 e-DAM: An e-Delphi consensus survey to inform the clinical utility of AMBLorTM: a novel prognostic biomarker for American Joint Committee on Cancer stage I and II cutaneous malignant melanoma
Krishna Ravulapalli, Diarmuid Coughlan, Rachel Abbott, Howard Peach, Michaela Fay, Penny Lovat, Aidan RoseAbstract
Introduction and aims
Cutaneous malignant melanoma (cMM) incidence continues to rise in the UK, creating unprecedented pressures on skin cancer services. Current American Joint Committee on Cancer (AJCC) staging provides only broad prognostic estimates, potentially leading to overtreatment in early-stage disease. AMBLor is a validated immunohistochemistry (IHC)-based biomarker that identifies nonulcerated AJCC stage I/II cMM at lower risk of progression. This study aimed to establish expert consensus on the potential clinical utility of AMBLor in personalizing early-stage cMM management.
Methods
A four-round modified e-Delphi survey was conducted between February 2023 and May 2025. Twenty-five UK skin specialist MDT (SSMDT) consultants participated in Round 1, with 18 completing all rounds. Rounds 1–2 explored challenges in managing early-stage cMM and potential biomarker use cases. Rounds 3–4 assessed the impact of an AMBLor low-risk result on key management scenarios identified from rounds 1–2, including sentinel lymph node biopsy (SLNB), adjuvant therapy, imaging and follow-up. Consensus was defined as strong (≥ 75%) or moderate (50–74%) agreement.
Results
Strong consensus emerged for biomarker utility in targeting radiological surveillance to higher-risk patients (100%), reducing follow-up for lower-risk patients (100%), prioritizing adjuvant therapy for highest-risk cases (95%), and improving SLNB selection (91%). In the context of an AMBLor low-risk result, moderate consensus supported not offering SLNB for pT1b melanoma (66%), adjuvant therapy for AJCC stage IIB melanoma (72%), computed tomography surveillance for stage IIB melanoma (50%) and reducing intensity of clinical surveillance for AJCC stages IA–IIA (50–56%).
Conclusions
The e-DAM study demonstrates strong expert support for integrating AMBLor into early-stage cMM clinical pathways. AMBLor-guided strategies could refine SLNB selection, rationalize adjuvant therapy and imaging provision, and reduce clinical follow-up burdens, thereby enhancing personalized care for patients with cMM, while alleviating service pressures. Prospective studies are now warranted to evaluate the real-world impact on outcomes, resource utilization, and patient experience.