The potential impact of ACOG guideline changes on genital melanoma detection rates in females: a retrospective cross-sectional analysis and implications for clinical practice

Abstract

Genital melanoma (GM) is a rare but aggressive cancer that accounts for less than 5% of vaginal cancers and 0.2–0.8% of all melanomas in the United States. The 2018 American College of Obstetricians and Gynecologists (ACOG) guidelines reduced routine pelvic exams for women aged 65 and older, raising concerns about later-stage GM diagnosis, worse survival rates, and potential underreporting. This study investigated the impact of these guideline changes on female GM detection rates through a cross-sectional analysis of female patients aged 18 and older in the All of Us database from 2012 to 2023. The analysis focused on melanoma in-situ (MIS) of the vulva using ICD-10-CM code D03.8 to calculate prevalence and incidence. The study identified 16 cases of vulvar MIS (0.006%, 95% CI [0.004-0.010%]) with a mean age of 64.6 ± 12.4 years at diagnosis. Prevalence peaked in the 61–70 age group (0.014%, 95% CI [0.000-0.029%]), with white patients showing the highest prevalence (0.009%, 95% CI [0.004-0.015%]). The overall incidence was 5.37 cases per million women per year. However, a decreasing trend was observed, with no cases reported between 2021 and 2023. This decline in reported cases may be linked to the 2018 ACOG guideline changes, potentially leading to later-stage diagnoses and poor outcomes. The study’s limitations include the inability to calculate yearly incidence due to lack of annual enrollment data and the absence of staging information. The findings suggest a potential connection between the ACOG guideline modifications and GM detection rates. While current incidence rates are similar to or higher than those before the 2018 changes, the decline in routine pelvic exams may contribute to later-stage diagnoses and poor outcomes. The absence of diagnosed GM cases in the past three years is particularly concerning and may reflect delayed effects of infrequent screening. Increased awareness, improved screening practices, and additional research are necessary to fully understand the impact of the 2018 ACOG guideline changes on GM diagnosis and treatment. Healthcare providers should consider performing yearly pelvic examinations, especially for patients over 65, while educating patients on early self-detection of GM.