Introduction: Early detection of cutaneous melanoma is crucial, as prognosis is strongly determined by Breslow thickness. Total-body photography (TBP) is increasingly used in high-risk populations, yet optimal surveillance strategies remain undefined. In our study, we aimed to evaluate how different follow-up approaches, including those incorporating TBP at varying frequencies, influence the early diagnosis of melanoma, as measured by Breslow thickness.

Methods: This retrospective cohort study included adult patients diagnosed with primary cutaneous melanoma at Rabin Medical Center between 2020 and 2025. Melanomas were classified into four groups according to the clinical setting at diagnosis: non-high-risk clinics; first visit to a high-risk clinic before TBP; high-risk follow-up with prior TBP only; and high-risk follow-up with both prior and repeat TBP on the day of diagnosis. Demographic, clinical, and histopathologic data were extracted. Differences in Breslow thickness were analyzed using analysis of covariance, and invasive versus in situ melanoma rates were assessed using multivariable logistic regression.

Results: A total of 282 melanomas from 249 patients were analyzed. Melanomas diagnosed in non-high-risk clinics were significantly thicker than those diagnosed in high-risk clinics (adjusted mean Breslow difference: 0.78 mm). Surveillance strategy was associated with invasiveness: invasive melanoma rates were highest in non-high-risk clinics (52%), followed by first-visit to high-risk clinic (39%), patients with prior TBP only (34%), and lowest in patients diagnosed during repeat TBP (20%; overall model p = 0.03). Overall Breslow thickness did not differ significantly between melanomas diagnosed during visits with prior TBP alone and those diagnosed during repeat TBP.

Conclusion: High-risk melanoma clinics incorporating TBP are associated with earlier melanoma detection and lower rates of invasive disease. Repeated TBP was associated with lower rate of invasive melanoma compared with baseline TBP and manual comparison on the day of diagnosis.