Knowing risk factors could help catch melanomas

The new study, published online today by JAMA Dermatology, identifies high risk patients who may benefit from tailored surveillance.

The incidence of melanoma that occurs on the skin is increasing in predominantly white-skinned populations and Australia’s incidence is among the highest in the world.

The study’s objective was to characterise melanoma patients and the clinical features associated with their melanomas according to patient risk factors - having many moles, a history of previous melanoma, and family history of melanoma - to improve the identification and treatment of a higher risk subgroup.

The researchers classified 2727 patients with melanoma from the Melanoma Patterns of Care Study as having high or lower risk, depending on whether they already had a personal or family history of melanoma, or many moles, or none of these three factors.

Thirty nine (39) per cent of patients were defined as higher risk due to family history, multiple primary melanomas or having lots of moles. The most common risk factor in this group was having many moles, followed by a personal history and a family history.

The authors report the average age at diagnosis was younger for higher-risk patients (62 versus 65 years) compared with those patients at lower risk because they did not have these risk factors. However, that age differed by risk factor: 56 years for patients with a family history, 59 years for those with many moles and 69 years for those with a previous melanoma.

Also, higher-risk patients with many moles were more likely to have melanoma on the trunk of the body, those with a family history were more likely to have melanomas on the limbs, and those with a personal history were more likely to have melanoma on the head and neck.

Lead author, Caroline Watts stated: “The results of our study suggest that a person’s risk factor status might be used to tailor their surveillance program in terms of starting age and education about skin self-examination or more intensive surveillance.

For instance, doctors could encourage people with many moles or with a family history of melanoma to start skin self-examination and monitoring at an earlier age than other people, and discuss the body sites that require particular attention.”

Limitations of the study include risk factors based on physician recall and patient medical records. The authors also did not assess the reliability or validity of the risk factor data.

The study was funded by the Cancer Institute NSW, with additional financial support from the Melanoma Institute Australia and the NSW Melanoma Network.