Using a patient’s risk factor status to tailor surveillance programmes
May 3, 2017
Key Points
Question
Does age at diagnosis and body site of melanoma differ according to patient risk factors?
Findings
In this population-based study of 2727 patients with melanoma, the average age at diagnosis was lower for patients with a family history (56 years) or with many nevi (59 years) compared with those without risk factors (65 years). Melanoma more commonly occurred on the trunk for those with many nevi, on the limbs for those with a family history, and on the head and neck for those with a previous melanoma.
Meaning
A person’s melanoma risk factors might be useful in tailoring skin self-examination and surveillance programs.
Abstract
Importance
The identification of a subgroup at higher risk of melanoma may assist in early diagnosis.
Objective
To characterize melanoma patients and the clinical features associated with their melanomas according to patient risk factors: many nevi, history of previous melanoma, and family history of melanoma, to assist with improving the identification and treatment of a higher-risk subgroup.
Design, Setting, and Participants
The Melanoma Patterns of Care study was a population-based observational study of physicians’ reported treatment of 2727 patients diagnosed with an in situ or invasive primary melanoma over a 12-month period from October 2006 to 2007 conducted in New South Wales. Our analysis of these data took place from 2015 to 2016.
Main Outcomes and Measures
Age at diagnosis and body site of melanoma.
Results
Of the 2727 patients with melanoma included, 1052 (39%) were defined as higher risk owing to a family history of melanoma, multiple primary melanomas, or many nevi. Compared with patients with melanoma who were at lower risk (ie, without any of these risk factors), the higher-risk group had a younger mean age at diagnosis (62 vs 65 years, P < .001), but this differed by risk factor (56 years for patients with a family history, 59 years for those with many nevi, and 69 years for those with a previous melanoma). These age differences were consistent across all body sites. Among higher-risk patients, those with many nevi were more likely to have melanoma on the trunk (41% vs 29%, P < .001), those with a family history of melanoma were more likely to have melanomas on the limbs (57% vs 42%, P < .001), and those with a personal history were more likely to have melanoma on the head and neck (21% vs 15%, P = .003).
Conclusions and Relevance
These findings suggest that a person’s risk factor status could be used to tailor surveillance programs and education about skin self-examination.
Sources:
Watts, CG, et al. Clinical Features Associated With Individuals at Higher Risk of Melanoma A Population-Based Study. JAMA Dermatol. 2017;153(1):23-29. doi:10.1001/jamadermatol.2016.3327
http://jamanetwork.com/journals/jamadermatology/article-abstract/2580297
See also editorial: Janda, M and Soyer, P. Greater Precision in Melanoma Prevention
http://jamanetwork.com/journal...
This article is featured in Issue 25 of Dermatology Research Review authored by Associate Professor Amanda Oakley.