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Using clinical features to treat patients at risk of melanoma

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Australian researchers have pinpointed a set of risk factors that could help doctors tailor individuals’ skin examinations and catch melanoma at an early stage.

The study, published online today by JAMA Dermatology, highlights how patients identified as being at high risk of developing melanoma may benefit from tailored surveillance.

The incidence of melanoma that occurs on the skin is increasing in populations with pale complexions, and Australia’s incidence is among the highest in the world.

Caroline Watts from the University of Sydney and co-authors examined clinical features associated with melanomas according to patient risk factors, including many moles, history of previous melanoma and family history of melanoma. The authors used this to improve the identification and treatment of patients at higher risk of melanoma.

The study included 2,727 patients with melanoma from the Melanoma Patterns of Care Study – 1052 (39 per cent) were defined as higher risk because of family history, multiple primary melanomas or many moles. The most common risk factor in this group was having many moles, followed by a personal history and a family history.

The authors reported that the average age at diagnosis was younger for higher-risk patients (62 vs 65 years) compared with those patients at lower risk because they did not have these risk factors.

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Additionally, higher-risk patients with many moles were more likely to have melanoma on the trunk, while 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.

Dr Watts wrote that the study suggested personal risk factor status would be useful to improve patient surveillance.

“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,” she wrote.

“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 included 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.

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