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Original Investigation
January 2017

Clinical Features Associated With Individuals at Higher Risk of MelanomaA Population-Based Study

Author Affiliations
  • 1Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  • 2NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW Australia
  • 3Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
  • 4School of Public Health, Rural Health Northern Rivers, Lismore, NSW, Australia
  • 5Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and the Discipline of Dermatology, The University of Sydney, Sydney, NSW, Australia
  • 6Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia
JAMA Dermatol. 2017;153(1):23-29. doi:10.1001/jamadermatol.2016.3327
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.

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