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May 2015

Redefining Dermatologists’ Role in Skin Cancer Early Detection and Follow-up Care

Author Affiliations
  • 1School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
  • 2Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, Australia
JAMA Dermatol. 2015;151(5):483-484. doi:10.1001/jamadermatol.2014.3875

Early diagnosis of melanoma leads to the best prognosis for patients and may be more likely achieved when those who are at high risk for melanoma undergo regular and systematic monitoring. However, many people rarely or never see a dermatologist. Risk prediction models (recently reviewed by Usher-Smith et al1) could assist to triage people into preventive care appropriate for their risk profile. Most risk prediction models contain measures of phenotype including skin, eye, and hair color as well as genetic mutations. Almost all risk prediction models also contain the number and size of nevi, as well as the presence of nevi with atypical features that are independently associated with melanoma risk. In the absence of formal population-based screening programs for melanoma in most countries worldwide, people with high-risk phenotypes may need to consider regular monitoring or self-monitoring of their nevi,2 especially since most melanomas are self-detected or found by a friend or relative. Another group of patients that will require regular monitoring are patients who have been successfully treated for their first melanoma, whose risk to develop a second melanoma is greatly increased.3,4 In a US study of 89 515 melanoma survivors, those with a previous diagnosis of melanoma had a 9-fold increased risk of developing subsequent melanoma compared with the general population, equating to a rate of 3.76 per 1000 person-years,3 while in an Australian study, risk of subsequent melanoma was 6 per 1000 person-years.5 Regular follow-up is therefore essential for melanoma survivors, especially during the first few years after initial melanoma diagnosis.

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