- Estimating an individual’s risk of developing melanoma:
- Can be clinically useful in determining primary prevention strategies and in directing the level of screening
- Patients identified as being at high risk for melanoma:
- May also be recruited to prevention trials
- Multiple factors are associated with risk for developing melanoma:
- Some factors are modifiable while others are inherent to the individual
- Skin type:
- Caucasians have at least 20 times the melanoma incidence of African Americans and five times the melanoma incidence of American Hispanics
- In addition, white patients with red or blond hair, fair complexion, or blue eyes:
- Are at increased risk for melanoma
- Age and Gender:
- The incidence of melanoma increases with age
- The incidence of melanoma is:
- 1.7-fold higher for women than men before 49 years of age
- Over age 70:
- The incidence of melanoma is 2.4-fold higher for men than women
- In general, the incidence of melanoma is:
- Higher in men than in women:
- Specifically, a man’s lifetime risk of melanoma development is approximately:
- 1.5 times greater than a woman’s risk
- Specifically, a man’s lifetime risk of melanoma development is approximately:
- Higher in men than in women:
- Overexposure to ultraviolet radiation (UVR) from the sun:
- Overexposure of UVR from the sun:
- Has been associated with an increased risk of melanoma
- Genetic sequencing data:
- Also support the role of UV melanomagenesis
- Known to be a tumor with one of the highest mutational loads:
- A seminal report of the melanoma effort within The Cancer Genome Atlas Program:
- Revealed that most somatic mutations in melanoma indeed have a “UV signature”
- A seminal report of the melanoma effort within The Cancer Genome Atlas Program:
- Data support that damage from sunburns in childhood or even in adulthood are associated with increased risk:
- A correlation has been identified between the number of severe and painful sunburn episodes and the risk of melanoma:
- Individuals who have a history of more than 10 severe sunburns are more than twice as likely to develop a melanoma compared those who have no history of sunburns
- A correlation has been identified between the number of severe and painful sunburn episodes and the risk of melanoma:
- Overexposure of UVR from the sun:
- Use of indoor tanning devices:
- Multiple studies support that indoor tanning device use is strongly associated with increased risk of melanoma
- A systematic review by the International Agency for Research on Cancer (IARC):
- Demonstrated a 15% increased relative risk of melanoma in individuals who had ever used a sunbed versus those who had never (RR 1.15; 95% CU 1.00 to 1.31)
- The dangers of indoor tanning have been corroborated by subsequent U.S. and Australian groups
- Young age of onset and higher frequency of use are key risk factors that are associated with even greater risk of melanoma
- Indeed, a well-designed Minnesota case–control study showed increased risk with number of years, hours, and sessions of indoor tanning, independent of outdoor sun exposure:
- These researchers also found that 97% of women diagnosed with melanoma before age 30 had indoor tanned
- Young patients who use indoor tanning devices more than 10 times annually have more than 7 times the melanoma risk compared to individuals who do not indoor tan
- A meta-analysis estimated a 1.8% increased melanoma risk for each additional tanning bed session
- Since 2009, the World Health Organization lists tanning beds as a Class I carcinogen
- Previous melanoma:
- Individuals with a personal history of melanoma have an increased risk of developing a second melanoma of approximately:
- 3% to 7%
- Individuals with a personal history of melanoma have an increased risk of developing a second melanoma of approximately:
- Benign nevi:
- Although a benign nevus is most likely not a precursor of melanoma:
- The presence of large numbers of nevi has been consistently associated with an increased risk of melanoma:
- Persons with ≥ 50 nevi, all of which are > 2 mm in diameter:
- Have 5 to 17 times the melanoma risk of persons with fewer nevi
- Persons with ≥ 50 nevi, all of which are > 2 mm in diameter:
- The presence of large numbers of nevi has been consistently associated with an increased risk of melanoma:
- Although a benign nevus is most likely not a precursor of melanoma:
- Individuals who tend to develop freckles:
- Also have an increased risk of melanoma
- Family history:
- Approximately 10% of individuals diagnosed with melanoma:
- Have a family member with a history of melanoma
- A family history of melanoma:
- Increases an individual’s risk of melanoma three- to eightfold
- Furthermore, persons who have two or more family members with melanoma:
- Are also at a particularly high risk
- When available, these patients should be referred to genetic counseling
- Approximately 10% of individuals diagnosed with melanoma:
- Genetic predisposition:
- Approximately 8% to 12% of melanomas:
- Occur in individuals with a genetic predisposition
- Specific genetic alterations have been implicated in the pathogenesis of melanoma
- Approximately 8% to 12% of melanomas:
- Atypical mole and melanoma syndrome:
- Previously known as dysplastic nevus syndrome, atypical mole and melanoma syndrome:
- Is characterized by the presence of multiple, large (> 5 mm) atypical dysplastic nevi generally in nonexposed areas of skin that represent a distinct clinicopathologic type of melanocytic lesion
- Melanomas can originate from either normal skin or from a dysplastic nevus
- Since the actual frequency of an atypical mole progressing to melanoma is small:
- Resection of all dysplastic nevi is not indicated
- However, new, changing, or symptomatic lesions that appear suspicious for melanoma on clinical and / or dermoscopic examination should be evaluated histologically
- Previously known as dysplastic nevus syndrome, atypical mole and melanoma syndrome:
Rodrigo Arrangoiz MS, MD, FACS, FSSO 