Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: a systematic review

Abstract

Understanding how individuals at high-risk of primary cutaneous melanoma are best identified, screened and followed up will help optimize melanoma prevention strategies and clinical management. We conducted a systematic review of international clinical practice guidelines and documented the quality of supporting evidence for recommendations for clinical management of individuals at high risk of melanoma. Guidelines published between January 2000 and July 2014 were identified from a systematic search of Medline, Embase and four guideline databases; 34 guidelines from 20 countries were included. High-risk characteristics that were consistently reported included many melanocytic naevi, dysplastic naevi, family history, large congenital naevi, and Fitzpatrick Type I and II skin types. Most guidelines identify risk factors and recommend that individuals at high risk of cutaneous melanoma be monitored, but only half of the guidelines provide recommendations for screening based on level of risk. There is disagreement in screening and follow-up recommendations for those with an increased risk of future melanoma. High-level evidence supports long-term screening of individuals at high risk and monitoring using dermoscopy. Evidence is low for defining screening intervals and duration of follow-up, and for skin self-examination, although education about skin self-examination is widely encouraged. Clinical practice guidelines would benefit from a dedicated section for identification, screening and follow-up of individuals at high risk of melanoma. Guidelines could be improved with clear definitions of multiple naevi, family history and frequency of follow-up. Research examining the benefits and costs of alternative management strategies for groups at high risk will enhance the quality of recommendations.

Relative Importance of Traditional Risk Factors for Malignant Melanoma in the Czech Population

“…To collect data on exposure to risk factors, a validated questionnaire developed by the Euromelanoma Task Force of the European Academy of Dermatology and Venereology was used (17). In accordance with the initial assumption that the risk models derived from the experience of sunny countries with heterogeneous populations (18)(19)(20)(21)(22) may not be equally informative for the Czech population; at the bivariate level, no association was found between MM and some variables which are typical surrogate indicators of UV exposure such as length of outdoor employment (less than one year, 1-5 years, 5-10 years, or over 10 years), severe sunburn resulting in blisters at age under 18 years, long-term stay in a sunny country, or use of sunbeds. Neither was skin reactivity to solar radiation associated with MM in this study.…”

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

“…• Healthcare providers must adapt their guidelines on surveillance of melanoma survivors for recurrences according to evidence for (cost)-effectiveness, which is likely to change as the impact of new therapies becomes better known (Mrazek and Chao, 2014;Watts et al, 2015;Rueth et al, 2015;Damude et al, 2016).…”

Malign Melanoma: Risk Factors and Major Clinical Findings

“…Ancak genel olarak MM gelişiminde rol oynadığı düşünülen başlıca risk faktörleri; deri tipi (açık ten), çevresel faktörler (ultraviyole maruziyeti), genetik zemin (CDKN2A gen mutasyonu), önceden var olan melanositik nevus sayısı, displastik nevus varlığı ve geçirilmiş melanom öyküsüdür (7). Bunlar dışında genel risk faktörleri içinde olmamakla birlikte, takip açısından varlığı önem taşıyan bazı durumlar da risk olarak kabul edilmektedir.…”

“…Açık ten, sarı-kızıl saç, açık göz rengi ve aşırı çillenme gibi ultraviyole hasarının kolay oluşabildiği bir fenotipin varlığı MM riskini arttırdığı en iyi bilinen durumdur (7). Bununla birlikte kutane melanom tiplerinin ultraviyole maruziyeti ile olan ilişkisi farklıdır.…”