Personal Risk-Factor Chart for Cutaneous Melanoma

Mackie, RonaM.; Freudenberger, Till; Aitchison, Tom

doi:10.1016/s0140-6736(89)92097-7

Cited by 276 publications

(143 citation statements)

References 11 publications

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“…Many factors have been related to melanoma risk, but multivariate models based on the analyses of case-control studies in several countries show a reasonably small number of critical variables. 20,21 Risk factors assessed in this study as potential confounders were: ethnicity (recoded to UK, European and Other); natural hair colour at age 21 (blonde/red, black/brown); eye colour (blue/grey/ green/hazel, black/brown); colour of skin before tanning (very fair/fair, olive/brown/asian); tendency to burn when exposed to sun for an hour without protection (sunburn, no sunburn); degree of freckling, based on previously sent pictorial prompts (none/few, many); number of moles on the back (none, 1-10, 11-30, 31-50, 50 or more); childhood sunburn experience (never, up to 10 times, more than 10 times) and age first arrived in Australia (born in Australia, 1-19 years, 20-39 years, 40-75 years). Average sun exposure during the respondent's lifetime was calculated and categorized based on the respondent's recollection of the amount of time generally spent outside during specific periods in their life (light < 400 hrs/yr, moderate 400-599 hrs/yr, heavy 600-799 hrs/yr, very heavy 800 hrs/yr and more).…”

Section: Data Collectionmentioning

confidence: 99%

Clinical whole‐body skin examination reduces the incidence of thick melanomas

Aitken

Elwood

Baade

et al. 2009

Intl Journal of Cancer

175

166

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Survival from melanoma is strongly related to tumour thickness, thus earlier diagnosis has the potential to reduce mortality from this disease. However, in the absence of conclusive evidence that clinical skin examination reduces mortality, evidencebased assessments do not recommend population screening. We aimed to assess whether clinical whole-body skin examination is associated with a reduced incidence of thick melanoma and also whether screening is associated with an increased incidence of thin lesions (possible overdiagnosis). We conducted a population-based case-control study of all Queensland residents aged 20-75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 eligible cases (78.0%) and 3,824 eligible controls (50.4%). Whole-body clinical skin examination in the three years before diagnosis was associated with a 14% lower risk of being diagnosed with a thick melanoma (>0.75 mm) (OR 5 0.86, 95% CI 5 0.75, 0.98). Risk decreased for melanomas of increasing thickness: the risk of being diagnosed with a melanoma 0.76-1.49 mm was reduced by 7% (OR 5 0.93, 95% CI 0.79, 1.10), by 17% for melanomas 1.50-2.99 mm (OR 5 0.83, 95% CI 5 0.65, 1.05) and by 40% for melanomas !3 mm (OR 5 0.60, 95% CI 5 0.43, 0.83). Screening was associated with a 38% higher risk of being diagnosed with a thin invasive melanoma ( 0.75 mm) (OR 5 1.38, 95% CI 5 1.22, 1.56). This is the strongest evidence to date that whole-body clinical skin examination reduces the incidence of thick melanoma. Because survival from melanoma is strongly related to tumour thickness, these results suggest that screening would reduce melanoma mortality.

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Section: Data Collectionmentioning

confidence: 99%

Clinical whole‐body skin examination reduces the incidence of thick melanomas

Aitken

Elwood

Baade

et al. 2009

Intl Journal of Cancer

175

166

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“…Several case-control studies in recent years have documented elevated risk for malignant melanoma in individuals with freckling tendency, for persons with increased numbers of acquired melanocytic nevi (Dubin et al, 1986;Elwood et al, 1986;Green et al, 1985a;Holman & Armstrong, 1984b;Beral et al, 1983;Hicks et al, 1985;Swerdlow et al, 1986) and for persons with clinically atypical nevi (Swerdlow et al, 1986;MacKie et al, 1989) …”

mentioning

confidence: 99%

Inter-clinician agreement on the recognition of clinical pigmentary characteristics of patients with cutaneous malignant melanoma. Studies of melanocytic nevi, VI

Roush

Barnhill²,

Ernstoff³

et al. 1991

Br J Cancer

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Summary The number and type of melanocytic nevi are among the most important known predictors of risk for cutaneous malignant melanoma. In this study, examinations of the skin were conducted by two to four clinicians on 153 patients with newly diagnosed melanoma, and the agreement among clinicians was quantified regarding number of nevi and freckling. The index of agreement (calculated as the intra-class correlation coefficient) was 59.7% and 69.0% for freckling on the right forearm and on the shoulders, respectively; agreement was above 50% for only one of six pairs of clinicians in examining freckling on the right forearm, while agreement was above 50% for four of the six pairs of clinicians in examination of freckling on the shoulder. For Materials and methodsOne hundred and fifty-three newly-diagnosed melanoma patients participated in the study and were examined in the Yale Melanoma Unit from 1 January 1983 to 1 July 1987. Participants were selected from incident cases of malignant melanoma referred to the Yale Melanoma Clinic for evaluation and treatment primarily from the southern Connecticut region. Criteria for enrollment in the study included newlydiagnosed malignant melanoma, non-Hispanic caucasian subjects, age limitation: above 20 and under 70 years of age.Patients with these criteria were invited to enroll in the study and informed consent was obtained. The proportion of eligible patients who actually participated exceeded two-thirds.Received 27 November 1990; and in revised form 22 March 1991.All study subjects underwent an exam of the entire skin, excluding the genitalia and including an assessment of freckling characteristics; a count of palpable arm nevi below the level of the axillae (nevi could be of any size); a count of any nevi on the arms, palpable or not; a count of total body nevi 3 mm or greater in longest diameter, a count of the total number of atypical nevi, and an in-depth assessment of the atypical nevi . Freckles were defined as light-tan to brown, completely macular lesions, without any surface change or distortion of skin cleavage lines, and generally measuring from 2-3 mm to 10 mm in diameter. Melanocytic nevi were defined as relatively flat (but associated with accentuation of skin cleavage lines) or raised lesions, generally measuring greater than 3 to 5 mm in diameter, and pink, flesh-coloured, or pigmented. Distinction of a junctional nevus from a simple lentigo is difficult. In our experience, most lentigines are macular, do not exhibit distortion of skin cleavage lines, and measure 2-3 mm in diameter (but may be larger). Junctional nevi, on the other hand, are frequently slightly palpable, exhibit distortion of skin cleavage lines, and usually measure greater than 3 mm in size. A small proportion of lesions can only be distinguished by histological examination. Nevi were further defined as not being obvious seborrheic keratoses, solar lentigines, warts or dermatofibromas. The designation of a nevus as atypical was based on the subjective assessment of each individual ...

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“…Five additional studies have reported limited (Chen et al, 1998) or no evidence of an association between sunlamp/sunbed use and malignant melanoma (Gallagher et al, 1986;Holman et al, 1986;Østerlind et al, 1988b;MacKie et al, 1989). However, most of these studies were based on relatively small number of subjects who were exposed to sunbeds and have presented very limited information on sunbed use.…”

Section: Discussionmentioning

confidence: 99%

“…In another study only limited evidence of a relation was found (Chen et al, 1998). In contrast, other investigations have not been able to demonstrate such an association (Gallagher et al, 1986;Holman et al, 1986;∅sterlind et al, 1988b;MacKie et al, 1989).…”

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confidence: 81%

True

et al. 2000

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Summary In a population-based, matched, case-control study from southern Sweden of 571 patients with a first diagnosis of cutaneous malignant melanoma and 913 healthy controls aged 16-80 years, the association between sunbed use and malignant melanoma was evaluated. A total of 250 (44%) cases and 372 (41%) controls reported ever having used sunbeds. A significantly elevated odds ratio for developing malignant melanoma after regular exposure to sunbeds was found, adjusted for hair colour, raised naevi, skin type and number of sunburns (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2-2.7). A dose-response relationship between total number of sunbed uses and melanoma risk was only found up to the level of 250 times. The OR was higher in individuals younger than age 36 years (adjusted OR 8.1, 95% CI 1.3-49.5 for regular vs never use). The association seemed to be true only for subjects with black/dark brown or light brown hair and among females. Lesions of the extremities showed the strongest association of increased risk with sunbed use. An increased risk was related to commercial exposure and to exposure during the winter. The results substantiate the hypothesis that exposure to sunbeds might increase the risk of developing malignant melanoma.

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Personal Risk-Factor Chart for Cutaneous Melanoma

Cited by 276 publications

References 11 publications

Clinical whole‐body skin examination reduces the incidence of thick melanomas

Clinical whole‐body skin examination reduces the incidence of thick melanomas

Inter-clinician agreement on the recognition of clinical pigmentary characteristics of patients with cutaneous malignant melanoma. Studies of melanocytic nevi, VI

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