Tailoring Melanoma Prevention With Personalized Risk Factors

In his 2015 State of the Union address, President Obama announced the creation of the Precision Medicine Initiative, a broad effort to allow health care providers to provide personalized prevention and treatment strategies to patients.¹ A recent report in JAMA Dermatology described how a person’s melanoma risk factor status could help clinicians to tailor preventative surveillance and guide patient education about skin self-examination.²

Caroline Watts, MPH, and colleagues characterized 2727 patients with melanoma as either high- or low-risk, based on whether the patients had 1 or more risk factors including high incidence of nevi, personal history, and family history. Of all included patients, 1052 (39%) were deemed high-risk for melanoma.

Among the high-risk patients, the most common risk factors were high incidence of nevi (62%), personal history (42%), and family history (28%). Patients with higher risk had a consistently younger mean age at diagnosis than the lower risk group, higher proportion of superficial spreading melanomas, fewer lentigo maligna melanomas, and lower proportion of melanomas larger than 1mm thick. Higher risk patients also had more melanomas on the trunk and limbs, whereas lower risk patients’ melanoma distribution tended to the head and neck.

The authors recommended tailoring surveillance and patient education about self-examination to a patient’s risk factors. They also recommended that dermatologists show patients where on the body melanoma is most likely to occur.

In an accompanying editorial, Monika Janda, PhD, of Queensland University of Technology, in Brisbane, Australia, and Peter Soyer, of The University of Queensland, Brisbane, discussed the report’s preventative applications in clinical practice.³ They wrote that the findings “allow initiating a discussion with patients…about partner-assisted skin self examination,” and made recommendations as to how to best engage patients regarding self-monitoring.