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    Risk Factors for Melanoma and Genetic Testing

    Although cutaneous melanoma results in more years of life lost than any adult cancer except breast cancer, 98% of local cases are cured. In fact, a 10-year study conducted in Schleswig-Holstein, an area of Germany, found that a screening program reduced mortality from 1.9 per 100,000 people to one death per 100,000.

     “You might say, ‘Why should we worry about assessing risk for melanoma, why not just screen the entire population?’” says David Polsky, M.D., Ph.D., who spoke to colleagues at the summer meeting of the American Academy of Dermatology (New York, 2015).

    READ: Melanoma subtypes challenging to diagnose, treat

    One problem is cost. In order to prevent a single death from melanoma, the researchers in Germany had to screen 111,000 men (compared with only 67 men in colon cancer, based on other published studies, for example).

    But dermatologists face another problem when it comes to screening: compliance. In a 2009 study conducted in western France, researchers used a self-assessment score to identify participants at high risk for melanoma, and referred 30% of them to dermatologists for a full body examination.

    ALSO READ: Skin cancer screenings target marathoners

    “But out of 2,400 high-risk patients, only 1,000 were compliant and actually showed up,” according to Dr. Polsky, who is the Alfred W. Kopf professor of cutaneous oncology, and director of the Pigmented Lesion Section in The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, Langone Medical Center. “It’s a bit of a problem. If we improve our risk prediction models, maybe our message to patients will be more impactful.”

    On follow-up, the physicians performed 95 biopsies, and found ten melanomas.

    “They found an eleven-fold enrichment in melanomas by going to this process of the risk score, which means you could reduce the number needed to screen by a factor of about ten,” Dr. Polsky explains.

    NEXT: Fine-tuning risk assessment

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