Why We Should Focus on Melanoma-Targeted Screening Strategies

Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study

Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.

Targeted Melanoma Screening: Risk Self-Assessment and Skin Self-Examination Education Delivered During Mammography of Women

Background

Melanoma, which is the sixth most common cancer in women, is visible on the surface of the skin; therefore, self-screening (skin self-examination [SSE]) may be beneficial.

Methods

A convenience sample of women undergoing mammography was sequentially assigned by week into this two-arm targeted melanoma screening intervention. Both groups saw an informational poster and received a brochure promoting risk self-identification and SSE education. One group received an additional 1-week SSE reminder. Participants completed baseline and 1- and 3-month follow-up surveys assessing SSE performance, identifying a concerning mole, scheduling a dermatology appointment, and anxiety due to the program. Performance of SSE between groups was compared using χ² analysis. The electronic medical record was reviewed for diagnosis of concerning moles.

Results

At 1 month, 384 of 420 (91.4% retention) women completed the survey. Of those, 311 (80.9%) performed SSE. Of those who performed SSE, 54 (14%) found a concerning mole at either 1 or 3 months. At 3 months, 346 (82.4% retention) women completed the survey. The number of women who performed SSE did not differ between groups at 1 month (χ² = 1.64, P = .17) or 3 months (χ² = 1.58, P = .12). Seven melanomas were found among 34 women who identified a concerning mole; examination of 4.8 women yielded one melanoma. Anxiety was low with a median score of 9.5 (range = 0–42.9).

Conclusions

Introducing melanoma risks and SSE education during mammography was feasible and did not demonstrate harms; thus, there is an opportunity to reach a large, at-risk population with limited burden for the participant and clinics.