Patients who are identified as high risk should undergo further scrutinizing including a full skin examination, physician counseling to avoid injurious sun exposures and regular self as well as professional surveillance.
According to one expert, this is a very interesting development in respect to risk assessment, allowing some patients to be cooperative members in the assessment of their melanoma risk. It is an online questionnaire that allows patients to screen themselves for melanoma from their own homes via the internet (http:// http://www.cancer.gov/melanoma risktool).
"This melanoma risk assessment tool helps facilitate the identification of individuals at higher risk for melanoma. It is an interactive tool in the form of a questionnaire, to help physicians predict the absolute risk for melanoma development in patients, and it also serves to better inform and put at ease those individuals who are seriously worried about melanoma disease, and such patients are not very difficult to find," says Mark R. Pittelkow, M.D., of the department of dermatology at the Mayo Clinic, Rochester, Minn.
Dr. Pittelkow says that the melanoma risk tool incorporates important patient information including where patients live - northern, central or southern United States, gender, race/ethnicity and ages of the patients.
Other vital parameters in the questionnaire include patients' skin type (light, medium or dark), any history of previous sun exposure/burn as well as a fairly accurate assessment of freckling and the number and size of moles (≤5 mm diameter, and ≥5 mm diameter) seen on the back and shoulders of the patients. Ten questions make up the online risk tool, which is the brainchild of Thomas R. Fears, Ph.D., an epidemiologist at the National Cancer Institute, Bethesda, Md. Dr. Pittelkow says that the melanoma risk assessment tool is based on a statistical model and consists of a patient's self-reported history and a brief physical exam by a physician.
He tells Dermatology Times that two large databases from a case control study involving 1,663 non-Hispanic white patients from the University of California, San Francisco, and the University of Pennsylvania were used in developing the model. Dr. Pittelkow also notes that the risk assessment tool is intended only for non-Hispanic whites, as the data for other races and ethnicities are too limited to accurately estimate risk.
Divide and conquer
"Some of the major benefits seen in using this risk assessment tool are to help clinicians better stratify patient risk, to identify higher-risk melanoma populations and then appropriately plan further screening interventions with those patients that require more attention," Dr. Pittelkow explains.
It is estimated that 62,190 new cases of cutaneous melanoma were diagnosed in the United States in 2006. In very high-risk individuals, screening and interventions have resulted in earlier stage diagnoses.
According to Dr. Pittelkow, the patients who are identified as high risk should undergo further scrutinizing including a full skin examination, physician counseling to avoid injurious sun exposures and regular self, as well as professional surveillance.
Dr. Pittelkow stresses that this risk assessment tool does not replace the healthcare professional's physical skin exam, and that all patients who use the questionnaire should visit their doctors and discuss the results. The risk assessment tool should not be used in those patients who have had a diagnosis of melanoma, melanoma in situ or non-melanoma skin cancer, as well as those with a family history of melanoma. These patients should be in regular screening and surveillance programs.