Identifying high-risk melanoma patients: The importance of acquiring a detailed family history.

Abstract

Background: It is essential to identify individuals with the highest risk of developing melanoma and to withhold individuals from surveillance with a low risk. However, international consensus on surveillance indications and the role of family history is still lacking.

Objective: To provide more insight into the association between a family history of melanoma and the risk of developing melanoma.

Methods: Adults who participated in the surveillance programme of the University Medical Center Groningen between June 1995 and November 2017 were retrospectively included. Participants were stratified into risk groups according to genetic assessment and family history following current Dutch guidelines: hereditary melanoma (risk group 1), familial melanoma (risk group 2) and their first-degree relatives (risk group 3), and other screening reasons (risk group 0). We included individuals fulfilling the 'possible familial melanoma' criteria (risk group 4) and their first-degree relatives (risk group 5), as evolving Dutch guidelines no longer recommend to screen these individuals. Melanoma incidence during follow-up was compared with the general population using standardized incidence ratios (SIRs), and the rate of developing melanomas was compared between risk groups and expressed as adjusted hazard ratios (aHRs).

Results: In total, 224 participants were included (mean age 44.7 years; 56.7% female). During a median follow-up of 5.6 years (IQR, 3.7-7.8), a total number of 61 melanomas were diagnosed among 38 (17.0%) participants. The overall melanoma risk was significantly higher than in the general population (SIR 73). The rate of developing melanoma in risk group 4 was comparable to risk group 2 (aHR 1.27, p = 0.576).

Conclusions: Stratification of individuals according to their family history of melanoma identifies those with a high risk of developing melanoma. Contrary to Dutch recommendations, surveillance should also be considered for melanoma patients fulfilling the 'possible familial melanoma' criteria.