title: Detection of primary melanoma in individuals at extreme high risk: a prospective 5-year follow-up study.
abstract: OBJECTIVE
  The clinical phenotype and certain predisposing genetic mutations that confer increased melanoma risk are established; however, no consensus exists regarding optimal screening for such individuals. Early identification remains the most important intervention in reducing melanoma mortality.
  
  
  OBJECTIVE
  To evaluate the impact of full-body examinations every 6 months supported by dermoscopy and total-body photography (TBP) on all patients and sequential digital dermoscopy imaging (SDDI), when indicated, on detecting primary melanoma in an extreme-risk population.
  
  
  METHODS
  Prospective observational study from February 2006 to February 2011, with patients recruited from Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia who had a history of invasive melanoma and dysplastic nevus syndrome, history of invasive melanoma and at least 3 first-degree or second-degree relatives with prior melanoma, history of at least 2 primary invasive melanomas, or a CDKN2A or CDK4 gene mutation.
  
  
  METHODS
  Six-month full-body examination compared with TBP. For equivocal lesions, SDDI short term (approximately 3 months) or long term (≥6 months), following established criteria, was performed. Atypical lesions were excised.
  
  
  METHODS
  New primary melanoma numbers, characteristics, and cumulative incidence in each patient subgroup; effect of diagnostic aids on new melanoma identification.
  
  
  RESULTS
  In 311 patients with a median (interquartile range [IQR]) follow-up of 3.5 (2.4-4.2) years, 75 primary melanomas were detected, 14 at baseline visit. Median (IQR) Breslow thickness of postbaseline incident melanomas was in situ (in situ to 0.60 mm). Thirty-eight percent were detected using TBP and 39% with SDDI. Five melanomas were greater than 1 mm Breslow thickness, 3 of which were histologically desmoplastic; the other 2 had nodular components. The benign to malignant excision ratio was 1.6:1 for all lesions excised and 4.4:1 for melanocytic lesions. Cumulative risk of developing a novel primary melanoma was 12.7% by year 2, with new primary melanoma incidence during the final 3 years of follow-up half of that observed during the first 2 years (incidence density ratio, 0.43 [95% CI, 0.25-0.74]; P = .002).
  
  
  CONCLUSIONS
  Monitoring patients at extreme risk with TBP and SDDI assisted with early diagnosis of primary melanoma. Hypervigilance for difficult-to-detect thick melanoma subtypes is crucial.
authors: Discipline of Dermatology, University of Sydney at the Sydney Cancer Centre, Sydney, New South Wales, Australia2Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South.
authors: Fergal J
authors: FJ
authors: Moloney
authors: Discipline of Dermatology, University of Sydney at the Sydney Cancer Centre, Sydney, New South Wales, Australia2Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South.
authors: Pascale
authors: P
authors: Guitera
authors: Discipline of Dermatology, University of Sydney at the Sydney Cancer Centre, Sydney, New South Wales, Australia2Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South.
authors: Elliot
authors: E
authors: Coates
authors: Discipline of Dermatology, University of Sydney at the Sydney Cancer Centre, Sydney, New South Wales, Australia2Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South.
authors: Nikolas K
authors: NK
authors: Haass
authors: Discipline of Dermatology, University of Sydney at the Sydney Cancer Centre, Sydney, New South Wales, Australia2Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South.
authors: Kenneth
authors: K
authors: Ho
authors: Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South Wales, Australia.
authors: Ritta
authors: R
authors: Khoury
authors: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
authors: Rachel L
authors: RL
authors: O'Connell
authors: Raudonikis Database Services, Mount Colah, New South Wales, Australia.
authors: Leo
authors: L
authors: Raudonikis
authors: University of Sydney at the Westmead Millennium Institute, Westmead, New South Wales, Australia9Melanoma Institute Australia, Westmead, New South Wales, Australia.
authors: Helen
authors: H
authors: Schmid
authors: University of Sydney at the Westmead Millennium Institute, Westmead, New South Wales, Australia9Melanoma Institute Australia, Westmead, New South Wales, Australia.
authors: Graham J
authors: GJ
authors: Mann
authors: Discipline of Dermatology, University of Sydney at the Sydney Cancer Centre, Sydney, New South Wales, Australia2Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia3Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Sydney, New South.
authors: Scott W
authors: SW
authors: Menzies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046169:Dermoscopy; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D010781:Photography; D010808:Physical Examination; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013997:Time Factors; D055815:Young Adult