Screening
Screening of the asymptomatic population for melanocytic nevi is relevant in that having a large number of nevi or having dysplastic nevi may be a marker for an increased risk of melanoma in some populations.[5][7][47][48][70][71][72] Patients who develop dysplastic nevi tend to share other risk factors that put them at risk for melanoma and non-melanoma skin cancer, including sun sensitivity, predisposition to sunburn, difficulty tanning, blonde or red hair colour, and a history of excessive ultraviolet exposure, including sunburns and the use of tanning booths. Therefore, it could be said that patients who harbour dysplastic nevi have a higher relative risk of developing melanoma compared with the population at large.[24] These patients have been the targeted population for screening for melanomas by dermatologists and clinicians alike, as they make up the majority of those who are at risk for developing melanoma.
Other at-risk groups include patients with hereditary melanoma and giant congenital melanocytic nevi (20 cm or larger in size). Hereditary melanoma is a rare genetic predisposition to develop melanoma found in familial kindreds with multiple members who have had multiple melanomas at a young age. Patients with hereditary melanoma make up a very small percentage of people with melanoma. This patient group does not include someone who has one first-degree relative with melanoma. However, patients with hereditary melanoma are almost certain to develop melanoma in their lifetime. Patients with giant congenital nevi are also at increased risk of developing melanoma but are exceedingly uncommon. Prospective studies indicate that the risk is approximately 2% to 5%, with most melanomas developing under the age of 5 years.[52]
Any acquired or inherited condition or drug that suppresses the immune system, such as xeroderma pigmentosa, also increases the risk of skin cancer. Skin self-exams with prompt evaluation of suspicious lesions are recommended for the general population by the American Academy of Dermatology. Routine full-body skin exams by a qualified practitioner are recommended for screening purposes in high-risk populations.
Skin self-examinations
Using a mirror to aid in the examination of surfaces that are not readily visualised, the patient should completely examine all areas of the body, including the plantar feet, in between the toes, under the breasts, the genitals, the armpits, the back of the legs, the neck, and the back. The recommendation by the American Academy of Dermatology is to have the patient check for nevi every month on the day of their birthday. Any concerning lesions should be promptly addressed with the patient's physician.[27] American Academy of Dermatology Opens in new window The US Preventive Service Task Force found that there is insufficient evidence to recommend regular skin self-examination.[73] The US Preventive Services Task Force do not recommend visual skin examination by a clinician to screen for skin cancer in adolescents and adults due to insufficient evidence to assess the balance of benefits and harms.[74]
Routine skin examinations by a qualified practitioner
No published consensus exists on the frequency of full body skin examinations for patients without a history of skin cancer. For higher-risk populations including melanoma-prone families, one method suggests initial skin examinations starting in the late teens/early 20s, continuing every 3 to 6 months until patient and physician are confident that there are no changing lesions, then increasing the interval to every 6 to 12 months.[32] In lower-risk populations, yearly and even every-other-year skin examinations may be performed.
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