PHOENIX — An analysis of more than 350,000 reports from skin cancer screenings has identified five melanoma risk factors that can flag candidates for total skin examinations, Dr. Darrell S. Rigel reported at a clinical dermatology conference sponsored by Medicis.
The risk factors, arranged to form the acronym HARMM, are:
▸ History of previous melanoma.
▸ Age over 50 years.
▸ Regular dermatologist absent.
▸ Mole changing.
▸ Male gender.
People with four or five factors were 4.4 times more likely to have a suspected malignant melanoma than were those with one or no risk factors. (See graph.)
The study's data came from 5 years of the American Academy of Dermatology's annual National Melanoma/Skin Cancer Program, which has screened more than 1.7 million people and detected more than 171,200 suspicious lesions since its start in 1985. Dr. Rigel, a clinical professor of dermatology at New York University, New York, and his coauthors said future mass screening initiatives should focus on providing total skin examinations to people with multiple risk factors (J. Am. Acad. Dermatol. 2007 May 7 [Epub doi:10.1016/j.jaad.2007. 02.010]).
During 2001–2005, participating dermatologists identified possible melanomas in 0.9% of 364,804 people between the ages of 18 and 100 years. The screenings also found suspected actinic keratoses in 17.5% of the population and suspected nonmelanoma skin cancers in 7.6%. The prevalence of suspected melanomas did not vary much over time; the low was 0.7% in 2003 and the high 1.2% in 2002.
People who met four or five of the HARMM criteria accounted for 13.6% of those diagnosed with suspected melan- omas but only 5.8% of the population screened and they were also the least likely to receive a total skin examination: 53.7% received a full body screening, compared with 62.5% of those with one or no risk factors, 58.4% with two risk factors, and 55.9% with three risk factors.
The observed trend toward fewer thorough examinations with higher risk troubled the researchers, who said it “suggests an area where risk targeting can have an impact on patient care and mass screening cost efficacy.” Suspected melanomas, they noted, were more often found on patients who received a total skin examination (odds ratio 1.4) than on those whose examination was of a specific lesion or just the face and arms. In patients with four or five HARMM risk factors, melanoma prevalence was 2.50% with total skin examination, 2.49% when specific lesions were examined, and 1.76% with face and arm examination.
The academy is revising its screening program materials to promote the HARMM criteria, said Dr. Rigel. “It turned out the more risk factors you had, the less likely you were to have a complete physical,” he told clinicians at the conference.
Nearly all the people who came to the annual screenings had at least one of the HARMM criteria. Three-quarters had two or more, and a third had three or more risk factors. About a third came to the screenings more than 1 year, and repeaters had a lower prevalence of suspected melanomas than did first-timers (0.85% vs. 0.97%).
History of a previous melanoma was the most ominous risk factor, with an odds ratio of 3.5 by univariate analysis. The presence of a mole that was changing was the next most serious (odds ratio 2.0).
More women were screened than men, but men were more often diagnosed with a suspected melanoma (odds ratio 1.4). This was especially true for men over 50 years of age, who made up 23.4% of the people screened and 31.6% of those in whom dermatologists suspected melanoma.
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