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Some of us are at increased risk of melanoma.
- Subjects with fair skin and hair are at increased risk of melanoma but the magnitude of the risk is only two-fold.
- Excessive sun exposure, especially in childhood, may be a risk factor for melanoma but this is often not present in the history. The relationship between melanoma and sunshine is very complex and not dose-dependent.
- The most consistent risk factor for melanoma in Caucasians is the number of naevi especially atypical naevi.The atypical mole syndrome phenotype is defined as the presence of more than 100 naevi with two or more atypical naevi and/or naevi on unusual sites such as the breasts in women, buttocks, feet and scalp. The presence of more than 100 naevi with atypical naevi can increase the risk of melanoma by five- to ten-fold.
- Family history is also crucial in determining melanoma risk. There is a two-fold increase in risk in subjects with a first-degree relative with melanoma but this risk may change significantly with age of onset and numbers of primaries.In the presence of the atypical mole syndrome phenotype and a positive family history, the risk is further increased and these patients should be followed up by a dermatologist.
There are, however, different skin phenotypes associated with melanoma and some melanoma patients have no excess of naevi. These subjects are usually very fair with freckles and may have sun damage with solar lentigines and solar keratoses. This highlights the presence of different at-risk phenotypes in melanoma.
A family history of other cancers is also important as melanoma can be found in the context of family cancer syndromes. The most common tumours which may cluster in melanoma families are pancreatic cancer, brain tumours and breast cancer, but all types of cancers may be found in melanoma- prone families.
