Clinical guidelines for melanoma

Clinical practice guidelines for identifying those at high risk of melanoma could be improved by providing information about how to identify high-risk individuals

Guidelines could be clearer on screening high-risk patients (Photograph: BSIP, Humbert/Amel, Magali/Science Photo Library)
Guidelines could be clearer on screening high-risk patients (Photograph: BSIP, Humbert/Amel, Magali/Science Photo Library)

Clinical practice guidelines for identifying those at high risk of melanoma could be improved by providing information about how to identify high-risk individuals, recommendations for clinical management of these individuals, and strategies to monitor them for new primary melanomas, according to a systematic review.

Reviewers from the University of Sydney, Australia, and the University of Oxford scrutinised 34 guidelines from 20 countries that were published between 2000 and 2014.

They found that high-risk characteristics which were consistently reported included many melanocytic naevi, dysplastic naevi, family history, large congenital naevi, and Fitzpatrick type I and II skin types. Most guidelines identified risk factors and recommended that high-risk individuals should be monitored, but only half provided recommendations for screening based on levels of risk.

The researchers also found that there was disagreement in screening and follow-up recommendations for those with an increased risk of future melanoma.

They recommend that guidelines would benefit from dedicated sections for identification, screening and follow-up of individuals at high risk, along with clear definitions of multiple naevi, family history and frequency of follow-up.

Watts CG, Dieng M, Morton RL et al. Br J Dermatol 2015; 172: 33-47


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