Rm. Mackie et al., ACCELERATED DETECTION WITH PROSPECTIVE SURVEILLANCE FOR CUTANEOUS MALIGNANT-MELANOMA IN HIGH-RISK GROUPS, Lancet, 341(8861), 1993, pp. 1618-1620
In 1983 a classification scheme was proposed for patients with atypica
l naevi, according to their personal and family history of melanoma an
d atypical naevi. To assess the predictive value of these features we
undertook prospective surveillance of patients at high risk of primary
melanoma. We followed up 116 patients each with 3 or more clinically
atypical naevi for at least 5 years. Patients are examined and naevi a
re photographed every 3-6 months; lesions showing disturbing change ar
e excised for histopathology. Among 85 patients with no personal or fa
mily history of melanoma, 5 invasive (level 2 or deeper) melanomas dev
eloped during 583 person-years of follow up. The expected number of in
vasive melanomas in this population would be 0.054; the increased risk
is significant (p < 0.001; relative risk 92 [95% CI 30-216]). There w
as a similarly increased risk of new melanoma also among 24 patients w
ith atypical naevi plus a history of previous melanoma (observed 2, ex
pected 0.022, p < 0.001; relative risk 91 [11-328]). By comparison, no
second melanoma developed among 25 patients with previous melanoma bu
t a normal naevus pattern during 213 person-years of similarly intensi
ve follow-up. The risk of melanoma was highest among 7 patients with a
typical naevi and a family history of melanoma (observed 6, expected 0
.009, p < 0.001; relative risk 444 [121-1138]). The median thickness o
f surveillance-detected melanomas was 0.75 mm (range 0.40-1.05 mm) in
this group. This study shows the value of clinical follow-up of high-r
isk patients to detect early thin melanomas.