Originally published as JCO Early Release 10.1200/JCO.2005.04.1277 on May 25 2006

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Identifying Individuals at High Risk of Melanoma: A Practical Predictor of Absolute Risk

Thomas R. Fears, DuPont Guerry, IV, Ruth M. Pfeiffer, Richard W. Sagebiel, David E. Elder, Allan Halpern, Elizabeth A. Holly, Patricia Hartge, Margaret A. Tucker

From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD; Melanoma Program, Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, PA; Melanoma Clinic and Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; and Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY

Address reprint requests to Thomas R. Fears, PhD, National Cancer Institute; Executive Plaza S, Room 8040, Bethesda, MD 20892; e-mail: fearst{at}epndce.nci.nih.gov

PURPOSE: We developed a model to estimate the 5-year absolute risk of melanoma to efficiently identify individuals at increased risk of melanoma for potential interventions.

PATIENTS AND METHODS: We used data from a case-control study with 718 non-Hispanic white patients with invasive cutaneous melanoma from melanoma clinics in Philadelphia, PA and San Francisco, CA; matched controls were 945 patients from outpatient clinics with similar catchment areas. All participants underwent extensive interviews and skin examinations. We selected easily obtained clinical characteristics and responses to simple questions for study in order to develop sex-specific relative risk models. These models were combined with incidence and mortality rates by United States geographic areas to develop estimates of the absolute risk of developing melanoma within 5 years.

RESULTS: Relative risk models yielded an attributable risk of 86% for men and 89% for women, using at most seven variables. Attributable risks did not vary by age, ultraviolet B flux or hours outdoors. The absolute individual risks varied widely, depending on age, other host characteristics, and geographic area. Individual absolute risk can be estimated using a program available online.

CONCLUSION: Our procedures allow for estimating the absolute risk of developing melanoma to assist in the identification of patients at high risk. Such high-risk individuals could undergo interventions including a complete skin examination, counseling to avoid sun exposures, regular self and professional surveillance, or participation in prevention trials. It is important to emphasize that these projections are not intended to identify current melanoma cases.

Supported by the Intramural Research Program of the National Institutes of Health and the National Cancer Institute.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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