Several observational studies have demonstrated lower Breslow depth and lower risk of advanced or fatal melanoma in screen detected melanomas using either monthly self-examination or regular clinical examination of skin. Specificity of screening is higher with clinical rather than self-examination and improves with increased clinician training. A recent German study reported a 47% decrease in melanoma mortality in a screened population at average risk.r
Australian studies have shown that six-monthly specialist skin examination, supported by dermoscopy and total body photography, is effective in reducing thickness of prospectively detected melanomas, and in reducing the number of ineffectual skin lesion excisions in those at very high risk of melanoma (CDKN2A pathogenic variant carriers or equivalent).r The intervention was also cost-effective compared with current practice.r
Not smoking is recommended because pancreatic cancer has a known association with smoking and there are reports of an increased risk of smoking-related head-and-neck cancers in CDKN2A pathogenic variant positive families.r
Sixth monthly surveillance is recommended for CDKN2A pathogenic variant carriers because of evidence of cost effectiveness in the Australian setting.r
Relatives who are non-carriers of an identified familial CDKN2A pathogenic variant have a higher risk of cutaneous melanoma than the general population (but lower than carrier relatives). This is probably explained by inheritance of other less penetrant melanoma susceptibility genes combined with shared environmental risks among family members. Less frequent (annual) melanoma surveillance may still be warranted for non-carrier relatives. (Link to Alfred Health - Melanoma risk calculator for health professionals. Link to QIMR Berghofer - Melanoma Risk Predictor)