Who is at risk for developing melanoma?
There are many factors that increase the possibility of developing melanoma. Having more than one of these factors increases the risk substantially.
The following factors increase risk
- The estimated relative risk of the association between melanoma and a changing mole is greater than 400 percent (Rhodes et al, 1987). The most important early changes are change in color, diameter increase and border change. Later, when the lesion is more invasive, an increase in height heralds a corresponding growth in depth. Bleeding, ulceration or discomfort are late signs and are associated with a worse prognosis. Because itching remains a prevalent early symptom in almost one half of patients with a melanoma, the onset of itching in a new or longstanding mole should not be ignored (Goldstein et al, 2001).
- Fair skin that burns easily (skin types I-III), tans poorly, or not at all have a 2-3 fold increase in risk http://www.skincarephysicians.com/melanomanet/risk_factors.htm.
- Blond hair, blue eyes, redheads are at special risk
- One or more blistering sunburns before age 18
- 3 or more summers having outdoor jobs as a teenager
- A mole that itches, bleeds, crusts or changes size
- Use of tanning beds
- Atypical Mole Syndrome includes a person who has 100 or more moles, one or more moles greater than 8mm diameter, one or more moles that look atypical. These people have a 40-60% greater chance of developing melanoma.(http://www.skincancer.org/)
- Approximately 1/3 of non-familial melanomas develop in association with an atypical mole.(http://www.skincarephysicians.com/melanomanet/risk_factors.htm)
- Dysplastic nevi (see picture at left) occur in 5-10% of the general population are typically larger (5 mm) than common banal nevi, have hazy borders, irregular coloration, or a fried-egg pattern. They are usually located on the trunk but may also appear on the extremities in females. These may be precursor lesions and should be considered as a marker of increased risk especially in families with a history of melanoma (Humphreys, 2001).
- People with more than 60 moles are 15 times more likely to develop melanoma than are those without moles.(http://www.skincancer.org/)
- Many freckles in sun-exposed areas, especially the upper back
- A history of non-melanoma skin cancer
- A family history of melanoma: Each person with a first-degree relative (parent, sibling, child) diagnosed with melanoma has a 50% chance of inheriting the disease. Although survival rates for familial melanoma are actually higher than nonfamilial cases because these families are educated and seek medical advice early.(http://www.skincancer.org/)
- A significant association between melanoma and intermittent sun exposure, sunbrun in adolescence, and sunburn in childhood(Elwood et al, 1997).
- Presence of 100 or more nevi, 6 or more dysplastic nevi, and blue eyes in a person with melanoma were significantly associated with a family history of melanoma. People with 2 or more family members with melanoma were more likely to develop melanoma at a younger age and to have multiple melanomas (Desmond et al, 2003).
- A previous history of melanoma
- Males are 2-3 times more likely to get skin cancer
- Radiation treatments
- Weakened immune system from immunologic suppressive drugs after organ transplantation, AIDS, or lymphoma is associated with a 4-5 fold increased risk for melanoma.(http://www.skincarephysicians.com/melanomanet/risk_factors.htm)
- Whites are 12 times more likely than blacks to get melanoma
- Living proximity near the Equator or at high altitude: Direct UVB levels at 8500 feet in Vail, Colorado, were about 60% higher than at sea level in New York and the same as those in Orlando, Florida, a site nearly 775 miles closer to the equator.(Rigel et al,1999)
- Increasing age due to accumulation of lifelong sun exposure
- Melanoma diagnosis while pregnant can transfer to baby
- Rare hereditary syndromes (albinism, Li-Fraumeni syndrome, xeroderma pigmentosa, Giant Nevi Syndrome)
- "Carriers of mutations in the breast cancer predisposition gene, BRCA2, have an increased risk of melanoma while carriers of mutations in the melanoma susceptibility gene, CDKN2A, exhibit a higher than expected risk of breast cancer. Survivors of melanoma had an 11% increased risk of developing breast cancer. The risk was higher in patients diagnosed with melanoma at or before age 50 years (19% increased risk), those diagnosed more recently (17% increased risk), and for the first 3 years after the melanoma diagnosis (25% increased risk). Overall, the risk of developing melanoma was increased by 16% in female breast cancer survivors. Younger patients (up to 50 years old) had a 46% increased risk of melanoma, while those who had undergone radiation therapy had a 42% increased risk." (Int J Cancer 2004;111:792-794)
- The American Cancer Society has identified the following carcinogens as risk factors for melanoma: coal, tar, and pitch, which are used in road paving and in some dyes; creosote, which is a wood preservative derived from tar; arsenic compounds, which are used in pesticides; and radium.(Dermatology channel)
- Persons with susceptible skin phenotypes and dyplastic nevi should be aware that certain professions are associated with a higher risk of melanoma -- work around explosives, chemist duties, volatile photographic chemicals, sources of ionizing radiation, exposure to polychlorinated biphenyls (PCB's), exposure to petroleum products (Austin et al, 1997; Langard et al, 2000).