Greater Precision in Melanoma Prevention

In 2015, President Obama announced the US Precision Medicine Initiative, and similarly, the European Union HORIZON 2020 Work Programme 2016 to 2017 called for personalized medicine research to better understand health, prevent and treat disease, and get people more engaged in self-management. In this issue of JAMA Dermatology, Watts et al present data that might be useful for clinicians to keep people engaged in examining their skin and may help to better design personalized melanoma prevention and early detection interventions. Watts et al classified 2727 patients with melanoma as having high or lower risk depending on whether they already had a personal or family history of melanoma, or many nevi, or none of these 3 factors. They then researched the age at diagnosis and body site distribution of the melanomas for these patients. Patients classified as high risk were younger, and in the high-risk group those with family history or many nevi were significantly younger compared with those with a prior personal history of melanoma. The authors also reported significant differences between risk groups with regard to body site, with high-risk patients having more melanomas on the trunk (not further specified) and limbs, while lower risk patients had a higher propensity for melanomas on the head and neck. These results fit well with the divergent pathways hypothesis which proposes that among people with lower genetic risk cumulative sun exposure will lead to melanoma at chronically sun-exposed sites of the body.

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