Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: a systematic review.

Watts CG1, Dieng M, Morton RL, Mann GJ, Menzies SW, Cust AE.

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Abstract

Understanding how individuals at high-risk of primary cutaneous melanoma are best identified, screened and followed-up, will help optimise melanoma prevention strategies and clinical management. We conducted a systematic review of international clinical practice guidelines and documented the quality of supporting evidence for recommendations for clinical management of individuals at high risk of melanoma. Guidelines published between January 2000-September 2013 were identified from a systematic search of Medline, Embase and four guideline databases; 33 guidelines from 20 countries were included. High risk characteristics that were consistently reported included many melanocytic naevi, dysplastic naevi, family history, large congenital nevi and Fitzpatrick Type I and II skin types. Most guidelines identify risk factors and recommend that individuals at high risk of cutaneous melanoma be monitored, but only half of the guidelines provide recommendations for screening based on level of risk. There is disagreement in screening and follow-up recommendations for those with an increased risk of future melanoma. High level evidence supports long-term screening of individuals at high risk and monitoring using dermoscopy. Evidence is low for defining screening intervals and duration of follow-up, and for skin self-examination, although education about skin self-examination is widely encouraged. Clinical practice guidelines would benefit from a dedicated section for identification, screening and follow-up of individuals at high risk of melanoma. Guidelines could be improved with clear definitions of multiple naevi, family history and frequency of follow-up. Research examining the benefits and costs of alternate management strategies for groups at high risk will enhance the quality of recommendations. This article is protected by copyright. All rights reserved.

KEYWORDS:

Melanoma; clinical management; clinical practice guidelines; follow-up; high risk; patient care; risk factors; screening; surveillance; systematic review