Identifying Persons at Highest Risk of Melanoma Using Self-Assessed Risk Factors.

OBJECTIVE: To develop a self-assessed melanoma risk score to identify high-risk persons for screening METHODS: We used data from a 1997 melanoma case-control study from Washington State, USA, where 386 cases with invasive cutaneous melanoma and 727 controls were interviewed by telephone. A logistic regression prediction model was developed on 75% of the data and validated in the remaining 25% by calculating the area under the receiver operating characteristic curve (AUC), a measure of predictive accuracy from 0.5-1 (higher scores indicating better prediction). A risk score was calculated for each individual, and sensitivities for various risk cutoffs were calculated. RESULTS: The final model included sex, age, hair color, density of freckles, number of severe sunburns in childhood and adolescence, number of raised moles on the arms, and history of non-melanoma skin cancer. The area under the receiver operating characteristic curve(AUC) was 0.70 (95% CI: 0.64, 0.77). The top 15% risk group included 50% of melanomas (sensitivity 50%). CONCLUSIONS: This self-assessed score could be used as part of a comprehensive melanoma screening and public education program to identify high-risk individuals in the general population. This study suggests it may be possible to capture a large proportion of melanomas by screening a small high-risk group. Further study is needed to determine the costs, feasibility, and risks of this approach.

The global epidemiology of HIV/AIDS.

HIV infected nearly 5 million and killed more than 3 million people in 2005. Whereas traditional epidemics have been limited to high-risk populations, in many regions, it has generalized to the at-large population, with heterosexual sex being the predominant source of transmission. The virus has hit sub-Saharan Africa the hardest, although major epidemics are now transpiring in Asia, Eastern Europe, and the Caribbean. The United Nations and World Health Organization have produced targeted prevention strategies to control the pandemic that focus on comprehensive prevention activities and universal access to care.

Relationship of uveal and cutaneous malignant melanoma in persons with multiple primary tumors.

Uveal and cutaneous melanomas differ in tumor biology, immunophenotypes and the demographic correlates of their occurrence. As a means to examine the possibility of some shared etiologic factors, we wished to learn if the 2 cancers occurred in the same individual more often than would be expected by chance. Data from the Surveillance, Epidemiology and End Results (SEER) program from 1973-1998 were utilized for this purpose. The number of persons who went on to develop a second melanoma was compared to that expected based on the incidence of each type of melanoma in the general population, after adjusting for age, sex, calendar year and residence. Given an initial cutaneous melanoma, there was a 10-fold increased risk of developing a second cutaneous melanoma (95% confidence interval [CI] = 9.4-10.6). Persons with uveal melanoma went on to develop cutaneous melanoma 4.6 times (95% CI = 2.9-6.8) more often than the population at large. In contrast, persons with cutaneous melanoma were not subsequently diagnosed with uveal melanoma at an appreciably elevated rate (standardized incidence ratio [SIR] = 1.4; 95% CI = 0.5-3.0). While these data offer some support for the hypothesis that uveal and cutaneous melanomas have 1 or more etiologies in common, the lack of symmetry in the pattern of second uveal and second cutaneous melanomas remains unexplained.