Why, Who and How We Should Screen for Melanoma

Purpose of Review Malignant melanoma is one of the deadliest skin cancers worldwide, and its incidence continues to rise. Discrepancies are observed worldwide in the recommendations for dermatological and genetic screening, in addition to follow-up guidelines for patients diagnosed with melanoma. This short review aims to summarise why there is a need for uniform screening guidelines and how to identify high-risk patients who would benefit from screening. Finally, it also reviews different modalities to monitor high-risk patients. Recent Findings It has been reported that identifying high-risk individuals leads to a higher pick-up rate of early stage melanomas in those individuals, which is important to ensure good prognosis and survival rates. The British Association of Dermatology has defined high-risk individuals as having > 10 × relative risk of developing melanoma compared to the general population and has advised against routine genetic testing in all melanoma patients. Guidance for eligibility criteria is provided within the National Genomic Test Directory and recommends panel testing for the following genes: CDK2N2A, CDK4 and BAP1 in select individuals. For the purpose of monitoring skin lesions, in vivo dermoscopy has been described to greatly increase diagnostic accuracy for the detection of melanoma due to its ability to show morphological features of melanocytic lesions. Sequential imaging or mole mapping has also been described as a useful monitoring technique in high-risk individuals to detect minor modifications that may indicate early malignancy. Summary Screening high-risk individuals is important to improve outcomes. Future studies in genetics are necessary to identify unidentified susceptibility genes as the current panel only detects mutations in 20% of families with melanoma. Artificial intelligence is likely to be of importance in the early detection of melanoma when combined with dermoscopic imaging.