>50 common melanocytic nevi |
100 |
Although the large number (>50) of melanocytic nevi is related to a greater risk for the development of melanoma, approximately 70% of melanomas originate in healthy skin - de novo melanomas. Melanomas associated with melanocytic nevi are independent from the fact of whether they are atypical or common.66 Pampena R, Kyrgidis A, Lallas E, Moscarella E, Argenziano G, Longo C. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications. J Am Acad Dermatol. 2017;77:938-45.
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>5 atypical nevi |
100 |
Atypical nevi are considered risk markers and not necessarily precursor lesions of melanoma.66 Pampena R, Kyrgidis A, Lallas E, Moscarella E, Argenziano G, Longo C. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications. J Am Acad Dermatol. 2017;77:938-45.
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Previous history of melanoma |
100 |
Patients who already had melanoma are more likely to develop another primary tumor. The relative risk is >10. The second primary melanoma occurs more frequently in the first two years after the first tumor, which probably reflects a higher level of surveillance for these patients. The probability of developing a second primary tumor is greater in patients with atypical nevus syndrome and/or a family history of melanoma.77 Doubrovsky A, Menzies SW. Enhanced survival in patients with multiple primary melanoma. Arch Dermatol. 2003;139:1013-8.
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Family history of melanoma |
83 |
The factors that cause members of the same family to develop melanoma can be genetic, environmental, behavioral, or simply random. Regardless of the cause, the family history of melanoma in a first-degree relative confers a relative risk of 1.7 to 3.0.88 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer. 2005;41:2040-59.
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Carriers of genetic mutations and polymorphisms associated with familial melanoma |
66 |
Germline mutations in genes with high penetrance (CDKN2A, CDK4, BAP1) pose a risk of melanoma of 60% to 90% throughout life.99 Ransohoff KJ, Jaju PD, Tang JY, Carbone M, Leachman S, Sarin KY. Familial skin cancer syndromes: Increased melanoma risk. J Am Acad Dermatol. 2016;74:423-36.
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Variants R and r of the MC1R gene pose a relative risk of 1.5 to 2.9.1010 Hu HH, Benfodda M, Dumaz N, Gazal S, Descamps V, Bourillon A, et al. A large French case-control study emphasizes the role of rare Mc1R variants in melanoma risk. Biomed Res Int. 2014;2014:925716.
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Immunosuppressed patients |
66 |
Those with multiple melanocytic nevi can benefit from TBM. |
Patients with altered immune systems are at increased risk of skin cancer. It has been described that patients with a history of organ transplantation using immunosuppressants have a 2 to 4-fold greater risk of melanoma than the general population.1111 Carr S, Smith C, Wernberg J. Epidemiology and Risk Factors of Melanoma. Surg Clin North Am. 2020;100:1-12.
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Previous history of intense and intermittent sun exposure |
66 |
Exposure to sunlight is related to a higher incidence of melanoma, especially to the intense intermittent type and during childhood and adolescence. The presence of signs of actinic damage is an indirect way of assessing prior exposure. A previous history of sunburns is related to a relative risk of 2.0 for the development of melanoma.88 Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer. 2005;41:2040-59.
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Indication of the exam after adolescence |
100 |
Adolescence, according to the World Health Organization, comprises the age group between 10 and 19 years old. In specific cases, such as atypical nevus syndrome, a family or previous history of melanoma and/or due to family members' anxiety, the exam may eventually be performed before this period, since there are no contraindications. |
Performing the exam in patients being followed during pregnancy |
100 |
Due to the structural alterations that can be observed in melanocytic lesions, for hormonal reasons and due to the increase in the volume of body parts during pregnancy, TBM should be performed when indicated, preferably, in the first trimester of pregnancy. There are no contraindications for its performance in any period of pregnancy. |