Effectiveness and causes for failure of surveillance of CDKN2A-mutated melanoma families.

Autor: van der Rhee JI; Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.i.van_der_rhee@lumc.nl., de Snoo FA; Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands., Vasen HFA; The Netherlands Foundation for the Detection of Hereditary Tumors, Leiden, The Netherlands., Mooi WJ; Department of Pathology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands., Putter H; Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands., Gruis NA; Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands., Kukutsch NA; Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands., Bergman W; Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of the American Academy of Dermatology [J Am Acad Dermatol] 2011 Aug; Vol. 65 (2), pp. 289-296. Date of Electronic Publication: 2011 May 12.
DOI: 10.1016/j.jaad.2010.06.067
Abstrakt: Background: For more than 25 years families with an increased susceptibility to melanoma have been under surveillance at our institution.
Objective: We sought to investigate the effectiveness of surveillance for CDKN2A-mutated families and causes for failure of the program in patients with more advanced tumors.
Methods: In a retrospective case-control study, Breslow thickness of melanomas diagnosed in relatives enrolled in the surveillance program were compared with melanomas of unscreened index patients. We investigated the influence of mode of detection and length of surveillance interval on outcome.
Results: Surveillance melanomas (n = 226, median thickness: 0.50 mm) had a significantly lower Breslow thickness (multiplication factor: 0.61 [95% confidence interval 0.47-0.80], P < .001) than index melanomas (n = 40, median thickness: 0.98 mm). Index melanomas were more likely diagnosed with a Breslow thickness greater than 1.0 mm (odds ratio: 3.1 [95% confidence interval 1.2-8.1], P = .022). In all, 53% of surveillance melanomas were diagnosed during regular screens, 7% during patients' first screen, 20% between regular screens, and 20% in patients who were noncompliant with the surveillance schedule. The majority of surveillance melanomas (58%) were detected within 6 months after the last screen. There was no correlation between tumor thickness and the length of the screening interval for tumors diagnosed within 24 months since the last screen.
Limitations: The study is retrospective.
Conclusions: Surveillance was associated with earlier detection of melanomas. Noncompliance was an important cause for failing surveillance. Shortening surveillance intervals may advance detection of tumors, but may paradoxically have little impact on prognosis.
(Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)
Databáze: MEDLINE
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