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Teaching non-specialist health care professionals how to identify the atypical mole syndrome phenotype: a multinational study
ICRF Cancer Medicine Research Unit, St James's University Hospital, Leeds, U.K..
Cancer Research Fund Medical Statistics Group, Oxford, U.K..
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2000 (English)In: British Journal of Dermatology, ISSN 0007-0963 (print), 1365-2133 (online), Vol. 142, no 2, 331-337 p.Article in journal (Refereed) Published
Abstract [en]

The atypical mole syndrome (AMS) phenotype is the strongest known risk factor for cutaneous melanoma but recognition of the phenotype has been claimed to be problematic and to require specialist assessment. This study determined the ability of previously unskilled doctors and nurses in five countries to recognize the phenotype after brief training. The system used was the AMS scoring system. This incorporates melanocytic naevus counts, clinical atypia of naevi and distribution of naevi. The agreement in scoring between the dermatologist and trained personnel was determined in 986 patients; overall agreement in diagnosis was 94·5% (kappa 0·70, P < 0·0001). The kappa scores in different countries ranged from 0·65 to 0·77 for individual naevus characteristics, indicative of good agreement. Accurate diagnosis of the atypical mole syndrome phenotype is possible by non-specialists. This has implications for collaborative studies of naevi, for screening and for both primary and secondary prevention of melanoma.

Place, publisher, year, edition, pages
2000. Vol. 142, no 2, 331-337 p.
Keyword [en]
AMS scoring system, atypical mole syndrome, melanoma, risk factor, teaching
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-14135DOI: 10.1046/j.1365-2133.2000.03405.xOAI: diva2:22697
Available from: 2008-11-14 Created: 2008-11-14 Last updated: 2009-08-19
In thesis
1. Cutaneous melanoma in children and adolescents and aspects of naevus phenotype in melanoma risk assessment
Open this publication in new window or tab >>Cutaneous melanoma in children and adolescents and aspects of naevus phenotype in melanoma risk assessment
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cutaneous malignant melanoma (CMM) is one of the most rapidly increasing cancers in the Swedish population. The aetiology of melanoma is a complex interplay between genetics, host characteristics and environmental factors. The host characteristic with the strongest association with CMM is a phenotype with high numbers of common naevi and with dysplastic naevi. The principal environmental factor is sun exposure.

Melanoma risk assessment (paper I)

In a multi-national study including 986 subjects from Sweden, Denmark, the UK, Germany and the Netherlands, the ability of primary care physicians and nurses to identify individuals at increased melanoma risk was assessed. The atypical mole syndrome (AMS) scoring system for melanoma risk was used. The AMS scoring system consists of a five point check list incorporating total body naevus counts, clinically dysplastic naevi and body distribution of naevi. After brief training, the overall agreement in diagnosis between the trained personnel and experienced dermatologists was 94.5% (kappa value 0.70, p<0.05). The study showed that the scoring system successfully can be taught to personnel in primary care.

The naevus phenotype in a population in northern Sweden (paper II)

The naevus phenotype was investigated in a population living in the inland of northern Sweden with a low melanoma incidence. Two hundred and one participants from the community of Storuman were included. The median naevus count was15 common naevi/individual, and the prevalence of dysplastic naevi was 11%. The median naevus count and prevalence of dysplastic naevi were significantly lower than previously described in populations with higher melanoma incidence and higher ambient ultraviolet exposure in southern Sweden. This geographical variation in naevus phenotype might be explained by differences in levels of sun exposure and in genotype.

Cutaneous malignant melanoma in children and adolescents (papers III–V)

During the years 1973 to 2002, 250 cases of primary CMM in individuals aged 0-19 years were reported to the Swedish Cancer Registry. Histological material was available for review in 87% of the cases registered during the two first decades (1973–1992). The diagnostic accuracy in the reviewed material was 88%.

The melanoma incidence doubled in teenagers between the first decade (1973–1982) and the second (1983–1992). During the third decade (1993–2002) the increasing trend was broken. A decrease in incidence was noted in boys during 1993–1997, and in girls during 1998–2002. In younger children the incidence remained extremely low, only 4 cases in children aged 0–9 years were reported during the studied 30-year period. The trunk was the most common melanoma site in boys, and legs and trunk were the most common sites in girls. Superficial spreading melanoma was the most frequent subtype, followed by nodular melanoma. During the two first decades (1973–1992), the median melanoma thickness decreased from 1.5 to 0.9 mm. The melanoma-specific 5-year survival rate was 93%. The most important prognostic factor was melanoma thickness. The prognosis for thin lesions was excellent, during a median follow up time of 12 years, no tumour less than 0.8 mm was lethal according to the Registry.

The results indicate that CMM in teenagers has many features in common with adult onset melanoma. The tudy also underlines the importance of not neglecting lesions suspected for malignant change in children and adolescents, as early detection and removal is crucial for the prognosis also in this young age group.

Place, publisher, year, edition, pages
Institutionen för biomedicin och kirurgi, 2006
Linköping University Medical Dissertations, ISSN 0345-0082 ; 961
melanoma, naevus, childhood, adolescence, prevention, epidemiology
National Category
Dermatology and Venereal Diseases
urn:nbn:se:liu:diva-7703 (URN)91-85643-73-4 (ISBN)
Public defence
2006-11-03, Eken, Campus US, Linköpings Universitet, Linköping, 09:00 (English)
The electronic version of the thesis is a corrected version of the printed version.Available from: 2006-11-09 Created: 2006-11-09 Last updated: 2009-08-22

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Rosdahl, Inger
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Dermatology and Venerology Faculty of Health SciencesDepartment of Dermatology and Venerology in Östergötland
Medical and Health Sciences

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