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Primiero CA, Maas EJ, Wallingford CK, Soyer HP, McInerney-Leo AM. Genetic testing for familial melanoma. Ital J Dermatol Venerol 2024; 159:34-42. [PMID: 38287743 DOI: 10.23736/s2784-8671.23.07761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
While the average lifetime risk of melanoma worldwide is approximately 3%, those with inherited high-penetrance mutations face an increased lifetime risk of 52-84%. In countries of low melanoma incidence, such as in Southern Europe, familial melanoma genetic testing may be warranted when there are two first degree relatives with a melanoma diagnosis. Testing criteria for high incidence countries such as USA, or with very-high incidence, such as Australia and New Zealand, would require a threshold of 3 to 4 affected family members. A mutation in the most common gene associated with familial melanoma, CDKN2A, is identified in approximately 10-40% of those meeting testing criteria. However, the use of multi-gene panels covering additional less common risk genes can significantly increase the diagnostic yield. Currently, genetic testing for familial melanoma is typically conducted by qualified genetic counsellors, however with increasing demand on testing services and high incidence rate in certain countries, a mainstream model should be considered. With appropriate training, dermatologists are well placed to identify high risk individuals and offer melanoma genetic test in dermatology clinics. Genetic testing should be given in conjunction with pre- and post-test consultation. Informed patient consent should cover possible results, the limitations and implications of testing including inconclusive results, and potential for genetic discrimination. Previous studies reporting on participant outcomes of genetic testing for familial melanoma have found significant improvements in both sun protective behavior and screening frequency in mutation carriers.
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Affiliation(s)
- Clare A Primiero
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
- Department of Dermatology, Hospital Clinic and Fundació Clínic per la Recerca Biomèdica - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ellie J Maas
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
| | - Courtney K Wallingford
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
| | - H Peter Soyer
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia -
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Aideen M McInerney-Leo
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Australia
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Wallingford CK, Maas EJ, Howard A, DeBortoli E, Bhanja D, Lee K, Mothershaw A, Jagirdar K, Willett R, Betz-Stablein B, Sturm RA, Soyer HP, McInerney-Leo AM. MITF E318K: A rare homozygous case with multiple primary melanoma. Pigment Cell Melanoma Res 2024; 37:68-73. [PMID: 37635363 DOI: 10.1111/pcmr.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
MITF E318K moderates melanoma risk. Only five MITF E318K homozygous cases have been reported to date, one in association with melanoma. This novel report uses 3D total-body-photography (TBP) to describe the dermatological phenotype of a homozygous MITF E318K individual. The case, a 32-year-old male, was diagnosed with his first of six primary melanomas at 26 years of age. Five melanomas were located on the back and one in the groin. Two were superficial spreading. Three arose from pre-existing naevi and one was a rare naevoid melanoma. 3D-TBP revealed a high naevus count (n = 162) with pigmentation varying from light to dark. Most naevi generally (n = 90), and large (>5 mm diameter) and clinically atypical naevi specifically were located on the back where sun damage was mild. In contrast, naevi count was low (n = 25 total) on the head/neck and lower limbs where sun damage was severe. Thus, melanoma location correlated with naevi density, rather than degree of sun damage. In addition to the MITF E318K homozygosity, there was heterozygosity for four other moderate-risk variants, which may contribute to melanoma risk. Further research is warranted to explore whether melanomas in E318K heterozygous and other homozygotes coincide with regions of high naevi density as opposed to sun damage. This could inform future melanoma screening/surveillance.
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Affiliation(s)
- Courtney K Wallingford
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ellie J Maas
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Antonia Howard
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Emily DeBortoli
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Deboshmita Bhanja
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Katie Lee
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Adam Mothershaw
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Kasturee Jagirdar
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Biochemistry and Molecular Biology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rod Willett
- Jimboomba Junction Family Practice and Skin Cancer Clinic, Jimboomba, Queensland, Australia
| | - Brigid Betz-Stablein
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard A Sturm
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aideen M McInerney-Leo
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
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