Researchers say the model helps health professionals identify individuals at highest risk, guiding early intervention and efficient resource allocation.
A next-generation melanoma risk prediction calculator designed to support clinical decision-making and targeted prevention strategies has been launched by QIMR Berghofer.
Developed using a decade of data from almost 42,000 participants in the landmark QSkin Study, the upgraded online tool now incorporates 16 self-reported factors, including age, skin type, hair colour and sunspot history.
The tool also accounts for regional variations in melanoma risk due to Australia’s diverse UV exposure levels.
The free resource, designed in collaboration with the QUT VISER team, is intended for use in both clinical practice and community health settings. The methodology and validation of the calculator have been detailed in JAMA Dermatology.
“In this cohort study of 41,919 participants with a 10-year follow-up, a new risk prediction tool for invasive melanoma was developed and, using 16 predictors, delivered improved prediction performances over previous tools,” the researchers wrote.
“The new tool would identify 76% of future melanoma cases within 10 years by targeting individuals in the top 40% of predicted risk.”
The population-based prospective cohort study in Queensland involved 10 years of follow-up from the baseline survey in 2011 and included individuals aged between 40 to 69 years who were melanoma-free at baseline and completed a comprehensive risk factor survey at recruitment.
Of the eligible participants, 55% were female, and the mean age at baseline was 55.4 years. A total of 706 new invasive melanomas were identified during 401,356 person-years of follow-up.
The researchers emphasised that the primary end point in their analyses was first invasive melanoma, principally because, especially in Australia but also in the US, there was strong evidence of widespread overdiagnosis of melanomas in situ.
“We contend that there is no clinical utility in increasing efforts toward encouraging even more diagnoses of such lesions, which would likely serve only to exacerbate the problem of overdiagnosis,” they wrote.
“Moreover, because there is considerable debate about the biological characteristics of melanomas in situ [specifically whether or not they are all destined to invade], and because the natural history of such lesions is altered irreversibly by their excision, we censored people diagnosed with preinvasive melanomas in our primary analysis.
“In sensitivity analyses, we ignored melanomas in situ and followed up only for individuals’ first occurrence of invasive melanoma; we found that the same terms were identified, indicating that the final form of this prediction model does not depend on how the model was technically specified.”
They also noted there was “emerging consensus that a systematic approach to the early detection of melanoma will involve some form of targeted screening among those identified as at high risk for melanoma”.
For instance, the American Cancer Society recommends that people with a family history of melanoma undergo regular skin examinations by a dermatologist. Similarly, Cancer Research UK advises that individuals with a strong family history of melanoma, or those who have had multiple melanomas, are at higher-than-average risk and may benefit from regular dermatological check-ups.
In Australia, the Cancer Council’s 2021 clinical guidelines recommend assessing all patients for their future melanoma risk using validated factors and models that integrate personal risk into an overall risk index.
The Royal Australian College of General Practitioners – whose members diagnose and excise around 80% of primary melanomas in Queensland – also advises using validated melanoma risk assessment tools and conducting opportunistic skin examinations for those at high risk of melanoma or keratinocyte cancer.
Building on this, in 2024, the Australian government announced plans to explore the feasibility of a national, targeted skin cancer screening program, aiming to implement risk-based strategies to stratify the population and optimize screening efforts.
Professor David Whiteman AM, senior scientist at QIMR Berghofer and lead author of the study, said the calculator offers health professionals a practical way to personalise melanoma prevention and surveillance.
“Early identification of people who are high-risk can prompt more regular skin checks and targeted follow-up, while sparing lower-risk people from unnecessary screening or procedures,” he said.
“This tool is our best approach yet to allow our medical teams to focus on the people and areas of greatest need.”
QIMR Berghofer health economists have estimated the direct costs of treating melanoma via the Australian health system is more than $272 million per year and growing.
Professor Whiteman said the risk calculator may help save lives and money.
“Improving how we target and treat melanoma isn’t just critical for people with melanoma; it’s also an important economic necessity,” he said.
“By helping to triage patients more effectively, this tool supports smarter use of healthcare dollars and could go some way to easing the burden on our healthcare system.”
The researchers noted that the risk calculator was not intended to replace medical advice, rather was a guide to inform people about their individual risk so they can discuss this with their doctor.
For health professionals, it represents a new way to align clinical decisions with individual risk profiles and to support more efficient population-level screening strategies.
The calculator is also feeding into national discussions about whether Australia should establish a targeted melanoma screening program, similar to current programs for breast, cervical, bowel and lung cancers.
“This cohort study has identified an improved tool that offers enhanced accuracy for predicting the future risk of invasive melanoma compared with existing tools,” the researchers concluded.
“In future research, we will assess the benefit of adding genetic information to the tool, and we have recently recruited a second, independent cohort in which to validate the tool externally in the years ahead.
“In the meantime, we see strong merit in assessing the performance of this tool independently in other settings.”
For more information about the tool see here.
