SkinCancerNet Article
Melanoma Can Run in Families
What we know about the "melanoma" genes

Like breast cancer, melanoma is a cancer that can run in the family. Between 5% and 10% of people who develop melanoma have a family history of this deadly skin cancer.

For some of these families, the genes for light-colored skin and other physical traits that increase the risk of skin cancer combine with years of unprotected sun exposure to cause the melanoma. But, researchers know this is not the case for all families with a history of melanoma.

In a few families, gene mutations that can be passed from one generation to the next increase the risk of developing melanoma. While not everyone in a family inherits one of these gene mutations, those who do have a greatly increased risk of developing melanoma.

Clues that a Melanoma Gene Runs in the Family
Often gathering a family history provides enough information to find out if a gene mutation for melanoma runs in the family. When a gene mutation for melanoma is passed down, the family tree often reveals the following:

• 2 or more first-degree relatives (parent, sibling, or child) or 3 or more blood relatives developed melanoma

• Multiple generations developed melanoma

• Family members developed melanoma in their 40s, 30s, or at an even younger age

• Family members with melanoma usually developed more than 1 primary (original) melanoma

• Family history of cancer of the pancreas

The more traits seen in the family tree, the more likely it is that a gene mutation for melanoma runs in the family.

Talking with relatives about skin cancer can have another benefit as one study found. When researchers set out to confirm a family history of melanoma by speaking with the affected family member or looking at the family member’s medical records, they learned that 82% of the relatives believed to have melanoma did not have melanoma. They had another type of skin cancer. This news relieved many who believed that they would eventually develop melanoma.

Other Risk Factors Play a Role
Dermatologists caution that while a family history of melanoma increases the risk of developing this skin cancer, it does not mean that everyone who inherits such a gene mutation will eventually develop melanoma. Research suggests that a number of risk factors play a role — even in people carrying a gene mutation for melanoma. Some risk factors, such as sun exposure and tanning-bed use, can be controlled.

How to Improve the Prognosis
While the genes we inherit from our parents can increase the risk of developing melanoma, prevention and regular screenings can improve the prognosis (a forecast of the probable outcome). Dermatologists recommend that everyone with a family history of melanoma:

• Avoid sun exposure. This means following a comprehensive sun-protection plan, which includes wearing protective clothing and applying sunscreen every day before going outdoors. The sunscreen should be broad-spectrum (offers protection from UVA and UVB rays) and have an SPF (Sun Protection Factor) of 15 or greater. To protect the skin, the sunscreen must be applied 20 minutes before going outdoors.

• Never use a tanning bed or other artificial tanning device. Dermatologists recommend self-tanning lotions to their patients who want the look of a tan. Even when using a self-tanner, be sure to apply a broad-spectrum sunscreen 20 minutes before going outdoors.

• Be under the care of a dermatologist. Regular examinations help detect suspicious changes that can be skin cancer. Research shows that dermatologists more accurately detect skin cancer than do other doctors. With early detection and treatment, melanoma has a 95% cure rate.

• Perform self-exams regularly. Between office visits, patients should regularly examine their bodies for signs of skin cancer. Everyone with a family history of melanoma should know how to perform this self-exam. A dermatologist should examine any new growth or change immediately.

People with a family history of melanoma may develop more than 1 primary (original) melanoma. Several studies have found that their prognosis is no worse than for patients who have 1 melanoma.

About Genetic Testing
People often believe that if they are under a doctor’s care because they have an increased risk of developing melanoma, genetic testing follows. Genetic testing involves drawing a person’s blood in order to check for a gene mutation. While a blood test can detect a known gene mutation that increases the risk of developing melanoma, this medical test is not routine.

Debate continues as to whether or not the information provided by genetic testing for melanoma is useful. To date, 3 gene mutations have been discovered. Researchers suspect that more, yet unknown, gene mutations that increase the risk of developing melanoma exist. If a gene mutation is not found, the person may have a false sense of security. Additionally, finding a gene mutation usually does not change a dermatologist’s recommendations for screening and preventive care.

Concerns about the possibility of genetic discrimination also exist. Genetic discrimination means that an employer or a company that sells insurance could use the information to discriminate against the person. For example, an insurance company could use this information to justify increasing a person’s premiums or denying coverage.

This is not to say that genetic testing is never recommended. Sometimes genetic testing is needed to assess a person’s risk of developing melanoma. When genetic testing is recommended, the patient should meet with a genetic counselor first. Genetic counseling educates the patient about genetic testing and assists the person in selecting genetic testing options.

On the Bright Side
While having an increased risk of melanoma can be frightening, knowing this can be life-saving. With early detection and treatment, melanoma has a 95% cure rate. Regular exams play a key role in early detection.

References:
Burden AD et al. “Genetic and Environmental Influences in the Development of Multiple Primary Melanoma.” Archives of Dermatology. 1999. March;135(3):261-265.

Ferrone CR et al. “Clinicopathological Features of and Risk Factors for Multiple Primary Melanomas.” Journal of the American Medical Association. 2005. October 5;294(13):1647-1654.

Niendorf KB et al. “Cutaneous melanoma: family screening and genetic testing.” Dermatologic Therapy. 2006. Jan-Feb;19(1):1-8.

Pasquini P et al. “Does Assessment of Family History of Melanoma Provide Valid Information?” Archives of Dermatology. 1999. December;135(12):1527-1528.

Piepkorn M. “Melanoma genetics: An update with focus on the CDKN2A(p16)/ARF tumor suppressors.” Journal of the American Academy of Dermatology. 2000. May;42(5 Pt 1):705-722.

An educational program brought to you by the American Academy of Dermatology.