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Psychosocial Issues in Familial Melanoma

This section reviews the literature examining risk reduction and early-detection behaviors in individuals with heightened risk of melanoma resulting from their family history of the disease and in individuals from hereditary families who have been tested for melanoma high-risk mutation status. The review also addresses risk perception and communication in individuals at heightened risk of melanoma.

Motivation and Interest in Genetic Testing for Risk of Melanoma

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Few studies have examined motivation and interest in genetic testing for melanoma risk. In general, the findings include the following:

  • High, but not universal interest in genetic testing.
  • Articulated benefits of testing among those at heightened risk.
  • A relative lack of examination of potential limitations of testing or reasons to forgo testing.

In Australia, a qualitative study (N = 40) found that almost all participants with a strong family history of melanoma were interested in genetic testing.[1,2] Genetic testing was favored by the participants for the following reasons:

  • Gaining information about their children's susceptibility to melanoma.
  • Having a greater understanding of their own risk.
  • Having a desire to advance melanoma research.
  • Having hope that tailored information would increase their motivation for sun-protective behavior.
  • Perceiving that melanoma is severe.

A Dutch study examined interest in CDKN2A testing (p16-Leiden mutation). Of 510 letters sent to members of 18 p16-Leiden-positive families recruited from the Pigmented Lesions Clinic at the Leiden University Medical Center in the Netherlands, 488 individuals responded by attending clinic for physical examination; an additional 15 family members also accompanied these individuals. Of these, 403 individuals were eligible for genetic counseling. A total of 184 family members followed through with counseling, and 141 of them opted for genetic testing. After the counseling session, 94 individuals returned a completed questionnaire. Older age predicted higher interest in genetic testing; reasons for having genetic testing included learning personal risk (57%) and learning the risk of one's child carrying the mutation (69%). Most participants (88%) felt that genetic testing would make a contribution to diagnostics within their family. However, some individuals (40%) reported that they had not expected to receive risk information concerning pancreatic cancer, and half of the participants (49%) reported increased worry about the possibility of developing pancreatic cancer.[3] Finally, in an Arizona qualitative study of 22 individuals with a strong family history of melanoma, none elected genetic testing even though it was provided as an option for them.[4]

Testing in children

Among 61 people tested for CDKN2A mutations (52.5% tested positive) from two large melanoma kindreds, most (75.4%) had children or grandchildren younger than 18 years and expressed interest in testing of minors (73.8%).[5] Among CDKN2A mutation carriers, most (86.7%) wanted their children or grandchildren to be tested, and among noncarriers, half (50%) wanted testing for their own children or grandchildren. The most cited reason for testing children was to aid in risk awareness and to improve protection and screening behavior.

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