Melanoma: rate your risk
Everyone is at risk of melanoma, but certain variables, known as risk factors, increase your chances of melanoma
developing. Risk factors are characteristics, conditions or behaviours that affect your chance of developing a disease.
In the case of melanoma, there are particular risk factors associated with increased risk of genetic mutations that may
result in melanoma developing.
Explore some of the risk factors associated with melanoma and investigate your own risk of developing melanoma.
Geography
Where you live influences your risk of developing melanoma. In different geographic locations melanoma incidence is
linked with ultraviolet (UV) radiation levels.
These levels vary around the world, according to latitude: highest in equatorial regions and weakest at the poles; and
altitude: higher levels are associated with higher altitude.
The ten countries listed below have the highest incidence of melanoma, but are not in order.
Australia, USA, Slovenia, Switzerland, New Zealand, Sweden, The Netherlands, Norway, Ireland, Denmark
1. Predict the order of countries from highest incidence to lowest incidence of melanoma.
…………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………….
Average Australian ultraviolet (UV) index
Australia has some of the highest UV levels in the world, due to latitude, dry climate, and high number of cloud-free days,
with particular regions having greater UV levels and incidence of melanoma, than others.
Ast1142 | Gene expression: Melanoma: rate your risk (worksheet)
© The University of Western Australia 2012
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Licensed for NEALS
This map shows the annual average UV solar radiation index across Australia from 1979 to 2007. The values cover a scale
from 0 to 14; higher values represent higher UV radiation which is more likely to damage your skin.
UV levels above three are enough to damage your skin and increase your risk of developing melanoma.
What the UV levels mean
The UV level can be related to ultraviolet radiation exposure as follows:
2. Where do you live?
…………………………………………………………………………………………………………………………………………………………………………………………….
3. What zone do you live in?
…………………………………………………………………………………………………………………………………………………………………………………………….
4. What is your exposure risk?
…………………………………………………………………………………………………………………………………………………………………………………………….
5. Circle the row that relates most closely to where you live and your UV exposure.
…………………………………………………………………………………………………………………………………………………………………………………………….
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
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Skin type
People of all skin types and races are at risk of melanoma, but the risk is higher in those with fairer complexions.
The Fitzpatrick skin type scale is used to describe skin colour and how your skin reacts to sun exposure. Which skin type
are you? How does this affect your risk of developing melanoma?
1. Rate the risk of developing melanoma for each skin type, from greatest to least.
IMAGE
SKIN INFORMATION
YOUR RANK
light brown skin
burns moderately
tans uniformly
pale white skin
always burns
never tans
moderate brown skin
burns minimally
always tans well
deeply pigmented
dark brown to black
skin never burns
white skin
always burns easily
tans minimally
dark brown skin
rarely burns
tans profusely
2. Which of these skin types do you most closely match? ………………………………………………………………………………….
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
3. Circle the information in the table below that relates to your skin type.
SKIN TYPE
SKIN INFORMATION
WHAT YOU CAN DO WHEN
EXPOSED TO SUN
Type I:
Type I:
always burns
Your skin is extremely susceptible to
sun damage. This increases your risk
of developing melanoma.
Protect your skin when UV levels are
3 and above. Check your skin
regularly for any changes.
never tans
pale white skin
Type II:
Type II:
white skin
Your skin is extremely susceptible to
sun damage. This increases your risk
of developing melanoma.
always burns easily
Protect your skin when UV levels are
3 and above. Check your skin
regularly for any changes.
tans minimally Always
Type III:
Type III:
light brown skin
tans uniformly
Your skin is susceptible to sun
damage. This increases your risk of
developing melanoma. Although
your skin may tan this is a sign of
sun damage that causes melanocytes
to produce more melanin in an
attempt to protect skin from further
UV damage.
Type IV:
Type IV:
moderate brown skin
always tans well
Your skin may be damaged by
exposure to UV radiation. Although
your skin may tan this is a sign of
sun damage that causes melanocytes
to produce more melanin in an
attempt to protect skin from further
UV damage.
Type V:
Type V:
dark brown skin
Your skin may be damaged by
exposure to UV radiation. Darker
skin offers more protection against
UV radiation due to more melanin in
your skin. This pigment gives skin its
colour, and also offers some
protection against UV radiation.
Melanoma still occurs in people with
darker skin.
burns moderately
burns minimally
rarely burns
tans profusely
Type VI:
Type VI:
deeply pigmented
Your skin may be damaged by
exposure to UV radiation. Darker
skin offers more protection against
UV radiation due to more melanin in
your skin. This pigment gives skin its
colour and also offers some
protection against UV radiation.
Melanoma still occurs in people with
darker skin.
dark brown to black
skin never burns
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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Protect your skin when UV levels are
3 and above. Check your skin
regularly for any changes.
Protect your skin when UV levels are
3 and above. Check your skin
regularly for any changes.
Protect yourself with sunscreen,
sunglasses, and avoid excessive
exposure.
Protect yourself with sunscreen,
sunglasses, and avoid excessive
exposure.
developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Moles
Moles, or naevi, are collections of pigmented skin cells (melanocytes) acquired over a person’s lifetime, or are present
from birth. Higher numbers of moles are associated with an increased risk of melanoma development.
Moles are usually pink, tan or brown, and are sometimes slightly raised; edges are usually well defined or rounded. Moles
can occur anywhere on the body. Moles are not the same as freckles which are flat, pigmented spots on your skin.
Freckles are found on areas of your body that are exposed to the sun, often your face and arms.
freckles
1.
melanoma arising from
an abnormal mole
normal mole with even normal mole with no
edges
change in size
normal mole with no
differences in colour
Estimate the number of moles on each person in the images below, circle the one with the highest risk of
developing melanoma.
How many moles do you have? How does this affect your risk of developing melanoma?
3. Count the number of moles on your upper arm, between your elbow and shoulder, to estimate the number of moles on
your body.
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
4. Circle the number of moles you counted on your arm, to estimate the total amount on your body.
a)
b)
c)
d)
0
1-5
6-11
11 +
5.Use this table to find out how number of moles relates to your risk of developing melanoma. Circle the feedback that
relates to your number of moles.
NUMBER OF MOLES ON YOUR ARM
FEEDBACK
0
The average number of moles in adults is 10 – 40. Less than 20 moles on
your entire body won’t increase your risk of developing melanoma.
However, always check your moles regularly for any changes in colour,
shape and size. See your doctor immediately if you notice changes.
1-5
If you have 20 – 50 moles on your entire body you have an increased risk of
developing melanoma. Check your moles regularly for any changes in
colour, shape and size. See your doctor immediately if you notice changes.
6-11
If you have more than 50 moles on your entire body you have an increased
risk of developing melanoma. Check your moles regularly for any changes
in colour, shape and size. See your doctor immediately if you notice
changes.
11+
If you have more than 100 moles on your entire body you have an increased
risk of developing melanoma. People with more than 100 moles should
have their skin checked regularly by their doctor. See your doctor
immediately if you notice changes.
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Age
Melanoma incidence increases with age. Like most cancers it’s more common in older age groups. In Australia the median
age at melanoma diagnosis is 60.8 years.
1. Rate the risk of developing melanoma, for each person in these images, on the basis of age, from lowest to highest.
Image
Rank
15 – 34 years
< 15 years
55 -74 years
35 – 54 years
How old you are influences your risk of developing melanoma.
2. Circle your age cohort to discover incidence of melanoma and what this might mean for your risk of developing
melanoma.
1.
2.
3.
4.
5.
< 15 years
15 – 34 years
35 – 54 years
55 – 74 years
75 + years
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
3. Circle the age feedback that relates to you.
Your age group
Age feedback
0 - 14
<15 years
Melanoma is rare in children.
15 - 34
15 – 34 years
6.4% of all melanoma cases are diagnosed in people under 35. Melanoma is
the most common cancer in younger Australians. See the table below for
more information about cancer in this age group.
35 - 54
35 – 54 years
25.3 % of all melanoma cases are diagnosed in people aged 35 – 54 years.
55 - 74
55 – 74 years
43.7% of all melanoma cases are diagnosed in people aged 55 – 74 years.
75 +
75 + years
24.5 % of all melanoma cases are diagnosed in people over 75 years.
Incidence (%) of the seven most common cancers in 15 – 34 year olds, Western Australia 2012.
CANCER TYPE
PERCENTAGE OF TOTAL CANCER CASES (%)
melanoma
15.3
testicular
11.2
lymphoma
7.8
thyroid
7.3
cervix
6.2
breast
5.4
colon / colorectal
4.9
Reference: Threlfall TJ, Thompson JR (2014). Cancer incidence and mortality in Western Australia, 2012. Department of Health, Western
Australia, Perth. Statistical Series Number 99.
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Personal or family history
Melanoma is a genetic disease that results from gene mutations. Mutations may be acquired over a person's lifetime
(somatic), or inherited (germline). Mutations can result in altered gene expression (changes in function of genes), and
changes to the amount and type of product genes produce, usually a protein.
These pedigrees illustrate two individuals with melanoma; one inherited, the other acquired.
1.
Select the profile which indicates melanoma due to acquired genetic mutations.
Profile A
Profile B
Profile A’s pedigree shows a pattern of inherited melanoma.
Inherited mutations in melanoma are rare, occurring in only 10% of melanoma patients. One inherited mutation occurs in
the CDKN2A gene. In Australia inherited CDKN2A mutations are associated with 0.2% of melanomas. The mode of
inheritance for this mutation is autosomal dominant. People with this mutation have a 50% chance of developing
melanoma.
Acquired mutations account for 90% of melanomas.
Profile B’s pedigree shows a pattern of acquired melanoma.
Acquired mutations account for 90% of all melanomas. One acquired mutation occurs in the BRAF gene. This mutation is
found in 50% of all melanomas, not all people with a BRAF mutation will develop melanoma.
Inherited mutations in melanoma are rare, occurring in only 10% of melanoma patients.
Having a personal or family history of melanoma can impact on your risk of developing melanoma.
Do you have a personal or family history of melanoma?
Complete the questions below to determine your inherited predisposition for melanoma.
2. Do you have a personal history of melanoma?
Circle or highlight the feedback that relates to you.
YOUR ANSWER
PERSONAL HISTORY FEEDBACK
yes
You have a personal history of melanoma so your risk of developing more melanomas in the
future is much greater. Check your skin regularly for any change, and have a doctor check your
skin annually. See your doctor immediately if you notice any changes.
no
Although you have no personal history of melanoma you still need to take care of your skin.
Acquired genetic mutations cause 90% of melanomas, and many of these mutations are
associated with overexposure to UV radiation.
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Sun exposure
UV radiation from sun overexposure is known to damage skin cells, and cause genetic mutations. The type of sun exposure
a person experiences, and effects of this exposure, influence your risk of developing melanoma. Intermittent (occasional)
sun exposure is a greater risk than chronic (frequent) sun exposure. However, this is not the case with other skin cancer
types.
Serious sunburn in childhood has been associated with increased risk of developing melanoma. Serious sunburn is
inflammation or injury to your skin due to overexposure to UV radiation; skin is painful, reddened, and may be blistered.
Your lifestyle, such as occupation and recreational activities, affects the amount of sun exposure you receive. Where you
live, your skin type and age, influences the amount and level of UV radiation you experience, and its impact upon your
skin.
Analyse these individual profiles, by combining everything you’ve learned about risk factors for melanoma.
1. Rate the risk of developing melanoma from highest to lowest, based on sun exposure, number of sunburns, geography,
age, family history, and lifestyle factors.
…………………………………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………………………………….
Person
A
B
C
D
E
F
Gender,
Age
Female aged
23
Male aged 40
Male aged 25
Male aged 35
Female aged
47
Female aged
30
Country of
origin
Australia
America
(arrived in
Australia age
26)
Australia
Africa (arrived
in Australia
age 33)
England
(arrived in
Australia, age
38)
Australia
Skin type
I
V
III
VI
II
IV
Occupatio
n
office worker
miner in
North-West
bricklayer
nurse
landscape
gardener
teacher
Leisure
activities
indoor netball,
hockey in
winter, beach
on weekends
over summer
gym, tennis at
night when
temperature
and UV are
lower
swimming in
summer,
jogging in
winter
jogging during
lunch and
after work,
gym all year
round
walking after
work,
gardening,
swimming
(indoor pool)
weekend golf,
walking during
lunch and
after work
Sun
exposure
intermittent,
3 hours per
week in
winter, 5 – 6
hours per
week springsummer
high, chronic
occupational
exposure;
when home
enjoys
spending time
outdoors
high, chronic
occupational
exposure
Intermittent,
medium
intermittent,
medium
exposure,
often works
under shade
intermittent,
medium
Family
history of
melanoma
none
sister with
melanoma
mother had a
melanoma
removed
none
father died of
melanoma
none
Childhood
sunburns
2
none
3
none
none
none
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Each aspect of a person’s profile was given a score based on the following scoring key:
1 point for
male’(melanoma is more common in men)
those who grew up in Australia (Australia has a high incidence of melanoma)
family history (family history increases melanoma risk)
each childhood sunburn (sunburn prior to 15 years of age increases melanoma risk)
intermittent sun exposure (intermittent sun exposure is associated with melanoma development)
6 points for skin type I
5 points for skin type II
4 points for skin type III
3 points for skin type IV
2 points for skin type V
1 point for skin type VI
Skin type is strongly associated with melanoma development: fairer skin types have a much higher risk.
How much UV radiation are you exposed to?
The amount of sun exposure you receive, and its effects on your skin, is associated with risk of developing melanoma.
Answer the following questions to learn how your sun exposure affects your risk of developing melanoma. Add up the
points for each of your answers to work out your sun exposure feedback.
2. In summer on average how much time do you spend outdoors each day when UV index is above 3?
Your answer
Points
< 1 hour
0
1 – 3 hours
1
3 hours
2
3. How many times have you experienced serious sunburn?
never
0
once
1
more than once
2
4. Do you use sun protection when you spend time outdoors in summer?
never
2
yes, sunscreen
1
yes, sunscreen and sun
protective clothing
0
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
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developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage
Add up your points and circle the feedback that is most relevant to you.
Your score and sun exposure feedback
Sun Smart Message
0:
Your sun exposure is minimal. This reduces your
risk of damaging effects of UV radiation on your
DNA, and reduces your risk of developing
melanoma.
Remember to practice SunSmart behaviours, such as
wearing protective clothing and sunscreen if you’re in
the sun.
1 – 2:
Your sun exposure is moderate. This reduces your
risk of damaging effects of UV radiation on your
DNA, and reduces your risk of developing
melanoma.
Remember to practice SunSmart behaviours, such as
wearing protective clothing and sunscreen if you’re in
the sun.
3 – 4:
Your sun exposure is high. This increases your risk
of damaging effects of UV radiation on your DNA,
and increases your risk of developing melanoma.
You could improve your sun exposure behaviour by
spending less time outdoors in summer. You also need to
practise SunSmart behaviours, such as wearing
protective clothing and sunscreen.
5 – 6:
Your sun exposure is very high. This increases your
risk of damaging effects of UV radiation on your
DNA, and increases your risk of developing
melanoma.
You could improve your sun exposure behaviour by
spending less time outdoors in summer, and practising
SunSmart behaviours, such as wearing protective
clothing and sunscreen.
Ast1142 | Gene expression: Melanoma: rate the risk (worksheet)
© The University of Western Australia 2014
version 1.0 reviewed December 2014
page 12
developed for the Department of Education WA
for conditions of use see spice.wa.edu.au/usage