Abstract
Purpose
Familial melanoma genetic testing (GT) guides management but is rarely offered due to limited clinical genetics capacity. We used the RE-AIM framework to evaluate a new Australian Familial Melanoma Clinic (FMC), which integrated comprehensive dermatology examination and GT.Methods
To inform the RE-AIM domains, demographic and clinical data were collected prospectively. A cost-minimization approach compared costs per patient associated with an embedded genetic counselor in a specialist department compared with referral to specialist genetics services. Experiential training of dermatology clinicians was evaluated qualitatively to capture impact. Data were mapped to the RE-AIM domains.Results
284 patients (September 2021-August 2024) were referred predominantly by general practitioners (43%) and dermatologists (26%). 256/284 (90%) were eligible, 246/256 (96%) accepted testing, and 37/246 (15%) tested positive (probands and relatives). Average staffing costs/patient were $83 (FMC) and $125 (genetics service). Total costs/patient, excluding infrastructure costs, were $560 and $620 for the FMC and genetics service, respectively. FMC benefits included improved GT access and fewer appointments. Clinicians reported high satisfaction and increased genomic confidence.Conclusion
The embedded genetic counselor model improved access to melanoma GT alongside streamlined dermatological assessment for high-risk individuals. Testing uptake was high, the model-of-care is cost-effective, and clinicians reported positive experiences.