Melanoma: Prevention and Early Detection
Skin cancer is the most common form of cancer in the United States.1 Melanoma, a type of skin cancer, is particularly dangerous. Although it accounts for only 1% of skin cancer cases, melanoma spreads quickly to lymph nodes, is less curable than other skin cancer types, and is responsible for most skin cancer deaths.2
This article will discuss prevention and early detection of melanoma. It will also explain a simple method that patients can use to screen themselves, and how the lab can help patients with melanoma.
Scope of the Problem
The American Cancer Society (ACS) estimates that in 2020 about 100,000 new cases of melanoma will be diagnosed, and about 7,000 people will die from melanoma.2 The incidence of melanoma has been steadily increasing for the past 30 years and is expected to continue to increase.3 The average age at diagnosis is 65 years, but melanoma is not uncommon in people as young as 30 years.2
Melanoma is one of the most preventable forms of cancer. Sun exposure, especially if sunburn occurs, is the leading risk factor, as is exposure to sources of artificial ultraviolet (UV) light such as tanning beds. Based on their individual characteristics, some people are more at risk than others (see Sidebar).3-5
In 2014 the Surgeon General issued a Call to Action report to address the increasing burden of melanoma. The report identifies groups of people who would most benefit from increased disease education and awareness that reducing exposure to UV radiation can prevent most skin cancers.6 Since the Call to Action was released, melanoma awareness and prevention have increased, but a comprehensive national program for skin cancer prevention is yet to be implemented in the United States.
A number of measures can help prevent melanoma. Counseling in primary care settings has been proven to modify behavior and decrease intentional tanning.6 The United States Preventive Services Task Force (USPSTF) recommends that clinicians counsel patients with fair skin who are 10 to 24 years old to minimize their exposure to sunlight and artificial UV light to decrease their risk of developing melanoma.3 The ACS recommends several precautions for people (see Sidebar) at increased risk of getting melanoma5,7:
- Avoid prolonged exposure to midday sun
- Wear a wide-brimmed hat
- Wear tightly woven clothing that covers arms and legs
- Wear sunglasses that block both UVA and UVB rays
- Use a broad spectrum sunscreen with an SPF of 30 or higher
- Avoid indoor tanning
Fortunately, melanoma is highly curable when detected in its early stages. The 5-year relative survival rate is 99% if caught early, at the localized stage, but only 25% for individuals with distant metastasis.8 However new treatments, such as immunotherapy, have revolutionized the treatment of advanced melanoma. A study has indicated that some regimens can result in 5-year survival rates of 50% or more for select people with advanced melanoma.9
Visual screening during a total body skin examination (TBSE) is an easy and effective way to detect new or changing moles. Given the lack of available evidence, the USPSTF does not currently support annual TBSE by a clinician.5 However, for at-risk patients (see Sidebar), many organizations and clinicians disagree.3 Regardless of this controversy, patients are encouraged to examine themselves each month using the ABCDE rule to identify suspicious moles (Figure).10,11