Prevention and Detection of Melanoma in the Primary Care Setting

In the United States, melanoma incidence rates are rising faster than for all other preventable or “early detectable” cancers. Early recognition and treatment of thin cutaneous melanoma have contributed to a decreased case-fatality rate over the past 50 years, but many at-risk Americans have yet to be screened. Primary prevention is directed to educating the public and health care providers to raise awareness of melanoma and change risk behavior, namely, excessive exposure to ultraviolet radiation. The goal of secondary prevention is to reduce morbidity and mortality through early detection strategies, including skin self-examination and skin screening. As yet, the only proposed measure for melanoma prevention is sun protection in childhood and adolescence, which may reduce the number of melanocytic nevi developing as an adult. Preventing adverse sun exposure in later years would likely be protective against melanoma, particularly the more ultraviolet radiation–related subtypes. Chemoprevention for melanoma is a developing field that may allow individuals at high risk for new primary melanoma to be targeted for intervention, although no oral or topical agent has yet been identified with proven efficacy in preventing melanoma. Approximately 59,580 Americans are expected to develop invasive cutaneous melanoma in 2005, with an estimated additional 40,000 or more cases of intraepithelial, melanoma in situ. The current lifetime risk for developing invasive melanoma is 1 in 65 Americans, a 20-fold increase since 1930 [1,2]. If noninvasive melanoma in situ is included, the lifetime risk rises to 1 in 37 Americans. It has been suggested that the increased incidence is largely the result of increased diagnostic scrutiny rather than a true increase in the incidence of disease [3,4]. However, the reported increase in both thick and thin melanoma in the United States and Australia would seem to refute this [5,6]. Over 7700 individuals will die from metastatic disease within the next year. More frequent recreational sun exposure (in the absence of