Public education programmes on the risks of skin cancer should involve the media, and specific advice given to children and teenagers. General public education programmes in the UK have been associated with reductions in melanoma thickness and therefore improved prognosis. However, it is unclear if this relationship is causal, as similar trends are present in areas without education campaigns, and there is concern that the increased volume of referrals to specialists may have displaced other specialist services.
Primary care can play an important role in terms of opportunistic advice to patients attending routine clinics. This should comprise information available in waiting rooms and specific (and repeated) preventive advice offered opportunistically during routine consultations, particularly to parents about their children.
Primary care has been involved in skin cancer prevention programmes in Australia since the early 1960s. Observational data suggest that these programmes have contributed to a reduction in skin cancer rates in Australians under the age of 60 years. Outside Australia, preliminary data show that nurse-led and media-led patient education programmes improve rates of skin self-examination, reduce fears of skin cancer and improve knowledge and sun avoidance. More data on the utility of such interventions in the generality of practice settings are needed.
The much higher incidence of melanoma in Australia has led to educational strategies to increase public awareness of risk, primary prevention measures to reduce risk, earlier recognition of abnormal signs in skin lesions, and thus earlier diagnosis.
The relative rarity of melanoma outside Australia means that population screening is not cost-effective. However, preliminary studies suggest that selective screening by using practitioner- or patientadministered skin cancer risk scores can identify a cohort of patients at higher risk.
The rationale for considering selective screening for melanoma is the disproportionate incidence in young adults (18% of melanomas present in people aged 20 - 35 years compared with only 4% of all cancers combined in this age group) and the curative potential of early treatment. Studies of the application of melanoma risk scoring systems have suggested that it is possible for patients to self-assess, with reasonable agreement between how patients appraise their skin characteristics compared with physician assessment. This identifies higher risk individuals with the potential to target screening more effectively.
Skin self-examination deserves specific mention. Fifty to sixty per cent of melanomas are first identified as being abnormal by patients, 10 - 20% by spouses or relatives and the remainder by healthcare workers. An American case - control study has suggested that patients who perform skin self-examination present with thinner tumours and consequently have lower mortality rates from melanoma by as much as 63% compared with those who do not perform skin self-examination.
More recent data have shown that among melanoma patients who develop a further primary melanoma, those who perform skin self-examination present with thinner tumours than those who do not. Although skin self-examination has not been publicized as much as breast or testicular self-examination, there appears to be sufficient evidence to encourage this in individuals at high risk of skin cancer and in patients who have been diagnosed with a skin cancer.
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