Introduction
Melanoma refers to a relentless form of skin cancer comprising myriad signal pathways regulating many cellular processes, making it challenging to treat. Skin cancer is broadly regarded as cutaneous melanoma and keratinocyte carcinoma. The former comprises the majority of incidence skin cancers, and melanoma makes up 1% of the cancers. Unfortunately, the global prevalence of melanoma is rising rapidly, with the American Cancer Society estimating that, in the US alone, there were approximately 106,110 new cases and 7180 deaths arising from the disease’s progression (Dhanyamraju & Patel, 2022). Melanoma has an overall 20% mortality rate and causes over 80% of cancer-related deaths globally, substantially attributed to its capabilities to metastasize to other organs and evade treatment. To prevent such adverse outcomes, early diagnosis is crucial and also aids in successful interventions, which comprise treatments such as surgical resection, chemotherapy, photodynamic therapy, immunotherapy, or targeted therapy. The literature review addresses multiple topics on melanoma, such as screening, risk factors, interventions, education, and awareness.
Articulated Findings
Abundant literature exists on melanoma, such as diagnosis, risk factors, etiology, the benefits of skin cancer screening, knowledge and awareness of the disease, and primary prevention strategies. Based on patient awareness, many healthcare institutions provide patients with self-administered questionnaires to assess their risk factors (Quéreux et al., 2010). Risk factors depend on various properties, such as skin freckles, sunburns during infancy, or a personal melanoma history. Moreover, the heritable etiologies leading to melanoma development are genetic syndromes predisposing people to the disease and heritable traits associated with the disease (Djavid et al., 2021). The most common melanoma hereditary illness is familial atypical multiple melanoma syndrome, increasing their risk for neural system tumors, pancreatic cancer, and more malignancies. The findings also demonstrate the benefits of awareness and interventions. For example, according to a literature search of 51 articles by Brown et al., interventions improved skin cancer knowledge and competence (2022). Moreover, melanoma-related interventions are more successful when administered to patients as a single drug or combination based on the tumor location, the stage and severity of the cancer, and the patient’s overall condition.
Synthesized review of literature
The major themes mentioned were melanoma mortality rates, screening interventions, education, and awareness. As screening for melanoma increases, more than 61% of the population undergoes the procedure annually, also allowing the detection of more types of malignancies and initiating treatment. The median diagnosis age for melanoma was 65, and men were the most likely to be diagnosed with it. The main interventions are training and education, using novel risk assessments and behavioral counseling, and offering patients risk-tailored prevention strategies.
Mortality rate
The costs, mortality, and morbidity associated with the diagnosis of melanoma have become a significant burden for the global healthcare system. Observational studies show that skin examination throughout the body is related to a low melanoma mortality rate and minimal higher-stage melanomas (Watts et al., 2021). Further, routine checkups over the last few years have helped lower melanoma mortality rates, as observed in Germany. Nonetheless, due to insufficient evidence of melanoma screening reducing the mortality rate, uncertainty about the effects of full-body screening, such as unnecessary biopsies or misdiagnosis, and minimal reports on cost-effectiveness, no country other than Germany contains an organization-based screening program for melanoma. Furthermore, of the total melanoma deaths recorded, a higher proportion was observed in unscreened groups (Henrikson et al., 2023). Examining the whole body or suspicious lesions was crucial to an early diagnosis, lowering the mortality rate.
Screening Interventions
Conducting targeted screenings based on identifying high-risk participants is cost-effective and valuable. It aids in identifying the main risk factors for melanoma, including a family or personal history of melanoma, having more than 40 naevus, skin phenotype I or II, freckles, atypical naevus, and a history of sunburns. Moreover, a low physician density directly correlates with screening for thick melanomas (Rat et al., 2015). When physicians detect melanomas instead of the patient, they are thinner. Similarly, the melanomas are more likely to be thin when conducted during a screening examination than when conducting routine care. Hence, general practitioners play a crucial role in screening patients for early diagnosis and raising opportunities for treatment. Moreover, Germany conducted a SCREEN pilot, whereby primary care physicians and dermatologists conducted a nationwide routine skin cancer screening for health-insured patients 35 years and older and observed for four years (Henrikson et al., 2023). During the follow-up period, there were 325 melanoma deaths, and a high proportion was among the group that had not been screened: 154 vs 171. The association between screening, a personal melanoma history, health-seeking behavior, and melanoma stage categories remained statistically significant with the number of deaths.
Education and Awareness
Expanding patients’ knowledge about the benefits and risks of skin cancer screenings, characteristics, and techniques will improve their understanding of its significance. In a study by Nickasch et al., the authors assessed participants’ knowledge of skin cancer by educating them on the statistics and risks associated with the illness in Wisconsin (2020). Being the most concerning of all skin cancer types, most of the population is unaware of it and its related risks. Thus, the healthcare system must educate all patients about self-skin screening, skin cancer risks, and the importance of sun-protective behavior. Also, according to a literature review by Djavid et al., identifying clinical trials, meta-analyses, and observational studies pertinent to melanoma prevention, evidence exists supporting screening across populations (2021). Populations learn how to properly use sunscreen and community-targeted measures to prevent melanoma. While proposed preventive chemotherapeutics are still minimal globally, they are continually evolving, and as techniques such as artificial intelligence and imaging for melanoma screening develop, the likelihood that they will improve melanoma prevention rises. Furthermore, Singh et al. also compiled literature hypothesizing that melanoma is highly preventable through primary prevention strategies (2024). They include avoiding exposure to ultraviolet light during peak times and using protection from the sun. The authors also explained that primary care physicians and general practitioners are responsible for promoting prevention techniques. Their roles entail pairing protective techniques with early detection activities and ensuring patients can access programs and resources aligning with existing systems and workflows.
While education and awareness of melanoma rises globally, barriers still exist that make prevention and treatment difficult. They include unclear requirements for counseling to prevent skin cancer, competing demands in the disease’s consultation, and limited access to primary care services, primarily in remote and regional areas (Becevic et al., 2021). Hence, potential opportunities exist to improve skin care prevention in primary care. Healthcare systems can achieve this by ensuring the ease of program delivery and providing risk assessment tools to increase prevention behavior.
Discussion and Analysis
While melanoma remains the most aggressive form of cancer with a high mortality rate, screening for skin infections, engaging in preventive interventions, and providing education and awareness will lower the mortality rate arising from related deaths. Undeserved and rural communities fail or delay seeking skin care due to healthcare constraints and the distances they must travel to see a dermatologist (Becevic et al., 2021). However, primary care settings in rural and urban America may save lives for sick patients who cannot afford specialty care. Regardless of the existence of preventive strategies, some challenges still exist that contribute to the current mortality rate. For example, while primary care physicians are tasked with preventive strategies for populations that may not afford special treatment, such as biopsies and chemotherapy, they cite a lack of adequate training on melanoma, confidence, and knowledge in diagnosing and treating it. Hence, more comprehensive strategies are required to promote timely diagnosis, treatment, and cancer prevention.
Markedly, the current interventions developed globally, while slow, have proven effective in intervening against melanoma. E-learning allows the dissemination of information to a wider audience, informing them about the risk factors of melanoma, screening strategies, treatment, and prevention. Moreover, using asynchronous teaching methods creates a learner-friendly environment, allowing users, including primary care physicians and patients, to complete their training on melanoma at a convenient pace, location, and time. The education includes dermatological care such as UV protection, screening procedures, and dermoscopy. Primary care physicians with adequate training in dermoscopy have an elevated sensitivity to detecting melanoma and naked eye sensitivity without affecting their specificity (Brown et al., 2022). With adequate training, they engage in diagnostic procedures that improve patient satisfaction and comfort, reduce false negatives and positives during melanoma screening and diagnosis, and benefit all people seeking treatment. Patient interviews and questionnaires to determine their risk factors and knowledge of melanoma are crucial to reducing its mortality rates.
References
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Brown, A. E., Najmi, M., Duke, T., Grabell, D. A., Koshelev, M. V., & Nelson, K. C. (2022). Skin cancer education interventions for primary care providers: A scoping review. Journal of General Internal Medicine, 37(9), 2267–2279. https://doi.org/10.1007/s11606-022-07501-9
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