Cutaneous malignant melanoma : aspects on prevention

Abstract

The general aims of the present thesis were to delineate factors of importance for prevention of cutaneous malignant melanoma (CMM). Three samples of patients with CMM, one sample of patients with dysplastic nevus syndrome (DNS) and a sample from the general population were studied. The patients with CMM, Stage I (n=231), were included in an information program aiming at increased satisfaction with information and knowledge about melanoma. A total of 694 patients were included in a study to investigate factors of importance for presenting with CMM > 2.0 min and 54 patients were investigated regarding signs and symptoms of CMM < 2.0 mm. Sun-related behaviours and attitudes to sunbathing were studied in a sample of DNS-patients (n=79). Reasons for nonattendance in a population based screening program for melanoma were investigated in a sample of the general population (n=501) out of which 201 individuals were identified as non-attenders. The Hospital Anxiety and Depression (HAD) scale, and study specific questionnaires concerning knowledge about melanoma and sun-related behaviours were used in combination with interviews. Data concerning medical status were collected from patient files and from the Regional Melanoma Registry.

Results: The information program increased satisfaction with information and knowledge about melanoma. Women and men participated to the same extent. Histogenetic type was the only factor distinguishing CMM with tumour thickness > 2.0 mm from thinner lesions. Nodular melanomas < 2.0 mm appeared to be smaller in diameter and were more often described as a new lesion compared to SSM. Family members played an important role in promoting medical attention of suspicious lesions. Accessibility to medical service was important in screening and early detection. Forgetfulness, lack of time and no perceived need for examination were the most frequently reported reasons for nonattendance in skin cancer screening. High and equal levels of knowledge about melanoma were found among attenders and non-attenders. A higher proportion of men was non-attenders. Extensive UV-exposure, although not always expressed in terms of sunbathing, was reported by DNS-patients. The most important reasons for sunbathing were attractiveness and to enjoy the warmth of the sun. The majority estimated their own risk for melanoma as equal or lower compared to the general population.

Conclusions: A number of obstacles in melanoma prevention were delineated, but aspects of improving prevention of CMM were also revealed, such as targeted group information, accessibility to medical services, notification that new lesions with small diameter may warrants medical advice and that relatives are important in promoting early detection.