Melanoma early detection and awareness: how countries developing melanoma awareness programs could benefit from melanoma-proficient countries.

Risk factors for melanoma are well known and have guided plans for primary and secondary prevention. The presentation of the disease, however, varies widely depending on the geographic area, ethnicity, and socioeconomic status. For this reason, many countries have developed specific strategies to increase public awareness and favor early diagnosis. Awareness campaigns, doctor education, and screening of high-risk subjects have all contributed to improve disease outcome in developed countries. The role of primary care physicians is particularly relevant in this regard. Developing countries are trying to implement similar measures. Future efforts to further improve the efficacy of preventive strategies should focus on populations that usually escape campaigns, such as elderly men and people with low socioeconomic status. Fast-growing tumors also require specific attention.

Integrated sun protection advice for the South African population.

Exposure to solar ultraviolet radiation (UVR) is associated with several cutaneous adverse effects. However, to the best of our knowledge, in South Africa there are no formal guidelines on sun protection. A group of South African dermatologists and researchers convened over the course of 1 year to deliberate on integrated advice for sun protection among the multi-ethnic South African population. For people with light skin and those with genetic skin disorders (e.g., oculocutaneous albinism), sun protection was identified as critical to prevent sunburn, skin cancer, and photoaging. The evidence is less clear for people with medium and darker skin types, especially the latter, in whom melanin may confer a degree of protection against some parts of the solar spectrum. Recent studies have demonstrated that visible light can cause pigmentary changes in individuals with darker skin types in particular. Sun protection for people of all skin colors is beneficial to protect against photoaging and ocular damage. Herein sun protection advice is suggested for South Africans of all skin colors to reduce morbidity and mortality from sun exposure, particularly relating to skin cancer. Several knowledge gaps are identified as future research priorities.

Skin cancers are the most frequent cancers in fair-skinned populations, but we can prevent them.

Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70-95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30 + sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation.

Guideline on the management of melanoma.

OBJECTIVE: 1. The Guideline for the Management of Melanoma has been developed in an attempt to improve management through the process of locating the best available evidence on which to base decisions. It is expected to help to improve the quality of care. 2. Melanoma remains a common cancer in South Africa. Despite the achievement of earlier diagnosis, it would appear from current statistics that at least 850 people continue to die of melanoma each year. Many of these deaths occur at a younger age than for other solid tumours, so the number of years of life lost due to melanoma exceeds that of many other cancers. It is seen as imperative to maximise effective management of melanoma. 3. Prevention of melanoma has not yet been achieved, and there are no conclusive data to show that current promotion of sun avoidance has substantially altered its incidence. 4. Early detection is an important factor in melanoma management, with diagnosis based mainly on changes in colour, diameter, elevation and border (irregularity of outline) of a skin lesion, asymmetry of a lesion, or a lesion different from other naevi. People at high risk of melanoma should be offered a surveillance programme. RECOMMENDATIONS: 1. All clinicians should be trained in the recognition of early melanoma. 2. If there is doubt about a lesion, the patient should be referred for specialist opinion (if readily available) or a biopsy should be undertaken. Biopsy of a pigmented lesion should be done only on the basis of suspicion of melanoma. Excision with a 2 mm margin is adequate. 3. Prophylactic excision of benign naevi is not recommended. In general, elective lymph node dissection is not indicated. 4. People with high-risk primary melanoma, lymph node involvement and melanoma in unusual sites (e.g. mucosal and disseminated melanoma) should be managed with support from a melanoma centre. VALIDATION: Melanoma management involves many medical specialties. Guidelines should therefore be developed through a multidisciplinary consensus. The Melanoma Advisory Board consists of a forum of dermatologists, oncologists, plastic surgeons and pathologists.