Melanoma and Thorough Skin Self-Examination in Australia - Literature review Example

Melanoma, otherwise known as malignant or cutaneous melanoma, is a cancer that begins in the melanocytes or the melanin-producing cells located – among other places – in the bottom layer of the skin’s epidermis (see What is Melanoma? 2010; for details on melanoma, see Swetter 2010). It may be the least common form of skin cancer, but its incidence in Australia is highest across the globe. And, being the most life-threatening skin cancer, it exacts toll not only in fiscal resources of the country but also on human lives. The impact of melanoma Australians have the reputation of having the highest incidence of skin cancer in the world. Records have it that two (2) out of three (3) Australians are diagnosed with skin cancer before they reach the age of seventy (70) (see Key Statistics 2008). Melanoma is also more common in Australia than in any other countries – i.e., Australians are four (4) times higher than those in America, United Kingdom and Canada and are ten (10) times higher than in other countries to be afflicted with this type of skin cancer (The Facts on Skin Cancer and Melanoma [n.d.]). Between melanoma and non-melanoma skin cancers, such as squamous basal carcinomas and basal cell carcinomas, melanoma is the least common type but the most life threatening type of skin cancer. In fact, the incidence of death on account of melanoma has been increasing more rapidly than that of any other cancer in white-skinned populations. In 1998, there were nine hundred seventy nine (979) deaths and a total of seven thousand eight hundred ninety-one (7,891) new cases (Aitken 2002, pp. 34). And, in 2001, 1.2 out of ten (10) Australians died because of melanoma (Key Statistics 2008). Likewise, it is one of the most common cancers affecting youth in the country (see Key Statistics 20080) and one of the most common cause of death from cancer in adults under forty (40) years (Aitken 2002, pp. 34). Below is a table of melanoma cases by age in Australia (see General Statistics 2009). Age Percentage of cases < 35 9.90 35-54 31.70 55-74 38.30 >75 20.10 Statistics has it, too, that the number of women affected by melanoma is set to increase by twenty-three per cent (23%) from four thousand and four (4,004) in 2002 to four thousand nine hundred twenty-six (4,926) in 2011. Among the men members of Australian population, the cases are expected to increase by twenty-eight per cent (28%) or from five thousand two hundred thirty-eight (5,238) in 2002 to six thousand seven hundred twenty-seven (6,727) in 2011 (see General Statistics 2009). Geographically, as melanoma of the skin is correlated with exposure to the ultraviolet (UV) radiation, it is expected that higher rates of this kind of cancer are to be found in the northern states and territories while lower rates are in the southern regions. But, incidence of melanoma is also accounted for by sun-protection behavior and the percentages of indigenous population, who happens to have lower rate of skin cancer than the non-indigenous, or Caucasian, population. According to official figures, then, the highest incidence of melanoma is in Queensland (65.3 cases per 1000,000 persons), followed by Western Australia (53), New South Wales (47.8), Tasmania (45.5), the Australian Capital Territory (45.2), South Australia (40), Victoria (37.4) and the Northern Territory (32.5) (see Cancer in Australia: An Overview 2008, pp. 58). The medical cost of treating melanoma in 2001 financial year was estimated at thirty million dollars. Its social and other costs on the community – such as the loss of wages, disruption to family life and reliance of persons on other community services – was not measurable and definitely extremely large (see General Statistics 2009). Since melanoma affects a large number of people in their earlier life, this skin cancer is causing more productive years of life lost than other kinds of cancers (see The Facts on Skin Cancer and Melanoma [n.d.]). What could be done to address the scourge of melanoma? As mentioned in the preceding section, Queensland – specifically its Caucasian population – has the highest melanoma rate in the country. In the period between 1980 and 1987, the region has 55.8 per 100,000 melanoma-afflicted male inhabitants and 42.9 per 100,000 melanoma-inflicted female inhabitants (see McLennan et al 1992). In 2004, melanoma was said to be the second leading form of cancer in men and women in Queensland. In the same year, of the 2,010 people in the region who were diagnosed with melanoma of skin, 286 died from the disease (see Queensland Government 2008). It has been medic ally established that melanoma is curable only if it is diagnosed and treated early. For, when melanoma is not removed in its early stages, cancer cells may grow downward from the skin surface and invade healthy tissues. Once it has spread to other parts of the body, it can be difficult to control (see Melanoma 2009; Swetter 2010). It may result ultimately to disfigurement or, worse, death (see Self-Examination [n.d.]). To arrest these trends and reduce the menace of melanoma, it may be worth following the intervention proposed by Howell (1997). Accordingly, much can be accomplished by a comprehensive melanoma-education to reduce the rising incidence and mortality from melanoma. Essentially, this education program aims to market excellent health habit. This is in line with the efforts by medical professionals to increase a public awareness on the importance of early diagnosis of melanoma. It may be made operational through different strategies, such as consistent Melanoma Monday in communities of Queensland where the public and especially those who are at increased risk may be taught the signs of in situ and early melanoma and the action to be taken if a suspicious spot is found. And, particularly, an important means of promoting awareness about melanoma is through thorough skin self-examination (TSSE, for brevity). TSSE may go with slogan “If you can spot it, you can stop it” (see Self-Examination [n.d.]). The TSSE is built on the premise that everyone should be taught how to examine their own skins. Children, in particular, must be taught at an early age so that by the time they are teens and adults they can do it themselves. Skin self-examination is indisputably the best way to stop skin cancer, specifically when it is complimented with yearly skin exams by a doctor (Self-Examination [n.d.]). TSSE is done regularly – i.e., once a month – to strictly monitor changes in one’s skin and, thus, ensure the early detection of skin cancer. Taking not more than ten (10) minutes, it is actually a small investment in what could be a life-saving procedure. The idea is that since there are three main types of skin cancer, and each has many different appearances, it is important to know the early warning signs of melanoma. These warning signs may be a skin growth that increases in size and appears pearly, translucent, tan, brown, black or multi-colored; a more, birthmark, beauty mark, or any brown spot that changes color, increases in size and thickness, changes in texture, is irregular in outline, is bigger than 6mm or ¼” – that is, a size of a pencil eraser; appears after age 21; a spot or sore that continues to itch, hurt, crust, scab, erode or bleed; and an open sore that does not heal within three weeks. These signs should not be overlooked. These are signs that one needs to see a doctor, preferably one who specializes in diseases of the skin, and particularly when one notes any change in an existing mole, freckle, or spot or if one finds a new one with any of the warning signs of skin cancer (see Self-Examination [n.d.] for details on how TSSE is done). How effective is TSSE? Berwick et al. (1996) reported about their five-year experimentation employing self-examination of skin by residents in the state of Connecticut in America. During the entire period of experimentation, which involved one thousand one hundred ninety-nine (1199) subjects of which only fifteen per cent (15%) practiced TSSE, detected were one hundred ten (110) lethal cases of melanoma. Accordingly, the figures that the experimentation was able to establish are sufficient to associate TSSE with reduced risk of melanoma incidence and to reduce the risk of advanced disease among melanoma patients. With all things taken to be correct in this experimentation, the researchers posit that TSSE may actually reduce mortality from melanoma by sixty-three per cent (63%). Investigating the patterns of detection and variables associated with early diagnosis of melanoma, Carli et al. (2003) found out that melanoma detected made by a dermatologist was associated with a statistically significant additional effect on early diagnosis. They stressed, thus, that future melanoma early diagnosis strategies need to adequately emphasize the role of TSSE among the adult population. Further, they recommended that dermatologists perform TSSE to identify suspect lesions. In 2004, Weinstock, Nguyen & Martin enrolled patients in a mole-mapping program that uses digital imaging of the skin. They noted that participants had positive feedback on the program. In fact, ninety-seven per cent (97%) of program participants ended up recommending it, and almost half (45%) of those who were not doing TSSE before their participation to the program reported practicing it after they received their images. Thus, the researchers concluded that TSSE that is assisted by imaging has the potential to substantially enhance and encourage its performance for the early detection of melanoma. With the proposition that TSSE is an important practice for early detection of melanoma, Weinstock et al. (2007) collected baseline information and did a randomized trial involving one thousand three hundred fifty-six (1,356) melanoma patients who were attending routine primary care visit in southeastern New England. They tried to determine whether a multi-component intervention can increase the performance of TSSE. Their conclusion is that the TSSE intervention was indeed effective in increasing performance of TSSE, which they anticipate to result to long-term benefits such as causing only a short-term excess of skin surgeries. Swetter et al. (2008) probed the efficacy of skin examination practices in early melanoma detection. And they came across with relative revelations. Among their subjects, those who received a physician skin examination within a year had a significantly thinner tumor at diagnosis. Too, those who examined all of their own moles most frequently – that is, at least every six months – had slightly thinner tumors than those who did not. Further, they found out that the use of melanoma picture as an aid in self skin-examination was associated with significantly thinner tumors. With all these findings, they concluded that physician skin examination was strong predictor of earlier melanoma detection as it is in fact associated with thinner tumors at diagnosis. Pollitt et al. (2009) examined associations between TSSE practices and tumor thickness in patients with recently diagnosed melanoma. They were eventually able to establish that patients who routinely examined their skin had thinner melanomas. Hence, it may be held that TSSE proves to be useful and inexpensive screening method to reduce the incidence of melanoma and reduce the development of advanced disease (Berwick et al. 1996). This intervention is rendered more effective when it is done regularly (see Weinstock et al 2007), it is supplemented or assisted by medical professionals, particularly dermatologists (Carli et al. 2003), and TSSE-related materials or aids (Pollitt et al 2009) such as mole maps (Weinstock, Nguyen & Martin 2004) and instruction materials (Weinstock et al. 2007). And, replicating this intervention is worth the effort (Berwick et al. 1996). Primary care providers should stand as strong advocates of TSSE (Weinstock et al 2007). It is significant to point out here that aside from being an effective mode of dealing with melanoma, TSSE is also proven to be very feasible. In 2002, Aitken et al. had found more than sufficient support from the communities, local medical professionals and pathology laboratories where and with whom they did their experimentation on the feasibility of a community-based TSSE (pp. 36). They recorded a significant 2.5-fold increase in participation to TSSE during the first phase of their experimentation, leading them to conclude that, having ascertained the feasibility of this intervention, it may be one of the last opportunities to develop a better strategy to combat the sting of melanoma. Specifics of TSSE as an intervention TSSE is the specific intervention that is being eyed to address the expansive problem of melanoma in Queensland. Designed to be community-based, this intervention has shown to be very feasible as previous intercessions of this sort had come to enjoy the support of communities and local medical personnel (see Aitken et al. 2002, pp. 33). To undertake this, there is need to enroll patients in a program that would intend to evaluate the impact of performing TSSE among the Caucasian residents of the region. The program that would make the intervention operational is going to be based in a medical facility – i.e., a hospital or a primary medical care unit. The primary tools with which data will be culled are consisted of structured questionnaire and personal interviews with the subjects – which are either accomplished or done face-to-face or through telephone or video calls. The participants of this program, which may be limited to Caucasians, will be composed of those with cutaneous melanoma and those without. Other demographic data/factors – e.g., age, sex, occupation, educational attainment, etc – may not be very significant in this study. The number of participants will be decided on later after some logistical concerns are resolved. The intervention program starts with a doctor doing the self-examination of the subjects’ skin. After which, they are taught how to proceed with it in their own or with the help of other people they are comfortable with. The subjects will be made to report back, or be contacted, in order to provide feedbacks. The program will run for a maximum of five (5) years, but with periodic analysis and evaluation of the culled data during its entire period. The expected impact of TSSE TSSE, together with sun protection, is a standard clinical recommendation to reduce the risk of melanoma. It is proven to effectively lead to earlier diagnosis of recurrence or second primary disease among patients (see Mujamdar et al. 2009). Poo-Hwu et al. (1999) reported that up to forty-four per cent (44%) of diagnosed recurrent melanoma was initially detected by patients based on symptoms raising suspicion of metastasis. And, while there is an absence of prospective evidence that post-melanoma diagnosis TSSE reduces morbidity and mortality, there is a strong indication that TSSE performance is related to a reduced risk of advanced disease (see Berwick et al. 1996) and increases survival (Berwick et al. 2005). An article in Cancer Journal for Clinicians in 2001 is about TSSE’s effectiveness in frustrating the development of second melanomas, which is said to be ten (10) to twenty-five (25) times greater than that for patients without a history of this form of skin cancer. In the preceding section of this paper, there are studies – e.g., Swetter et al. 2008 and Pollitt et al. 2009 – that associated TSSE with thin melanoma. The thickness of the melanoma indicates how long it’s been there, and what the risk is of its spreading. That is, a thin melanoma is highly curable in some ninety-five (95) patients while with thick melanoma the chance of a cure decreases (see Melanoma Patients 2001). Of course, although self-examination leads to earlier diagnosis, it is in any way meaning that it is panacea for melanoma. Doctors actually are one in saying that TSSE needs periodic follow up examinations with surgical oncologist or dermatologists. This translates to careful surveillance, so to speak, over the human skin (see Melanoma Patients 2001). Indeed, a sizeable investment for a life-long gain. References: Aitken, J.F. et al. 2002. A randomized trial of population screening for melanoma. Journal of Med Screen, 9, pp. 33-37. Berwick, M., et al. 2005. Sun exposure and mortality from melanoma. Journal of National Cancer Institute, 97 (3), pp. 195-199. Berwick, M., Begg, C., Fine, J., Roush, G. & Barnhill, R. 1996. Screening for cutaneous melanoma by skin self-examination. Journal of the National Cancer Institute, 88 (1), pp. 17-23. Cancer in Australia: an overview, 2008. Australian Institute of Health and Welfare. Available at: http://www.aihw.gov.au/publications/can/ca08/ca08.pdf [Accessed 20 April 2010]. Carli, P. et al. 2003. Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group of Melanoma. Archives of Dermatology, 139 (5), pp. 607-612. General statistics, 2009. Melanoma Patients Australia. Available at: http://www.melanomapatients.org/content/view/133/241/1/0/ [Accessed 20 April 2010]. Howell, J. 1997. Skin self-examination for melanoma – another golden rule. Seminars in Cutaneous Medicine and Surgery, 16 (2), pp. 174-178. Key statistics, 2008. Australian Government, Department of Health and Ageing. Available at: http://www.skincancer.gov.au/internet/skincancer/publishing.nsf/Content/fact-2 [Accessed 20 April 2010]. McLennan, R., Green, A.C., McLeod, G.R. & Martin, N.G. 1992. Increasing incidence of cutaneous melanoma in Queensland, Australia. Journal of National Cancer Institute, 84, pp. 1427-1432. Melanoma, 2009. Medline Plus. Available at: http://www.nlm.nih.gov/medlineplus/melanoma.html [Accessed 20 April 2010]. Melanoma patients: follow up exams improve survival of second skin cancers, 2001. Cancer Journal for Clinicians, 51, pp. 207-208. Mujumdar, M. et al. (2009). Sun protection and skin self-examination in melanoma survivors. Psychooncology, 18 (10), pp. 1106-1115. Pollitt, R.A. et al. 2009. Efficacy of skin examination practices for early melanoma detection. Cancer Epidemiology, Biomarkers and Prevention, 18, pp. 3018-3023. Poo-Hwu W.J., et al. 1999. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma. Cancer, 86 (11), pp. 2252–2258. Queensland Government. 2008. Sun safety and skin cancer statistics. Available at: http://www.health.qld.gov.au/sunsafety/documents/factsheet_skin_stats.pdf [Accessed 20 April 2010]. Self-examination, [n.d.]. The Skin Care Foundation. Available at: http://www.skincancer.org/Self-Examination/ [Accessed 20 April 2010]. Swetter, S. 2010. Malignant melanoma. WebMD. Available at: http://emedicine.medscape.com/article/1100753-overview [Accessed 20 April 2010]. Sweeter, S. et al. 2008. Efficacy of physician and self skin-examination practices for early melanoma detection (Abstract). Available at: http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=33783 [Accessed 22 April 2010]. The facts on skin cancer and melanoma, [n.d.]. Australian Cancer Research Foundation. Available at: http://www.acrf.com.au/plugins/newsfeed.cgi?rm=content&plugin_data_id=4680 [Accessed 20 April 2010]. Weinstock, M., Nguyen, F.Q. & Martin, R.A. 2004. Enhancing skin self-examination with imaging: evaluation of a mole-mapping program. Journal of Cutaneous Medicine and Surgery, 8 (1), pp. 1-5. Weinstock, M. et al. 2007. Melanoma early detection with thorough skin self-examination: the ‘check it out’ random trial. National Institutes of Health Public Access. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440310/pdf/nihms-25376.pdf [Accessed 20 April 2010]. What is melanoma?, 2010. American Cancer Society. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_melanoma_50.asp [Accessed 21 April 2010]. Read More