Skin cancer prevention practices among malignant melanoma survivors: a systematic review
This systematic review was conducted to evaluate and summarize the existing literature on prevalence of ultraviolet radiation (UVR) exposure, sun protection, and screening behaviors among individuals diagnosed with malignant melanoma (MM).
The search was performed in PubMed, CINAHL, PsycINFO, ScienceDirect, EMBASE, and ERIC from inception of each database through July 2014. Studies were included if (1) individuals diagnosed with MM were the primary sample, (2) measured UVR exposure, primary and secondary preventive behaviors, (3) original research communication that constitutes an entire set of empirical data, (4) observational design, and (5) English peer-reviewed. Studies were excluded if (1) all of the inclusion criteria were not met and (2) duplicates, conference abstracts, editorials, news, letters to the editor, comments, reviews, feature articles, white papers, and guidelines.
The search resulted in 255 articles that were screened for relevance; however, only 15 articles met all of the inclusion criteria. Most of the studies were cross-sectional (n = 10), used self-administered surveys (n = 8), and were conducted in North America (n = 10). The sample sizes ranged considerably, but were mostly Caucasian (n = 6) and included a higher proportion of women (n = 8). Evidence demonstrated that individuals with MM still engaged in sunbathing, indoor tanning, and reported sunburns. Moreover, survivors reported inadequate levels of both sun protection and skin self-examinations.
The findings highlight the need for intensifying intervention strategies to reduce the risk of new primary MMs in this group. Future research should increase in rigor and include more diverse populations and regions.
KeywordsMM survivors UVR exposure Sun protection behaviors Skin self-examinations
Compliance with ethical standards
Conflict of interest
None of the researchers will be benefitting financially from the study or the publication. Vinayak K. Nahar, M. Allison Ford, Javier F. Boyas, Stephanie K. Jacks, Rizwana Biviji-Sharma, Mary A. Haskins, and Martha A. Bass have no conflict of interests to report. Robert T. Brodell discloses the following potential conflicts of interest: Honoraria have been received from presentations for Allergan, Galderma, and PharmaDerm, a division of Nycomed US Inc. Consultant fees have been received from Galderma Laboratories, L.P. Clinical trials have been performed for Genentech and Janssen Biotech Inc. The material in this article is not believed to be relevant to any of these reported conflicts.
Since this was a systematic review, informed consent was not required.
We have observed appropriate ethical guidelines and legislation in conducting the study. Since this was a systematic review, approval was not required by the IRB at the University of Mississippi.
- American Academy of Dermatology (2014) How to perform a self-exam. https://www.aad.org/spot-skin-cancer/understanding-skin-cancer/how-do-i-check-my-skin/how-to-perform-a-self-exam. Accessed 1 Dec 2014
- American Cancer Society (2014a) Cancer facts and figures. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index\. Accessed 22 Aug 2014
- American Cancer Society (2014b) Skin cancer prevention and early detection. http://www.cancer.org/cancer/cancercauses/sunanduvexposure/skincancerpreventionandearlydetection/skin-cancer-prevention-and-early-detection-skin-exams. Accessed 1 Dec 2014
- Borland R, Hill D, Noy S (1990) Being sunsmart: changes in community awareness and reported behavior following a primary prevention program for skin cancer control. Behav Change 7(3):126–135Google Scholar
- Bränström R, Kasparian NA, Chang YM, Affleck P, Tibben A, Aspinwall LG, Azizi E, Baron-Epel O, Battistuzzi L, Bergman W, Bruno W, Chan M, Cuellar F, Debniak T, Pjanova D, Ertmanski S, Figl A, Gonzalez M, Hayward NK, Hocevar M, Kanetsky PA, Leachman SA, Heisele O, Palmer J, Peric B, Puig S, Schadendorf D, Gruis NA, Newton-Bishop J, Brandberg Y (2010) Predictors of sun protection behaviors and severe sunburn in an international online study. Cancer Epidemiol Biomarkers Prev 19(9):2199–2210. doi: 10.1158/1055-9965 CrossRefPubMedPubMedCentralGoogle Scholar
- Pagoto SL, Schneider KL, Oleski J, Bodenlos JS, Merriam P, Ma Y (2009) Design and methods for a cluster randomized trial of the Sunless Study: a skin cancer prevention intervention promoting sunless tanning among beach visitors. BMC Public Health 9:50. doi: 10.1186/1471-2458-9-50 CrossRefPubMedPubMedCentralGoogle Scholar
- Pfahlberg A, Kölmel KF, Gefeller O (2001) Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. Br J Dermatol 144(3):471–475. doi: 10.1046/j.1365-2133.2001.04070.x CrossRefPubMedGoogle Scholar
- Skin Cancer Foundation (2014) Step by step self-examination. http://www.skincancer.org/skin-cancer-information/early-detection/step-by-step-self-examination. Accessed 1 Dec 2014
- Soto E, Lee H, Saladi RN, Gerson Y, Manginani S, Lam K, Persaud AN, Wong R, Alexandrescu DT, Fox JL (2010) Behavioral factors of patients before and after diagnosis with melanoma: a cohort study-are sun-protection measures being implemented? Melanoma Res 20(2):147–152. doi: 10.1097/CMR.0b013e328328f802 CrossRefPubMedGoogle Scholar
- Weinstock MA, Risica PM, Martin RA, Rakowski W, Smith KJ, Berwick M, Goldstein MG, Upegui D, Lasater T (2004) Reliability of assessment and circumstances of performance of thorough skin self-examination for the early detection of melanoma in the Check-It-Out Project. Prev Med 38(6):761–765. doi: 10.1016/j.ypmed.2004.01.020 CrossRefPubMedGoogle Scholar
- Williams AL, Grogan S, Clark-Carter D, Buckley E (2013) Appearance-based interventions to reduce ultraviolet exposure and/or increase sun protection intentions and behaviours: a systematic review and meta-analyses. Br J Health Psychol 18(1):182–217. doi: 10.1111/j.2044-8287.2012.02089.x CrossRefPubMedGoogle Scholar