Despite substantial efforts at the primary
prevention level, the incidence and mortality rates of cutaneous melanoma
continue to increase among light-skinned population worldwide. Surgical
excision of the primary lesion remains the only effective treatment for early
disease, while treatment for advanced melanoma, i.e., adjuvant immunotherapy
for regional disease or chemotherapy for metastatic disease, offer only modest
survival benefit. Prevention strategies in melanoma are directed towards
reducing solar exposure, particularly in childhood and adolescence, and
decreasing the rate of sunburns by avoiding sun exposure during the peak
sunlight hours, wearing protective clothing, and applying high SPF sunscreens.
The role of solaria remains a controversial issue, with several case/control
studies suggesting an association between melanoma risk and artificial tanning.
Improvements in melanoma survival over the past
decades are due to increased awareness of melanoma and, consequently, detection
of the disease at an early, prognostically favorable stage. Several parameters
have improved early detection activities of melanoma, either by the public or
by physicians. The ABCD criteria have been a useful paradigm for early detection
guidance, although it does not cover the small diameter (<6 mm) or nodular
melanomas, which are a leading cause of melanoma mortality, particularly in
elderly males. Therefore, the message of a “new” or “changing” skin lesion, has
been recently advocated (ABCDE, with E standing for Evolution) to increase
awareness about these ultimately fatal lesions.
In addition to physical examination, a number of
diagnostic techniques, such as photography, dermoscopy, and computer image
analysis have been shown to enhance the diagnostic ability of physicians and
facilitate the examination of pigmented lesions. Lately, the novel concept of
chemoprevention has been introduced, but its potential role and efficacy in
melanoma prevention are under investigation.
