Barriers to risk-understanding and risk-reduction behaviors among individuals with a family history of melanoma

A systematic review and synthesis of qualitative and quantitative studies evaluating provider, patient, and health care system-related barriers to diagnostic skin cancer examinations

Melanoma-screening examinations support early diagnosis, yet there is a national shortage of dermatologists and most at-risk patients lack access to dermatologic care. Primary care physicians (PCPs) in the United States often bridge these access gaps, and thus, play a critical role in the early detection of melanoma. However, most PCPs do not offer skin examinations. We conducted a systematic review and searched Ovid MEDLINE, EMBASE, and the Cochrane Library from 1946 to July 2019 to identify barriers for skin screening by providers, patients, and health systems following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Of 650 abstracts initially identified, 111 publications were included for full-text review and 48 studies met the inclusion criteria. Lack of dermatologic training (89.4%), time constraints (70%), and competing comorbidities (51%) are the most common barriers reported by PCPs. Low perceived risk (69%), long delays in appointment (46%), and lack of knowledge about melanoma (34.8%) are most frequently reported patient barriers. Qualitative reported barriers for health system are lack of public awareness, social prejudice leading to tanning booth usage, public surveillance programs requiring intensive resources, and widespread ABCD evaluation causing delays in seeking medical attention for melanomas. Numerous barriers remain that prevent the implementation of skin screening practices in clinical practice. A multi-faceted combination of efforts is essential for the execution of acceptable and effective skin cancer-screening practices, thus, increasing early diagnosis and lowering mortality rates and burden of disease for melanoma.

Evaluating sun protection behaviors and skin self-examination practices among the family members of melanoma patients in Turkey: A cross-sectional survey study

To evaluate the preventive practices in family members of melanoma patients regarding melanoma in Turkey and compare our results with similar studies by a literature review. A questionnaire-based, cross-sectional study was conducted in 52 participants over the age of 18 years. The questionnaire consisted of the items regarding melanoma risk factors, sun protection behaviors, skin self-examination (SSE), and family communication. Sun exposure (76.9%) and sunburns (69.2%) were relatively well-known melanoma risk factors. The knowledge of risk factors regarding phenotypical features were low (<50%). The participants who were at least high-school graduates had a significantly higher level of knowledge of risk factors. Compliance with sun protection measures (sunscreen, hat, sunglasses, long-sleeve shirt use) was low (19.2%-42.3%) on almost all items with the exception of shade seeking (73.1%). The most common reported reason for not applying sunscreen was not having a habit of sunscreen use. Only one third of the participants (32.7%) performed SSE. The most commonly reported reason for not performing SSE was not knowing the necessity of SSE. The number of participants who stated that they had received information from the melanoma patient about the disease was 19 (36.5%). We documented the knowledge, preventive measures, and family communication deficiency regarding melanoma among family members of melanoma patients. Results of our study may contribute to the development and implementation of educational programs and interventions targeting family members of the melanoma patients.