STEP 1: Prevention and early detection
This step outlines recommendations for the prevention and early detection of melanoma.
Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce cancer risk (Cancer Council Australia 2018).
Recommendations for preventing melanoma include:
- Avoid using solariums.
- Avoid getting sunburnt, especially to the point of blistering and skin peeling because multiple episodes have been shown to increase the risk of developing melanoma.
- Protect skin from the sun during sun protection times (when the ultraviolet [UV] levels are 3 or above) by using a combination of:
- long-sleeved clothing
- broad-brimmed hats
- broad-spectrum sunscreens with an SPF of 30 or higher
- sunglasses
- seeking out shade.
- Always protect children from sunburn and long-term overexposure to the sun.
People should be encouraged to use a combination of sun protection measures to avoid reliance on one form of sun protection, and as an adjunct to minimising UV exposure.
The risk factors for developing melanoma include:
- a personal history of melanoma or non-melanoma skin cancer
- a family history of melanoma
- increased numbers of nevi on a total body count (> 100 of more than 2 mm)
- increased numbers of dysplastic naevi – people with more than 5 dysplastic nevi have a 10 times greater chance of developing melanoma than people who have no dysplastic nevi (NCI 2018)
- solarium use
- a fair complexion (including fair skin with poor tanning ability, light or red-coloured hair and blue or green eyes)
- a history of blistering sunburn
- multiple solar keratoses (Cancer Australia 2017a)
- high levels of intermittent sun exposure (e.g. during outdoor recreation or sunny holidays)
- immune suppression and/or transplant recipients
- increasing age.
Patients with an increased risk to develop melanoma should receive education from a general practitioner or dermatologist about skin self-examination and sun protection advice.
Patients with a high risk of developing melanoma may need:
- a total skin check every six to 12 months by a dermatologist or general practitioner with skills in dermoscopy
- surveillance photography (for people with multiple naevi)
- sequential dermoscopic imaging
- referral to a dermatologist or cancer geneticist for people with a family history of cancer in two first-degree relatives.
Population screening is not appropriate for melanoma. However, opportunistic identification of high-risk patients and subsequent total body cutaneous examination of these patients should be practised (Cancer Council Australia Melanoma Guidelines Working Party 2019).
It is important for clinicians to be aware of high-risk groups and ensure that individuals in those groups are aware of their increased risk, establishing a surveillance program that includes regular total skin examinations (Cancer Council Australia Melanoma Guidelines Working Party 2019).
