Moles and melanomas--who's at risk, who knows, and who cares? A strategy to inform those at high risk

Abstract

Background: Malignant melanoma is uncommon but potentially fatal. Knowledge and attitudes play an important part in the early detection of this skin cancer.

Aim: To assess knowledge, risk perception, and intended behaviour related to melanoma compared with actual risk status. To suggest measures to improve the primary and secondary prevention of melanoma in general practice for a high-risk group.

Method: A prospective questionnaire survey was carried out on consecutive adults attending in 16 randomly selected group practices. Applying MacKie's personal risk factor chart for melanoma, the study assessed self-reported risk, knowledge of skin cancer--especially malignant melanoma--and self-reported preventive activity.

Results: A total of 3105 (69%) attenders completed the questionnaire. The responders showed greater concern for minor rather than major clinical signs in pre-existing moles. Young people and the professional classes were the least knowledgeable about skin cancer and exhibited the most risky behaviour in terms of sun exposure, failure to check their skin, and to seek medical advice about new or changing moles. The majority of an 8.7% high-risk group showed lack of awareness of their increased risk, and women in this group reported the highest desire for a suntan and the use of sunbeds. In addition to showing less concern than their low risk counterparts about moles growing in size, they were also reluctant to seek medical advice about new moles.

Conclusion: Consideration should be given to targeting primary prevention and selective screening in general practice towards a high-risk group for malignant melanoma. Young people and the professional social class should receive particular attention.