Advances in Prevention and Surveillance of Cutaneous Malignancies

Abstract

Skin cancer affects 1 in 5 Americans, resulting in significant morbidity and mortality. Treatment costs and rates of skin cancer and melanoma continue to rise, making preventative measures increasingly important. However, there is conflicting evidence about efficacy of primary and secondary prevention strategies in decreasing incidence and improving early diagnosis. The US Preventative Services Task Force 2016 guidelines did not endorse routine skin cancer screening because of "insufficient evidence." Yet, countries like Australia have shown the feasibility and cost-effectiveness of primary sun safety interventions and secondary prevention measures such as routine skin cancer surveillance. Additional emerging evidence shows that regular skin cancer screening in high-risk populations improves early detection and decreases melanoma mortality. New technology may enhance prevention, promote accurate diagnoses, and improve management of melanoma and nonmelanoma skin cancers. Here, we place rising rates of melanoma within historical context, review costs, efficacy, and evidence for primary and secondary skin cancer prevention and examine the evolving role of novel technologies in the field.

Keywords: Melanoma; Primary prevention; Secondary prevention; Sun safety; Sunscreen.

Figure 1

Timeline of the history of melanoma. Melanoma was first described in Europe in 1804 and in North America in 1837. Historically, tanning as a fashion trend is a relatively new phenomenon that was popularized in the 1920s. Prior to the 1900s, pale skin was associated with beauty, wealth, and higher social class, whereas tanned skin was associated with manual labor. These attitudes were captured in artwork of the time, for example in Seurat’s A Sunday Afternoon on the Island of La Grande Jatte. However, in the early 20th century, attitudes shifted toward sun-seeking behavior rather than protection, and this shift was reflected in magazine articles and advertisements of the time. Increased sun exposure in the 1920s contributed to the rise in incidence of melanoma seen decades later during the mid-20th century. Following popularization of the tan, the bikini was introduced in 1946, and the first commercial tanning center was developed in 1978. Attributions: Issac Parrish, courtesy of National Library of Medicine. A Sunday on La Grande Jatte, Georges Seurat, 1884, courtesy of Art Institute of Chicago. Before and after photography for therapy for rickets, courtesy of Wellcome Collection Gallery. Cherry Walker modeling swimsuits at Surfers Paradise, courtesy of John Oxley Library. Spinning Top Sunset, courtesy of Jessie Eastland.