Promoting prevention and early recognition of malignant melanoma.

Research continues to support several of the traditional risk factors for melanoma: a personal history of melanoma, basal or squamous cell carcinomas, the presence of moles, sun sensitivity, occupational exposure to certain substances, or a depressed immune system (ACS, 2007; Batailee et al., 2007; Batistatou et al., 2007). These are now joined by several new risk factors, namely, a history of dysplastic nevi, nevi persisting into adulthood, the use of pesticides, and not being vaccinated with BCG or vaccinia vaccines (Fortes et al., 2007; Krone et al., 2005; Shors et al., 2006). In addition, current pathology and pharmacology studies point towards an endogenous origin for malignant melanomas. Malignant melanoma's profile is expanding on a genotypic and phenotypic level. New evidence shows increasing rates of melanoma in minority ethnicities, especially Asians and Hispanics, people in lower socioeconomic groups, as well as elderly White men (Hu et al., 2006; Reyes-Ortiz et al., 2006); therefore, health care practitioners should screen these high-risk demographic groups more closely (Cormier et al., 2006; Hu et al., 2006; Reyes-Ortiz et al., 2006). Also, more educational materials tailored to these at-risk populations, especially minorities and the elderly, need to be formulated as the majority of melanoma awareness materials are created to target the middle-aged Caucasian demographic (Cockburn et al., 2006; Hu et al., 2006). Most PCPs are not performing skin exams regularly, and lack of time and confidence are major reasons for this omission (Geller et al., 2004). This finding underscores Pender's theory that if practitioners have a perceived higher confidence in their ability to perform cutaneous exams, then they are more likely to perform routine full skin exams and sun-protection education (Pender et al., 2002). Pender makes it clear that patients will act in their own best interest, changing dangerous behaviors and increasing healthy practices if they have the knowledge, tools, and incentives to do so (Pender et al., 2002). Thus, practitioners need to educate patients on the benefits of sun avoidance and regular skin exams. In this way, providers function as a vital influence on a patient's own adaptation of health-promoting behaviors (Pender et al., 2002). Primary care providers need to help remove the barriers of social prejudice through campaigning for stricter legislation, which will tighten regulations on indoor tanning salons. Whitehead (2004) notes, "More emphasis on policy-driven initiatives that work through social examination and modification" lead to a community health-promoting empowerment (p. 314). According to Pender and colleagues (2002), communal health awareness is necessary for an individual to make a solid commitment to a health-promoting behavior. Hopefully, as practitioners become more aware of the major risk factors for melanoma, the rate of melanoma prevention for at-risk patients will increase. This review has served to highlight those risk factors, and the tools which practitioners have to decrease melanoma's morbidity and mortality: appropriately identifying high-risk patients, performing in-office annual skin exams, offering patient education regarding self-skin exams and sun-protective behaviors, and pushing for stronger restrictions on the indoor tanning industry. If practitioners can skillfully utilize these tools, then a significant achievement against the progression of malignant