This study was conducted with the aim of documenting melanoma risk factors among the surveyed residents of the Silesian Voivodeship and assessing the preventive measures taken against this malignant tumor. Unfortunately, it revealed that melanoma prevention is not widely practiced, underscoring the need for interventions aimed at improving behaviors that prevent the development of this particular cancer, especially among patients in higher-risk groups. This appears to be particularly important considering the rising incidence of melanoma and high treatment costs. In addition to implementing targeted educational interventions, greater emphasis should be placed on enhancing the quality of guidance provided by physicians and introducing appropriate guidelines for comprehensive skin examinations.
This study was conducted to document melanoma risk factors among the surveyed residents of the Silesian Voivodeship and evaluate the preventive measures taken against this malignant tumor. Unfortunately, it revealed that melanoma prevention is not widely practiced, highlighting the need for interventions aimed at improving behaviors that prevent the development of this cancer, especially among patients in higher-risk groups. This seems particularly important given the rising incidence of melanoma and its high treatment costs. Despite numerous risk factors, the surveyed population of Silesian residents seldom engaged in skin self-examinations or regular dermatoscopic check-ups. Only 55% (131; 55.74%) of individuals with fair skin complexion performed skin self-examinations, and as much as 30% (5; 31.25%) with a history of melanoma had never checked their pigmented lesions. Annual dermatoscopic examinations were carried out by 4% (6; 3.8%) of respondents with numerous pigmented lesions, 3% (8; 3.4%) with fair skin complexion, and 0% of participants with a familial or personal history of melanoma.
Studies conducted in California on melanoma risk factors showed that 31.5% of respondents had fair skin complexion, and 2.4% had more than 10 pigmented nevi. Those with fairer skin and sunburns more frequently reported recent skin examinations, and respondents with 10 or more pigmented nevi were almost 2.5 times more likely to have undergone prior melanoma screening than those without any nevi. Respondents with a personal history of melanoma were 7 times more likely to have sought screening. The history of melanoma in immediate family members and spouses was also significantly associated with recent screening [14]. Other studies evaluating the frequency of skin self-examination indicated that 23–61% of the surveyed population reported performing self-examinations at least once a year, with higher rates in Australia and the United States, and among those with a familial or personal history of melanoma. Unfortunately, the same studies revealed that nearly 18% of respondents who had melanoma would disregard new or changing pigmented lesions and not seek medical attention [15]. Analyses conducted in Cyprus and the USA also indicated that the presence of melanoma risk factors in respondents correlated with more frequent skin self-examinations[16, 17]. Annual clinical skin examinations by dermatologists were also more common among individuals with a familial (15% of men and 14% of women) and personal history (83% of men and 86% of women) of melanoma [18]. These findings suggest that melanoma prevention among the surveyed residents of the Silesian Voivodeship, who are burdened by numerous risk factors, is suboptimal and lower than in other studied populations. It is possible that for some reason, knowledge about the risks of this cancer and its prevention did not reach the surveyed population or was disregarded. Therefore, further investigation of this issue is necessary to improve melanoma prevention efforts among the population of the Silesian Voivodeship.
In our own study, regular self-examination of pigmented lesions was reported by 32% (129; 53.09%) of women and 13% (57; 36.30%) of men. More than 40% (173; 43.03%) of participants had never examined their pigmented lesions. Women performed skin self-examination more frequently than men. More than 50% (129; 53.09%) of women and 36% (57; 36.31%) of men conducted self-examination at least once a year, while 44 (18.11%) women and 22 (14.01%) men did it monthly.
In a study conducted among Cypriots, 59% of respondents performed skin self-examination, of which 21% did it monthly and 7% did it annually [16]. A study in Romania revealed that half of the participants conducted skin self-examinations, with one-third of them doing it regularly (22.48% monthly and 13.28% annually) [15]. The data from our own study indicate that women performed skin self-examination more frequently than men. Similar results were obtained by Kasparian et al. in their research on respondents without a history of melanoma: skin self-examination was more frequently reported by women (70%) than men (67%), and one-third of both women and men without a history of melanoma had never examined their pigmented lesions [18]. However, in the United States, men (16%) performed skin self-examination more often than women (13%) [17]. Twin studies also indicated that 29% of women and 36% of men had ever conducted skin self-examinations. Female gender was associated with a lower likelihood of recent skin screening [14, 17].
Based on the aforementioned data, social campaigns to educate about skin self-examination are needed in many places worldwide, as this practice is still not widespread enough. In Poland, especially in the Silesian Voivodeship, it is important for knowledge about melanoma prevention to be widely disseminated among the entire population and reach men. For comparison, a study conducted among dermatologists, a group with very high knowledge about melanoma and its prevention, showed that 72% of respondents routinely examined their pigmented lesions, with 25.4% performing self-examination monthly, 24.5% every six months, and 17.2% annually. Among all respondents from that study, 67% conducted skin examinations at least once a year, and this was not significantly related to gender [19]. Routine skin self-examination is crucial, as it is associated with significantly reduced mortality due to melanoma through early detection. About 75% of melanomas are detected by patients themselves or by their spouses, friends, and others not related to medicine. Dermatology and oncology societies recommend monthly comprehensive skin self-examination in high-risk groups such as individuals with a personal history of melanoma or with atypical mole syndrome. Despite such recommendations, the rate of systematic self-examination of the skin among patients is low, which could be improved through proper education [20].
Based on our own study, it was found that a significant 80% (311; 77.75%) of participants had never undergone dermoscopy, and over 50% (215; 53.75%) were unaware of what the mentioned examination entails. Less than 3% (11; 2.75%) of respondents had dermoscopy once a year, while 11% (45; 11.25%) had it once in their lifetime. Among individuals with a family history of melanoma, only 43.75% (7; 43.75%) had undergone dermoscopy.
In another study, it was shown that a larger proportion, 25.4% of participants, had undergone dermoscopy at least once in their lifetime, and nearly 40% had sought advice from a dermatologist or another specialist to assess their pigmented lesions. Furthermore, one-tenth of respondents lacked knowledge about dermoscopy, in comparison to half of the respondents from our own study [21].
In a study conducted among individuals with a family history of melanoma, it was demonstrated that 43% of respondents had clinical skin examinations at least once a year, and 17% had them every two years. Meanwhile, 27% of participants had never had their skin examined by a doctor [22]. In comparison to the mentioned studies, the analyzed group of Silesian residents exhibited significantly lower adherence to preventive skin examinations, which is particularly concerning among individuals with a family history of melanoma, as they belong to a high-risk group for the development of this cancer.
As reasons for not undergoing routine dermatoscopic examinations, nearly 40% (154; 38.5%) of respondents cited a lack of knowledge that pigmented lesions should be examined by a dermatologist using this method. Another 40% (175; 43.75%) stated that their pigmented lesions did not raise suspicion, and 5% (20; 5%) were afraid to have them examined. More than 12% (50; 12.5%) of participants were unaware that dermoscopy should be performed annually, and as a reason for less frequent examination, over 4% mentioned the long waiting time for a dermatologist's appointment, and 11% (44; 11%) cited the absence of changes in their pigmented lesions since the last examination.
For over 50% of respondents, enlarging, changing appearance, itching, pain in a current pigmented lesion, or the appearance of a new suspicious-looking mole would motivate them to seek a follow-up dermatologist's visit. A study from Romania indicated that the appearance of a new or changing pigmented lesion would prompt 29% of respondents to visit a dermatologist and 26% to visit a family doctor, yet 35% of participants would ignore these symptoms [15].
In another study, 52% of respondents believed that bleeding from a pigmented lesion was the only reason to consult a doctor [23]. These are concerning findings, as bleeding is not a common symptom and might not even occur, leading to delayed or missed skin cancer diagnoses.
Studies conducted among medical students, a group with above-average knowledge of melanoma, revealed that their motivations for skin examinations included early detection of skin cancer (54%), fear of cancer (31%), cancer in relatives or friends (11%), and doctor's recommendations (22%). As reasons for not undergoing skin examinations, 3% of students mentioned fear of a diagnosis [24].
Among other reasons for not undergoing clinical dermatological examinations, factors included lack of time, forgetfulness, belief that it's not important, and the belief that they didn't have suspicious pigmented lesions [8]. In our own study, over 40% of respondents also mentioned that their pigmented lesions did not raise suspicion.
This raises the question of whether patients are adequately qualified to assess the oncological suspicion of pigmented lesions. Although skin self-examination is simple and effective in detecting melanoma, examinations involving doctors are crucial for early melanoma detection, leading to better outcomes for this cancer [25].
In studies conducted among the rural poor population in Wielkopolska concerning preventive examinations, dermatoscopy was the least frequently performed examination (7.4%). Barriers to participating in preventive examinations included lack of time, lack of need or a sense of health (32.8%), long waiting times (17.2%), and fear of costs (9%) [26]. In our own study, high examination costs were a problem for 5.5% of the surveyed group, nearly 10% of respondents cited a lack of time, and 4.25% mentioned the excessively long waiting time for an appointment. Therefore, proper promotion of preventive skin examinations is crucial through education and informative campaigns, free screening for high-risk individuals, referrals for dermoscopy by family doctors, official guidelines disseminated by healthcare professionals, mobile screening units in areas with limited healthcare access offering free skin examinations and education about melanoma and other skin cancers. This is especially important considering that almost 40% of respondents were unaware that pigmented lesions should be examined by a dermatologist using dermoscopy. This constitutes a significant portion of the surveyed group, although nearly 77% of Turkish students were unaware of skin cancer screening examinations [27].
Interestingly, 5% of respondents were afraid of dermoscopy, and in another study, 7% of individuals reported it as unpleasant [28]. Dermoscopy is a painless procedure, and this should be emphasized in conversations with patients. While a comprehensive dermoscopic examination includes checking areas such as the oral cavity, eye conjunctiva, anus, and genitalia, which could be embarrassing for the patient, many other routine medical examinations are far less comfortable. Hence, patient communication and explaining the essence of the examination are crucial to maintain the accuracy of dermatological skin examinations.
Over 97% (154; 97.47%) of participants with numerous pigmented lesions had never been referred to a dermatologist for dermoscopy. Only 46 (18.11%) women and 17 (10.83%) men reported that a doctor had examined their skin for pathological lesions. Among those with a close family member with a history of melanoma, only one person received information about melanoma prevention from a doctor.
Studies conducted in Romania also revealed infrequent clinical skin examinations performed by doctors. Within a year, only 13.8% of participants in the control group and 26.4% with their own history of melanoma had undergone examinations [15]. In contrast, in Australia, skin examinations conducted by doctors were more prevalent, involving around one-third of the study group within the last 12 months. Skin examinations were more common among individuals with greater sensitivity to UV radiation, lighter skin tones, higher awareness of skin cancer risk, and among females [29].
In a study of American military veterans, a group at increased risk of melanoma due to exposure to UV radiation and barriers to sun protection during military actions, where high rates of sunburns and overrepresentation of older white men were present, less than one-third (30.88%) reported ever having a skin examination by a doctor. Among respondents reporting skin examination by a doctor, 35% had a family history of skin cancer, 39% had moderate to severe sunburns, and 30% used tanning beds [30]. In comparison to the mentioned analyses, individuals with risk factors for melanoma in the surveyed group of Silesian residents were provided insufficient healthcare and received rare preventive actions.
In studies among patients with a history of squamous cell skin cancer, doctors were the main source of information for 24.4% of patients, and doctor's recommendations increased the likelihood of taking preventive actions. In total, 38.5% of respondents reported skin assessments performed by doctors before cancer diagnosis (95.2% by dermatologists and 2.4% by general practitioners). Overall, 76.7% of patients declared receiving medical advice, with the most frequent suggestions being regular skin examinations by doctors (55.1%). Only 3.3% of patients mentioned that a doctor recommended self-examination of the skin [31].
In our study, only one person with a close family member with a history of melanoma received information about melanoma prevention from a doctor. In another study where 41% of respondents lost a family member due to melanoma, the majority reported discussing the family history of melanoma with a doctor. Half of the respondents noted receiving recommendations from healthcare professionals to undergo skin examinations by a doctor, and 59% received recommendations for self-examination of pigmented lesions. However, only 34% emphasized that the clinician instructed them on how to properly perform self-examinations [22].
Screening individuals with a family history of melanoma is crucial, as about 7 to 15% of melanoma patients have a family history in this direction, and the risk of developing melanoma doubles if a first-degree relative has previously been diagnosed with melanoma. Most of the risk is likely related to family members' sun exposure, and less so to inheritance [6]. Proper training of general practitioners in examining pigmented lesions would improve melanoma prevention in Poland, as they are in the most common contact with patients. It's crucial that additional training for general practitioners in skin examination is free and widely accessible. Patients with melanoma risk factors should also be included in regular skin cancer prevention programs led by dermatologists, as they possess the greatest knowledge and skills in melanoma recognition among all medical specialists.