A randomized trial to improve early detection and prevention practices among siblings of melanoma patients

An intensive educational intervention targeting siblings of recently diagnosed melanoma patients leads to sustained improvements in the rate of self skin-examination, according to a new study.

Published in the August 15, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that the diagnosis of melanoma in a family member represents a unique teaching opportunity for lasting behavioral change targeting skin self-examination.

The study is the first randomized trial comparing the impact of interventions on skin cancer prevention and screening practices in a high-risk family group.

Melanoma is a cancer arising from pigmented cells called melanocytes, most commonly found in the skin. Because of its tendency to rapidly become invasive and metastasize to other organs, it is the deadliest of skin cancers. Regular, whole body skin examinations remain the most effective screening tool to reduce mortality rates and detect melanomas before they become invasive and fatal.

Over the last 50 years the incidence of melanoma has increased 15-fold, more than any other cancer, and in the last 25 years mortality has increased 28 percent. Exposure to ultraviolet radiation from the sun or tanning lamps greatly increases an individual's risk. Melanoma risk is 2-8 times higher among people with a first-degree relative (e.g., father, mother, or sibling) diagnosed with the disease. However, many high-risk families are never screened by physicians or perform skin self-examinations.

Led by Alan Geller, M.P.H., R.N. of the Department of Dermatology at the Boston University School of Medicine, a team of investigators conducted a trial to evaluate an intensive, personalized intervention to improve screening and prevention practices in siblings of melanoma patients: 1) conducting routine skin self-examinations; 2) receiving skin cancer screening exams by a dermatologist; and 3) using sun protection practices to prevent cancer. High-risk siblings were randomly assigned to receive either the intervention or the standard of care and followed for 12 months. Subjects assigned to the intervention received three telephone-counseling sessions and personalized, targeted educational reading material mailings, and were referred to free screening exams. Subjects in the control arm were notified by their affected sibling and encouraged to see a physician.

After 12 months the intervention was successful in significantly increasing the number of siblings who performed skin self-examinations, including comparing moles and surveying the back, compared to the control group. However, there was no difference between intervention and control groups for either physician examinations or use of sun protection largely because of improved physician screening in the control group. In both the intervention and control groups the use of sunscreen increased.

This study provides insight into patterns of melanoma screening and protection practiced by this high-risk population. Furthermore, by identifying the behaviors that can be modified, it "may provide a useful foundation for future efforts to target the more than half million siblings at risk for melanoma," conclude the authors.