Psychosocial Issues in Familial Melanoma
Another study based in the United Kingdom examined sunburn rates in 170 individuals with a family history of melanoma compared to 140 controls matched to age, sex, and geographical location. Of those with a melanoma family history, 31% reported sunburn in the previous summer (compared to 41% of controls); melanoma families reported better sun-protection behaviors than controls overall. Across controls and those with a family history of melanoma, younger males were more likely to report recent sunburns; also across controls and those with a family history of melanoma, those relatives with atypical mole syndrome, and a belief in their ability to prevent melanoma, showed better sun protection.
One qualitative study of 20 FDRs of melanoma patients recruited from a high-risk clinic at the University of Arizona identified perceived unmet needs for physician communication of risk status, including greater consistency in communication, education for patients concerning the importance of family history to risk status, and needs and desire for more complex advice (e.g., reapplication of sunscreen and wearing clothing with ultraviolet protection factor).
There are also a number of studies that have examined early-detection behaviors in individuals at increased risk for melanoma. In a U.S. sample of 404 siblings drawn from a clinic population of melanoma patients, only 42% of individuals had ever seen a dermatologist; 62% had engaged in skin self-examination; 27% had received a physician skin examination; and only 54% routinely used sunscreen. Female gender was related to greater sunscreen use; those older than age 50 were more likely to have received a physician skin examination. Having a dermatologist was strongly related to all three outcomes (skin self-examination, physician examination, and sunscreen use). In a U.S. study of 229 FDRs referred by patients attending clinic, about half (55%) reported ever having a total cutaneous examination, and slightly more (71%) reported ever performing skin self-examination. Common predictors of skin examination (physician and self-examinations) included physician recommendation and low perceived barriers of screening. Interestingly, 14% of the sample had not told their primary care doctor about their sibling's melanoma diagnosis. One U.S. study showed that half (53%) of FDRs had never received a total cutaneous screening by a physician; only 27% had received a physician recommendation to have a screening. Early detection adherence was related to the following: higher education level; more melanoma risk factors; health-care provider recommendation for screening; perceived risk for melanoma; and perceived severity of melanoma. Interestingly, parents of melanoma patients were less likely to have pursued screening than siblings and children.
A cross-sectional Australian study of 120 individuals from families with a known CDKN2A mutation found that in the past 12 months, 50% reported engaging in skin self-examinations at least four times and 43% had undergone at least one clinical skin examination. In contrast, 15% had not performed a skin self-examination in the past 12 months, and 27% had never had a clinical skin examination. Correlates of skin cancer screening behaviors included having a prior history of melanoma, a physician's recommendation, and stronger behavioral intentions. Additional correlates for skin self-examination included self-efficacy, perceived efficacy of melanoma treatment, and melanoma-specific distress. Perceived risk for developing melanoma was not significantly associated with skin cancer screening behaviors.