Prevention and early detection of malignant melanoma.

In addressing the problem of malignant melanoma, family physicians should emphasize primary prevention. This includes educating patients about the importance of avoiding excessive sun exposure and preventing sunburns, and advising them about the importance of prompt self-referral for changing nevi. Family physicians should be able to perform an overall risk assessment for melanoma, particularly to identify persons with familial atypical mole syndrome. Patients with such high risk should be strongly considered for referral for dermatologic surveillance. Because there are no systematic studies in primary care populations, there are no data on which to base recommendations for periodic screening in this setting. However, when performing any part of the physical examination, family physicians should be alert for suspicious nevi. Nevi detected by the family physician or pointed out by the patient should be subject to excisional biopsy with accepted techniques or be referred for such a procedure.