Weinstock Martin A
Dermatoepidemiology Unit, Veterans Affairs Medical Center and Department of Dermatology, Rhode Island Hospital and Brown University, Providence, Rhode Island 02908, USA.
Clin Cancer Res. 2006 Apr 1;12(7 Pt 2):2297s-2300s. doi: 10.1158/1078-0432.CCR-05-2559.
The public health problem of melanoma is difficult. Recent decades have seen substantial efforts directed at primary prevention, yet the incidence of melanoma continues to increase. Substantial efforts have been devoted to improving treatment, yet melanoma retains a poor prognosis if simple surgical excision is not curative. Early detection has made remarkable progress, however. Five-year relative survival has increased from approximately 80% in 1975 to greater than 90% in 1996. Even so, almost 8,000 Americans are projected to succumb to melanoma in 2005. Because most of these fatal melanomas are visible on the skin surface at a curable phase in their evolution, more can and must be done. To improve the early detection practices of clinicians, we have developed an eight-step Basic Skin Cancer Triage algorithm, which forms the core of a curriculum that we have shown can result in improved skills, attitudes, and practices. We are now in the process of attempting to test a Web-based version of that curriculum in a randomized trial. Skin self-examination also has tremendous potential for contributing to early detection of melanoma. We have tested an intervention to encourage thorough skin self-examination in a randomized trial and found it effective in increasing the performance of this procedure, on increase that is sustained for at least a year, while resulting in only short-term increases in surgical procedures on the skin. Early detection has not yet reached its full potential effect on the public health problem of melanoma and is poised to further reduce melanoma mortality.
黑色素瘤的公共卫生问题颇具难度。近几十年来，人们在一级预防方面付出了巨大努力，但黑色素瘤的发病率仍在持续上升。在改善治疗方面也投入了大量精力，然而，如果单纯手术切除无法治愈，黑色素瘤的预后依然很差。不过，早期检测已取得显著进展。五年相对生存率已从1975年的约80%升至1996年的90%以上。即便如此，预计2005年仍有近8000名美国人会死于黑色素瘤。由于这些致命的黑色素瘤大多在其发展的可治愈阶段在皮肤表面可见，所以能够且必须采取更多措施。为改善临床医生的早期检测实践，我们开发了一个八步基本皮肤癌分诊算法，该算法构成了一门课程的核心，我们已证明这门课程能提高技能、改变态度并改进实践。我们目前正在进行一项随机试验，尝试测试该课程的网络版。皮肤自我检查在黑色素瘤早期检测方面也具有巨大潜力。我们在一项随机试验中测试了一种鼓励彻底皮肤自我检查的干预措施，发现它能有效提高这一检查的执行率，这种提高至少能持续一年，同时仅导致皮肤外科手术短期增加。早期检测对黑色素瘤公共卫生问题的潜在影响尚未完全发挥出来，有望进一步降低黑色素瘤死亡率。
