The prevention of cutaneous malignant melanoma: High-risk groups, chemoprevention, education, and screening

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Abstract
The ultimate strategy in the control of any disease is prevention. Nowhere in medicine is this more true than in oncology, as the physical, emotional, social, and economic morbidity consequent upon the natural history of neoplastic disease and its treatment (even when successful) is truly enormous. The ability to prevent a given disease has typically lagged far behind our ability to treat that disease. Historically, physicians have been accustomed to focusing on the treatment of established disease, an enterprise that can be undertaken without any knowledge of the disorder’s etiology and pathogenesis. In addition, prevention efforts shift the realm of activity from the one-on-one physician/patient interaction to the far more complex public arena of social policy, resource allocation, education, and behavior modification. In order to undertake a successful prevention program for a particular disease, one must (1) understand at least some of the causal pathways by which the disorder comes into being, (2) identify subsets of the general population who are at risk of developing this condition, (3) communicate to the target audience in a comprehensible and compelling fashion the appropriate etiologic information and the need to act upon it, (4) develop an intervention strategy that can be applied successfully to the target audience, and (5) demonstrate that this intervention alters the natural history of the disease in a significant fashion. Classically, this requires proving that the intervention can actually reduce mortality rates for the disease of interest.