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  1. 1. WHO criteria for screening Based on: Wilson-Jungner criteria for appraising the validity of a screening programme <ul><li>Important health problem </li></ul><ul><li>Accepted treatment for recognized disease </li></ul><ul><li>Facilities for diagnosis and treatment </li></ul><ul><li>Suitable latent and symptomatic stage </li></ul><ul><li>Suitable test or examination </li></ul><ul><li>Test acceptable to population </li></ul><ul><li>Natural history of condition understood </li></ul><ul><li>Agreed on policy on whom to treat </li></ul><ul><li>Cost of finding economically balanced with overall health </li></ul><ul><li>Case finding should be continuous process </li></ul>
  2. 2. Melanoma statistics <ul><li>Melanoma is the Fourth most common cancer in Australia </li></ul><ul><ul><li>Melanoma is one of the commonest cancers among 15-44 years old </li></ul></ul><ul><ul><li>In men, melanoma is the 3 rd most common cancer after prostate & bowel cancer </li></ul></ul><ul><ul><li>In women, melanoma is the 3 rd most common cancer after breast & bowel cancer </li></ul></ul><ul><li>Australia has the world’s highest incidence rate of melanoma </li></ul>
  3. 3. Melanoma incidence and mortality <ul><li>Melanoma represents 10% of all cancers </li></ul><ul><li>More than 10,000 cases diagnosed annually </li></ul><ul><ul><li>58% occurs among men </li></ul></ul><ul><ul><li>42% occurs among women </li></ul></ul><ul><li>Around 1250 people die from melanoma each year </li></ul><ul><ul><li>68% male </li></ul></ul><ul><ul><li>32% female </li></ul></ul><ul><li>Male death rates increased by 3.3% between 1993 and 2003 </li></ul><ul><li>Female death rates increased by 9.1% between 1993 and 2003 </li></ul>
  4. 4. Risks of Melanoma <ul><li>Melanoma risk increases with: </li></ul><ul><li>Exposure to UV radiation </li></ul><ul><ul><li>episodes of sunburn </li></ul></ul><ul><li>People who have </li></ul><ul><ul><li>increased numbers of unusual moles (dysplastic naevi) </li></ul></ul><ul><ul><li>depressed immune systems </li></ul></ul><ul><ul><li>family history (10%) </li></ul></ul><ul><ul><ul><li>mutations in genes CDKN2A and CDK4) </li></ul></ul></ul><ul><ul><li>fair skin </li></ul></ul><ul><ul><li>previous melanoma </li></ul></ul>
  5. 5. Diagnosis of melanoma <ul><li>Detection: </li></ul><ul><li>Self-examination: irregular and changing skin lesions. </li></ul><ul><li>Skin doctors: screen individuals annually (dysplastic naevi) </li></ul><ul><li>Symptoms and diagnosis </li></ul><ul><li>Usually asymptomatic </li></ul><ul><li>Look for ABCDE </li></ul><ul><ul><li>A symmetry </li></ul></ul><ul><ul><li>irregular B order </li></ul></ul><ul><ul><li>uneven C olour </li></ul></ul><ul><ul><li>D iameter (usually over 6 mm) </li></ul></ul><ul><ul><li>E volving (changing and growing) </li></ul></ul><ul><li>Diagnosis is by biopsy to remove the whole lesion </li></ul>
  6. 6. Naked eye inspection of melanoma Superficial spreading melanoma Nodular melanoma Lentigo maligna melanoma Basal cell cancer (BCC)
  7. 7. Treatment of melanoma <ul><li>Surgery can be curative </li></ul><ul><li>For thin melanomas: </li></ul><ul><ul><li>removed 1-2cm of normal skin around it </li></ul></ul><ul><ul><li>draining lymph nodes, if involved, removed </li></ul></ul><ul><li>For thick melanomas </li></ul><ul><ul><li>high dose interferon after surgery </li></ul></ul><ul><ul><li>clinical trials of vaccines </li></ul></ul><ul><li>For widespread disease </li></ul><ul><ul><li>chemotherapy is borderline effective can palliate </li></ul></ul><ul><ul><li>radiotherapy may palliate local symptoms </li></ul></ul>
  8. 8. Prognosis of melanoma <ul><li>Prognosis </li></ul><ul><li>Melanoma five years survival: </li></ul><ul><ul><li>99% if detected before spread </li></ul></ul><ul><ul><li>92% after diagnosis </li></ul></ul><ul><ul><li>65% in regional spread </li></ul></ul><ul><ul><li>15% in widespread </li></ul></ul><ul><li>The Cancer Council Helpline on 13 11 20 </li></ul>
  9. 9. Expenses of melanoma treatment <ul><li>Cost of treating skin cancer </li></ul><ul><li>Non-melanoma (2000-2001): $264 million </li></ul><ul><li>Melanoma (2000-2001): $30 million </li></ul>
  10. 10. Melanoma prevention <ul><li>Prevention </li></ul><ul><li>Avoiding sunburn between 10am and 3pm </li></ul><ul><ul><li>wear a hat that covers the head, neck and ears, </li></ul></ul><ul><ul><li>wear sun protective clothing </li></ul></ul><ul><ul><li>seek shade </li></ul></ul><ul><ul><li>wear close-fitting sunglasses </li></ul></ul><ul><ul><li>wear an SPF30+ sunscreen </li></ul></ul><ul><li>Avoid using tanning salons </li></ul>
  11. 11. Melanoma awareness campaign
  12. 12. Prompt list for screening programme <ul><li>Condition should be a sufficient concern to public health </li></ul><ul><li>Programme should be population focused </li></ul><ul><li>In case of melanoma, every skin condition that have potential for malignancy should come under the programme </li></ul><ul><li>General awareness campaign on the condition be raised </li></ul><ul><li>Programme management team should include both clinical and non-clinical health personnel </li></ul><ul><li>Medical personnel should have sufficient skills to recognise and manage the condition and its precursors/preclinical stage </li></ul><ul><li>Screening is not an stand alone programme, rather a continued process to detect condition at an early stage to prolong survival </li></ul><ul><li>The programme development process should observe the WHO criteria for screening programme. </li></ul>
  13. 13. Useful links & readings on melanoma and screening Clinical Practice Guidelines for the Management of Melanoma in Australia and NZ: Cancer Council Australia: The Melanoma Foundation: What is screening: Criteria for screening: Article: Rampen FHJ, et al. Fundamentals of skin cancer/melanoma screening campaigns. Clinical and Experimental Dermatology 1992;17:307-312 Book chapter: Gordis, L. Epidemiology (4 th Ed). Saunders Elsevier, Philadelphia 2009 (pages: 85-106)