Skin cancer, namely melanoma, basal cell and squamous cell carcinoma, is accounted for around one million new cases of cancer and 9800 deaths each year in the United States . Exposure to solar ultraviolet radiation has been identified as the most modifiable risk factor. Melanoma, one of the deadliest yet easily preventable and treatable cancer, has grounded scientific and epidemiological rationales for numerous prevention programs that can be essentially divided into "population approach" and "high risk approach". .
High Risk Approach Individual and target-focused intervention is the essence of "high risk approach" strategy. High risk groups targeted include people with fair complexion, severe sunburn in childhood, photosensitivity, pre-malignant skin lesions such as solar keratoses, immunosuppression (renal transplant), and outdoor workers with prolonged high level of UVR exposure . The prevention strategies involve routine use of sun protection; perform monthly self-examination of skin; frequent physical examinations scrutinizing for new skin lesions or changes by dermatologists according to the ABCD guideline . Baseline color photographs of skin can be taken and repeated every 3 to 12 months . In addition, skin biopsy or excisions can be done as a precaution. Rarely, genetic screening for those with genetic predisposition may be feasible . .
Strength and Limitation The strength of high risk approach lies upon the fact that the intervention is tailored for individuals at risk and patient is more likely to be motivated. It is more cost effective where resources are focused on those in need and it avoids interference of those at low risk. However frequent skin examinations may lead to noncompliance as it is very tedious to perform and may be seen as "non-normative behaviors". Older people are presenting with late melanoma because they are unable to perform self-examination due to poor eyesight and age-related handicap .
