Melanoma: The Risk Factors and Preventative Approach in Adolescents 

Introduction

Melanoma may develop within an existing mole or dissimilarly appear as a new mole. The most common form of cancer in the US is that of the skin. The three prevalent types are: basal cell carcinoma, squamous cell carcinoma, and melanoma. Melanoma is the deadliest of these three — which, according to CDC, claimed 8,188 lives in 2016. This is because it often and rapidly metastasizes, damaging other areas of the body. In adolescents, does the restrictive legislation of indoor tanning bed use positively affect the rate of new cases of melanoma compared to promoting preventive education alone? These legislations are explored as a solution to slow and halt the increasingly alarming numbers of melanoma cases in adolescents (Centers for Disease Control and Prevention, 2019).

Melanoma: The Risk Factors and Preventative Approach in Adolescents

Susceptibility to developing melanoma is possessing non-modifiable genetic risk factors such as skin pigmentation, family history, and hair and eye color (Centers for Disease Control and Prevention, 2019). Modifiable risks include the overexposure to ultraviolet (UV) rays via sunlight, tanning bed use, and limited educational efforts on melanoma. For this reason, it is important to have regular skin checks by a dermatologist, especially if one has a genetic predisposition or environmental factors of developing melanoma. Raising awareness at a young age may be instrumental in reducing the rate at which adolescents are diagnosed. Evidence has shown a strong correlation of developing skin cancer in people that utilize tanning beds. Particularly, when adopted as a practice during adolescence, it astonishingly increases the risk of melanoma by 75% (World Health Organization, 2014).

Adolescent Development and Tanning Bed Use

According to the World Health Organization (2014), adolescents are individuals that fall within the age range of 10-19 years. This is a sensitive period of development where education, awareness, and experiences forge the ability to assume adult responsibilities. Tanning beds have been linked to cancer, however, adolescents overlook the health risks and continually expose themselves by engaging in these practices. It then poses the question, what determines the rate and intensity to execute a plan to combat melanoma? It should not be limited to primary healthcare professionals during a diagnosis to equip adolescents with the anticipatory guidance to make sound decisions throughout their lifespan. Most noteworthy, the misinformation that melanoma affects a single race when all races are susceptible to this type of cancer (Williams et al., 2013).

Factors Influencing Adolescent Behavior

In a study conducted by Williams et al. (2013), adolescents participated in a questionnaire to ascertain their level of understanding and their attitude toward skin safety. Though they are aware of protective methods and the vulnerability of the skin to UV radiation, there are multiple factors that play a role in their judgment. It comprises familial and peer influences, as well as media-set standards of beauty. When compared to natural sunlight, the body requires approximately 10-15 minutes to convert vitamin D into its active form within the 290 - 300 nm UVB range. UV damage is manifested in tanning and sunburns, these are prerequisites for cancer. Tanning beds emit 320 - 400 nm UVA which penetrates deeper into the skin causing more damage seen as a tan. Therefore, even though it is convenient to get a tan indoors, tanning beds are directly linked to cancer. Furthermore, the International Agency for Research on Cancer has not declared an expected decline in trends among adolescents (International Agency for Research on Cancer, 2014).

Educational Campaigns and Health Promotion

There are several educational campaigns on melanoma yet it has not garnered the attention that it deserves. All too regularly, we see the disconnect between what is taught and how it is translated into practice. It therefore falls on the public to bridge the gap and promote wellbeing influences. A sole approach cannot solve it, therefore nurses play a vital role in the lives of these individuals. During the school session, the school nurse has some degree of responsibility to implement CDC School Programs to Prevent Skin Cancer guidelines to allow the students to make skin-safe choices (Driscoll & Darcy, 2015). In summer months when adolescents spend a large amount of time in the sun, nurses in outpatient clinic settings are then tasked to promote early detection and reinforce prevention by educating the parents as well as adolescents. The issue needs to be addressed during this young age because as one grows older, the likelihood of conforming to new practices is relatively low. According to the Centers for Disease Control and Prevention (2019), data collected in 2016 showed that 67,474 new cases of melanoma were those aged 50 and above. Advocating for and reinforcing the restrictive legislation of indoor tanning bed use in minors through joint efforts can influence the outcome presently and in the future.

Restrictive Legislation and Behavioral Prohibition

According to Healthy People, their objective for 2020 included reducing the rate of tanning by artificial UV rays in adolescents from 15.6% in 2009 to 14%. The first state to establish restrictive legislation to combat tanning bed use in minors was California, and subsequently 34 other states followed suit with varying degrees of restriction. Results yielded that in 2015 to 2017, there was a drastic decrease in the percentage of adolescents that use tanning bed devices. As a result, we can see the dire need for a supplement to health promotion and education among the adolescent age group in order to effectively yield favorable results of changed behavior. Yet as health care professionals and caregivers continue to see the trend of melanoma in adolescent cases due to modifiable risks not only gives a feeling of apprehension but also inspires action in care for the youth because they are the future but also to reduce unnecessary strain on the economy and patient families? Recalling the concept of behavioral prohibition, restrictive legislation is proposed to supplement health promotion in order to slow and halt the increasing trend of melanoma diagnosis among adolescents. Another factor related to adolescent tanning bed usage is the role parents play in predicting the use of tanning beds by their adolescents. Studies indicate that maternal modeling behaviors (maternal indoor tanning behaviors) and gate-keeping behaviors (permitting or refusing the use of tanning beds) were significantly associated with indoor tanning use by their adolescents (Driscoll & Darcy, 2015). This further supports the case that primary care counseling and parental guidance will not be effective as the only method to curb this scourge.

Conclusion

In light of the limited data presented, it is clear to see that exclusive health promotion and education among adolescents is not feasible to slow or halt the substantial increase of melanoma diagnosis. Instead, without foregoing the importance of knowledge, restrictive legislation should be employed around the world in order to maximize effectiveness, save and preserve lives and resources. Favorable results have been produced with even varying degrees of this type of legislation, but if uniformly supported as a total ban for adolescents respective to age of adulthood between nations, findings support that implementation will prove successful.

References

Centers for Disease Control and Prevention. (2019). Melanoma. Retrieved from https://www.cdc.gov/cancer/skin/melanoma/

Driscoll, D., & Darcy, L. (2015). The Role of Nurses in Skin Cancer Prevention. Journal of Nursing Education and Practice, 5(3), 45-52. doi:10.5430/jnep.v5n3p45

International Agency for Research on Cancer. (2014). Tanning Beds: Risks and Regulations. Retrieved from https://www.iarc.fr/tanning-beds-risks/

Williams, A. L., et al. (2013). Adolescents' Knowledge and Attitudes Towards Skin Safety. Journal of Adolescent Health, 52(4), 453-459. doi:10.1016/j.jadohealth.2012.10.001

World Health Organization. (2014). Health for the World's Adolescents: A Second Chance in the Second Decade. Retrieved from https://www.who.int/maternal_child_adolescent/topics/adolescence/second-decade/en/