Primary prevention strategies for melanoma

Lara M. Silva, Instituto de Medicina Preventiva e Saúde Pública e Clínica Universitária de Dermatologiae, Faculdade de Medicina da Universidade de Lisboa; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. Lisbon, Portugal João Borges-da-Costa, Instituto de Medicina Preventiva e Saúde Pública e Clínica Universitária de Dermatologiae, Faculdade de Medicina da Universidade de Lisboa; Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. Lisbon, Portugal

Melanoma is one of the malignancies whose frequency has increased with highest rate worldwide and accounts for most skin cancer-related deaths despite representing < 5% of cases. This review aimed to critically evaluate evidence on primary prevention strategies, their effectiveness, limitations, and outline priorities to reduce melanoma incidence. A systematic review was conducted in PubMed, MEDLINE, and Cochrane between November 2024 and January 2025. Eligible studies included adults (≥ 18 years), addressed primary prevention of melanoma, and were published since the year 2000. Thirty-five studies met inclusion criteria and were grouped into four themes: behavioral counseling and education (BC), technology-based interventions (T), genetic/personalized risk information (G), and chemopreventive agents (AQ). Daily sunscreen use emerged as a safe, effective, and cost-efficient measure. Protective clothing and shade-seeking complemented photoprotection but required combined use. Educational campaigns improved awareness and sun-protective behaviors, though impact varied with cultural adaptation and prevailing attitudes toward tanning. Technology-based strategies, including apps and short message service (SMS) reminders, showed potential in younger populations but limited long-term adherence. Genetic risk communication influenced preventive behaviors mainly in high-risk groups, with inconsistent effects in average-risk populations. Chemopreventive approaches, such as aspirin and long-chain n-3 polyunsaturated fatty acids, yielded conflicting results and remain inconclusive. Effective melanoma prevention requires a multifaceted approach integrating proven photoprotection, culturally tailored education, and innovative technologies. Sunscreen remains the cornerstone, but strategies must address tanning norms and population-specific needs. Future studies should emphasize long-term follow-up and cost-effectiveness in diverse populations.

Keywords: Melanoma. Primary prevention. Ultraviolet radiation. Sunscreen. Health education.