Melanoma literacy among the general population of three western US states

Oregon primary care providers as a frontline defense in the War on Melanoma™: improving access to melanoma education

Melanoma is one of the deadliest forms of skin cancer but is typically cured with surgical excision when detected early. As an access point to medical care, primary care providers (PCP) play an integral role in early skin cancer detection. However, limited time for examinations and dermatologic training may present barriers to effective skin examination in the primary care setting. As a facet of Oregon Health & Science University's War on Melanoma™ (WoM), our multi-pronged outreach initiative aims to provide PCPs across Oregon with free, convenient, and effective melanoma education. The WoM PCP education campaign was disseminated starting in May 2019 through primary care networks throughout the state of Oregon to 12,792 PCPs, and education was delivered across several platforms: online multimedia tools, large group didactics, individualized practice-based sessions, and in-person distribution of materials to clinics. To date, 829 PCPs have participated in the online Melanoma Toolkit for Early Detection curriculum, 1,874 providers have attended CME didactics, and 9 clinics have received facilitated meetings by Oregon Rural Practice-based Research Network. Eighty-three clinics (comprising 770 providers) were visited on-site and provided educational materials, and more than 150 PCPs have received a free smartphone dermatoscope to aid in skin examination and e-consultation. OHSU's WoM has successfully implemented a multifaceted approach to provide accessible melanoma education to PCPs across the state of Oregon. As a result, we hope to encourage appropriate skin examination in the primary care setting and improve PCPs' diagnostic accuracy and confidence in pigmented lesion evaluation.

Advancements in Melanoma Treatment: A Review of PD-1 Inhibitors, T-VEC, mRNA Vaccines, and Tumor-Infiltrating Lymphocyte Therapy in an Evolving Landscape of Immunotherapy

Melanoma, an aggressive skin cancer, presents significant therapeutic challenges. Consequently, innovative treatment strategies beyond conventional chemotherapy, radiation, and surgery are actively explored. This review discusses the evolution of immunotherapy in advanced melanoma, highlighting PD-1/PD-L1 inhibitors, mRNA vaccines, Talimogene Laherparepvec (T-VEC), and tumor-infiltrating lymphocyte (TIL) therapies. PD-1/PD-L1 inhibitors such as pembrolizumab and nivolumab block immune checkpoints, promoting T-cell cytotoxic activity and improving overall survival in patients with advanced melanoma. T-VEC, a modified oncolytic herpes virus, promotes a systemic anti-tumor response while simultaneously lysing malignant cells. mRNA vaccines, such as Moderna's mRNA-4157/V940, take advantage of malignant-cell-specific neoantigens to amplify the adaptive immune response while protecting healthy tissue. TIL therapy is a form of therapy involving ex vivo expansion and reinfusion of the patient's tumor-specific lymphocytes and has been shown to provide durable tumor control. While these therapies have demonstrated promising clinical outcomes, challenges such as tumor resistance, high financial burden, and limited accessibility pose challenges to their widespread use. This review explores combination therapies such as PD-L1 inhibitors with mRNA vaccines, or TIL therapy, which aim to enhance treatment through synergistic approaches. Further research is required to optimize these combinations, address barriers preventing their use, and control adverse events.

Evidence-Based Communication to Increase Melanoma Knowledge and Skin Checks

Rates of melanoma-the deadliest form of skin cancer-have increased. Early detection can save lives, and patients have a critical role to play in checking their skin. We aim to identify health communication messages that best educate the public and increase intentions toward skin checks. After viewing messages intended to increase melanoma knowledge, participants correctly identified a greater proportion (74.6 vs 70.4%) of moles (mean number = 17.9, 95% confidence interval [CI] = 17.5-18.3 vs 16.9, 95% CI = 16.6-17.3; P < .001, partial eta-squared = 0.03) and had knowledge of more melanoma warning signs (mean number = 5.8, 95% CI = 5.7-5.8 vs 5.6, 95% CI = 5.5-5.7, P = .01, partial eta-squared = 0.02). After viewing messages intended to increase self-confidence in checking their skin accurately, they were also more likely to report greater intentions to do a skin check on a scale of 1-5 (mean number = 3.8, 95% CI = 3.7-3.9 vs 3.6, 95% CI = 3.4-3.7, P = .005, partial eta-squared = 0.02). Online melanoma messages aimed at increasing both melanoma knowledge and skin-check confidence may be most effective in improving the accuracy of skin self-examinations and intentions to do them.