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A Systematic Review of the Literature

Nadine A. Kasparian, BA(Psych, Hons I), PhD; Jordana K. McLoone, BPsych(Hons I), PhD; Phyllis N. Butow, MPH, PhD

Arch Dermatol. 2009;145(12):1415-1427.

Objective  To conduct a systematic review of the literature to identify the prevalence of, and demonstrated risk factors for, psychological distress among individuals affected by, or at high risk of developing, melanoma. For a substantial subset of patients, the diagnosis and/or treatment of cutaneous malignant melanoma may cause significant psychological distress.

Data Sources  Using the MEDLINE, PsycINFO, and CINAHL databases, published studies (1988 to March 2008) of individuals affected by melanoma were included if they examined the demographic, clinical, psychological, and/or social correlates of emotional distress.

Study Selection  Searches were restricted to publications in English and were supplemented by citation lists in retrieved articles and contact with researchers.

Data Extraction  A total of 356 articles were critically appraised by 2 reviewers to assess eligibility and clinical evidence level. A total of 44 studies met the inclusion criteria.

Data Synthesis  Approximately 30% of patients with melanoma reported clinically relevant levels of psychological distress, as measured by a range of validated scales, with symptoms of anxiety more prevalent than depression. A number of empirically demonstrated risk factors for distress were identified, including female sex, younger age, lower education, visibility of affected body site, lack of social support, and negative appraisal of melanoma.

Conclusions  Routine psychological screening of patients with melanoma is widely recommended as standard practice; however, standard screening measures may have limited sensitivity and specificity as demonstrated by the wide range of results reported in this review. Development of a brief screening tool that incorporates empirically supported risk factors is recommended to improve the timely identification and support of those patients most susceptible to adverse psychological outcomes.

Author Affiliations: School of Women's and Children's Health (Dr Kasparian) and Prince of Wales Clinical School (Dr McLoone), Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales (Drs Kasparian and McLoone); and Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, New South Wales (Dr Butow).

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