Introduction

Cutaneous Malignant Melanoma (CMM) is a dangerous form of skin cancer arising from melanocytes. The care pathway for CMM outlines the structured journey patients undergo from diagnosis to treatment, involving a multidisciplinary team to ensure timely and effective care for optimal patient outcomes. The incidence rates of CMM are on the rise globally, presenting a significant healthcare challenge. With the fair-skinned Swedish population notably exhibiting one of the highest incidences, standing at 36.9 for men and 32.6 for women per 100,000 individuals (age standardized to the Swedish population in 2000), the urgency to address this escalating trend is evident. Comparatively, the world standard rates are 19.8 for men and 21.0 for women per 100,000 population. This study conducted over a span from 1990 to 2006, aimed to project the long-term effects of incidence changes, population growth, and preventive measures on CMM cases in Western Sweden.

Historical Trends and Current Status

In Western Sweden, where rates surpass the national average, the burden of CMM is pronounced. Over the past decade, national incidence rates have surged by more than 5% annually, contributing to approximately 500 CMM-related deaths each year in Sweden, equating to a national mortality rate of 5.2 per 100,000 population. The delay from symptom onset to seeking medical attention, known as patient delay, plays a crucial role in outcomes. Despite these concerning trends, the five-year survival rates for individuals with thin CMMs (T1) in Sweden surpass 90%, highlighting the importance of early detection and prompt treatment in combating this rising public health challenge. The study area reported an incidence rate of 44 per 100,000 population, pointing the pressing need for effective interventions.

Five Modelling Scenarios

A software using computer simulation was used to create a model that predicted the total number of melanoma cases expected from 2014 to 2023. The study’s system dynamics modelling projected five scenarios for the future, each with distinct implications. Notably, the improved overall secondary prevention scenario showed promising outcomes. After a decade, this strategy could lead to a remarkable 42% decrease in CMM cases larger than 4 mm and a 10% increase in cases smaller than or equal to 1 mm, compared to the business-as-usual scenario.

Key findings

Under the business-as-usual scenario, CMM cases are projected to increase by 36% over the next decade without changes in care pathways or preventive measures. Alternatively, an enhanced secondary prevention strategy, with a 25% decrease in patient delay and a 50% decrease in doctor delay, could lead to a 42% reduction in melanomas larger than 4 mm and a 10% increase in melanomas 1 mm or smaller, emphasising early detection’s importance. Cutting patient delay by 25% had a more significant impact on early detection than reducing doctor delay by 50%, as patient delay allows more tumor growth time. Teledermoscopy and total body photography can aid in mitigating doctor delay, while public awareness and skin self-examination are vital for reducing patient delay, especially in high-risk groups. Improved secondary prevention notably affects the thickness of rapidly growing CMMs, particularly nodular CMM, the most prevalent fast-growing type.

Implications and Recommendations

The research showcases the critical role of timely interventions in reducing patient and doctor delays, crucial for early detection and improved prognosis. Prioritising enhanced secondary prevention, particularly for fast-growing CMMs, could significantly impact future morbidity and mortality rates. These findings underscore the importance of strategic planning and proactive measures in combating the rising burden of CMM.

Conclusion

System dynamics modelling proves invaluable for healthcare policymakers in managing the complexities of CMM care pathways. Insights from this study enable stakeholders to make informed decisions, addressing the evolving landscape of CMM incidence and treatment strategies. Given that CMM disproportionately affects a younger population, its societal cost is high, underscoring the importance of effective intervention and prevention measures.