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ABSTRACT Shakya, Sapana. Screening for Melanoma for At-Risk Population: A Practice Guide. Unpublished Doctor of Nursing Practice scholarly project, University of Northern Colorado, 2019. Melanoma is a lethal skin cancer that kills one American every hour (American Academy of Dermatology, 2018b). The incidence and prevalence rate of melanoma is on the rise and continues to affect people, increasing the mortality and morbidity rate and financial burden of the disease. In 2016, the U.S. Preventive Services Task Force concluded that there was insufficient evidence to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults. However, this recommendation was only applicable to the patients who were asymptomatic. The routine skin cancer screening has shown promising results in patients who are at high risk for melanoma (American Cancer Society, 2018b). Primary care providers do not perform routine skin cancer screenings for melanoma or do not even perform screening to identify if the patients are at high risk for melanoma or not. Thus there is a lack of a standardized screening tools/models and workflow processes to include melanoma screening in the clinic settings. To address this need, an evidence-based melanoma screening workflow algorithm was developed specifically to a federally qualified health center in a rural and small mountain community in Northern Colorado. The workflow algorithm included the self-assessment of melanoma risk score (SAMScore) as the risk prediction model to screen patients at high risk for melanoma. The Doctor of Nursing Practice (DNP) scholarly project was implemented to screen patients for melanoma between ages 35 to 75 years old for annual exams, excluding well women visits, who were able to speak, read, and write in English. Depending on the screening result, an appropriate intervention was done by the providers of the clinic by performing a full-body skin exam or biopsy or referral or educating patients on primary prevention of melanoma. The project was evaluated by utilizing the Donabedian framework. After implementation, there was a 300% increase in the number of melanoma screenings completed, increased awareness on melanoma, and melanoma screening protocols among the providers and patients. The clinic has continued to utilize the melanoma screening algorithm and SAMScore to screen patients for melanoma and continues to distribute the handout on primary prevention of melanoma by the American Association of Dermatology. Further studies are needed to assess the validity of the SAMScore in languages other than English and French and evaluate the effectiveness of the SAMScore and the melanoma screening algorithm in a larger clinic with a greater number of staff.

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