Submit Your Article CMED MEACR meeting
Home Print this page Email this page Users Online: 1332
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 5  |  Page : 247-253

Knowledge and awareness assessment of dental students about malignant melanoma


1 Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
2 Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University, Istanbul, Turkey

Date of Submission22-Jun-2021
Date of Decision18-Aug-2021
Date of Acceptance02-Sep-2021
Date of Web Publication28-Oct-2021

Correspondence Address:
Gaye Keser
Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Marmara University, BaSibuyuk Saglik Yerleskesi BasibuyukYolu9/334854,Maltepe, Istanbul
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccij.ccij_74_21

Rights and Permissions
  Abstract 


Background: Epidemiological studies have shown an increased tendency to malignant melanoma worldwide. Dentistry students need comprehensive up-to-date information about malignant melanoma to give their patients correct advice. The purpose of this study is to assess 3rd, 4th, and 5th grade students' level of knowledge and awareness about malignant melanoma. Materials and Methods: In our study, a questionnaire consisting of 11 questions was applied to a total of 229 students, 93 3rd grade, 64 4th grade, and 72 5th grade students who were educated at Marmara University, Faculty of Dentistry. In this survey, students' level of knowledge and awareness was examined. Results: A total of 75 (32.75%) male and 154 (67.25%) female students were included in the study. There was a statistically significant difference between grades in terms of participation rate to the statement “Oral melanomas are more aggressive than skin involvement” (P = 0.000). Participation rate of 3rd grades (30.11%) was significantly lower than 4th grades (45.31%) and 5th grades (48.61%) (P1 = 0.004; P2=, 0.000). There was a statistically significant difference between grades in terms of participation rate to the statement “Oral melanoma lesions are usually asymptomatic” (P = 0,000). Participation rate of 3rd grades (15.05%) was significantly lower than 4th grades (39.06%) and 5th grades (58.33%) (P1 = 0.002; P2 = 0.000). Participation rate of 4th grades was significantly lower than 5th grades (P = 0.033). Conclusion: Providing the necessary training on malignant melanoma will improve the knowledge and awareness of dentistry students.

Keywords: Awareness, malignant melanoma, oral cancer


How to cite this article:
Celik I, Keser G, Pekiner FN. Knowledge and awareness assessment of dental students about malignant melanoma. Clin Cancer Investig J 2021;10:247-53

How to cite this URL:
Celik I, Keser G, Pekiner FN. Knowledge and awareness assessment of dental students about malignant melanoma. Clin Cancer Investig J [serial online] 2021 [cited 2021 Dec 6];10:247-53. Available from: https://www.ccij-online.org/text.asp?2021/10/5/247/329483




  Introduction Top


Malignant melanoma is a notably aggressive tumor which produces melanin and originated from pluripotent neural crest-based melanocyte cells.[1] Malignant melanoma is biologically one of the most deadly and unpredictable one of all neoplasms. With being the 3rd most common skin cancer, it is only 3% of all skin cancers diagnosed in each year. Yet, it forms approximately 75% of all skin cancer-related deaths.[2],[3]

Melanocytes are mainly based on the stratum basale of the epidermis layer of skin. On a related point, malignant melanoma is most frequently seen on the skin. In addition, melanocytes are also based on the stratum basale of the epithelial layer which is equivalent of epidermis in mucosas. Malignant melanomas can appear on any mucosal location with melanocytes, though they are not as common as skin cancers. The most widespread regions of mucosal melanomas are nasal mucosa, paranasal sinuses, oral cavity, and nasopharynx, respectively.[4] According to the National Cancer Database Report on Cutaneous and Noncutaneous Melanoma, 91.2% of all melanomas are observed on skin, whereas ocular (5.2%), mucosal (1.3%), and unknown primary melanomas (2.2%) are seen less frequent. Approximately 25% of cutaneous melanomas are observed in the head-and-neck region, 40% in the extremities, and the rest are observed on the body parts. Mucosal melanomas are observed more than half on the head-and-neck region, and the rest mainly consist of urogenital and anorectal mucosa.[5] About 25% of all melanomas are head-and-neck melanomas. In the meantime, approximately 10% of all head-and-neck melanomas are mucosal melanomas.[4] Mucosal melanoma is more aggressive due to being faster propagative and building up more frequent metastasis, compared to cutaneous melanoma. Primary oral malignant melanoma prevalence is 4 in a 10 million population, per year.[6] While this neoplasm accounts for 0.2%–8% of all malignant melanomas,[3],[7],[8],[9],[10] it accounts for 0.5% of all oral cavity cancers and is an important neoplasm that needs to be differentiated from all other oral pigmentations.[7],[8],[9],[10],[11] Jackson and Simpson[12] reported that oral malignant melanomas account for <2% of all melanomas, whereas Reddy et al.[13] stated 0.3%–1.3% incidence.

Common etiologic factors for cutaneous melanomas are UV exposure, fair skin, freckles, red hair, and sun sensitivity. No etiologic factor other than ethnic differences has been defined for mucosal melanoma.[14] Oral malignant melanoma is not related to sun exposure. However, alcohol intake, smoking, chronic irritation due to dentures, and inhaled environmental carcinogenic play important role although no direct relationship has been proved yet.[8],[15],[16],[17] Besides, latest studies emerged BAP1 expression (BRCA1-related protein, Breast Cancer gene) in oral malignant melanoma cases.[18]

According to the World Health Organization (WHO), although the number of malignant melanoma is growing faster worldwide than any other cancer, yearly increase in incidence rates differs in populations. Predictions are that melanoma incidences double in every 10–20 years.[19] Increasing incidence rate varies geographically between “high incidence regions” such as Australia, “medium incidence regions” such as Canada and the USA, and “low incidence regions” such as Scotland and India.[2],[20] According to the GLOBOCAN 2020 database of the WHO, The International Agency for Research on Cancer (IARC), the number of new cutaneous melanoma cases seen in 2020 is 16.171, being the 3rd most common cancer after breast and prostate cancer. Mucosal melanomas are most common in India, Uganda, and Japan; however, cutaneous melanomas are less common in these countries. According to GLOBOCAN 2020 database, the number of new cutaneous melanoma cases is 324.635 globally. About 173.844 of these are men, whereas 150.791 are women and total number of death is 57.043. As for 2018, the number of new cases was 287.723 and total number of death was 60.712. The number of new cases is 1.756 and total number of death is 888 in 2020 in Turkey. Some researchers have suggested that the actual incidence is not higher in the countries such as Japan and Uganda but appears to be due to relatively low cutaneous melanoma incidence in these racial groups.[5]

Oral malignant melanoma is an adult neoplasm observed rarely under 20 years of age.[6],[17] Some researchers remark decades 4–6. Incidence is the highest,[7],[14],[17] whereas others point to decades 4–7[21],[22] and some 5–7.[23],[24] The average age of affected people is 55–56.[6],[8],[22],[25] Studies also revealed that men were affected more compared to women.[2],[3],[6],[7],[14],[21],[22],[23],[24],[26],[27],[28] They account for 11%–12.4% of all melanomas in Japan,[14],[21],[26] and 0.2%–8% in the Europe and USA.[14],[21] Primary oral melanomas are rarely detected and account for <2% of all melanomas in the USA according to D'Silva et al.[29]

Oral malignant melanomas are most common in hard palate and maxillary gingiva.[3],[4],[6],[7],[8],[14],[17],[21],[22],[23],[25],[26],[28],[30] Other regions where it is seen are base of the mouth, buccal mucosa, tongue, and lips.[3],[6],[7],[8],[17],[22],[23] Lips are the region that oral malignant melanoma incidence is the least.[23]

Oral malignant melanoma has much worse prognose compared to cutaneous equivalent.[17] Ten-year survival rate is <30%.[28] In some studies, 5-year survival rate is stated as 0%–20%[26] and 13%–22%,[5] 7%,[22] 15%–38%,[8] 15%,[21] 5%–20%,[7] 15%–30%,[4] and 6.6%–40%[23] in other studies.

The rate of survival of metastatic lesions is extremely poor.[6] The most common regions for metastasis melanoma are buccal mucosa, tongue, and mandible.[4],[23] Another prognostic indicator of oral malignant melanoma that is significantly related to the general survival rate is anatomic region.[17],[23] According to Wang et al., survival rate of oral malignant melanoma patients who have different tumor regions are 51, 40, and 43 months for gingiva, hard palate, and other regions, respectively. The higher survival rate of gingiva-affected oral malignant melanoma patients may be resulted from the ease of the inspection of lesion, therefore, ease of diagnosis, and access during surgery compared to other regions.[31]

In general, the poor prognosis for oral melanoma is linked with difficulty of access to wide resection and tendency for early hematogenous metastasis. The survival rate of younger patients is higher compared to older patients.[5] Five-year survival rate is low that increasing the importance of aggressive treatment need and subsequent follow-up.[4]

Although there are studies on malignant melanoma knowledge and awareness in other nations in the literature, there is none on dental students' knowledge in our country. The purpose of this study is to assess 3rd, 4th, and 5th grade students' level of knowledge and awareness about malignant melanoma.


  Materials and Methods Top


The study protocol of this study was approved by Marmara University Faculty of Medicine Non-Interventional Clinical Research Ethics Committee on 05.03.2021 with protocol number 09.2020.1378. A total of 229 students including 93 3rd grade, 64 4th grade, and 72 5th grade, studying in Marmara University Faculty of Dentistry were included in this study. The participants whose level of knowledge and awareness was assessed were given an 11-question survey. The questions were multiple choice, and they only asked for class information not names. All students were invited to participate on a voluntary basis beginning in 3rd grade and ending in 5th grade.

Statistical analysis

Minitab 17 Statistical Software is used for statistical analysis. Chi-square test was used to compare descriptive statistics (mean, standard deviation, and frequency) as well as qualitative data. Significance was assessed at P = 0.05 level.


  Results Top


A total of 229 students were included in the study and 75 (32.75%) of them were male, whereas 154 (67.25%) of them were female. About 93 (40.61%) of the students were in 3rd grade, 64 (27.95%) were in 4th grade, and 72 (31.44%) were in 5th grade students. There was no statistically significant difference between women (44.16%) and men (37.3%) in terms of the participation rate to the statement “Malignant melanoma ranks third among skin cancers with a rate of 3%.” (P = 0.142). Moreover, there was no statistically significant difference between gender in terms of participation rate to the statement “Primary treatment for malignant melanoma is surgery.” (P = 0.545). Participation rate of women (85.71%) was significantly higher than men (70.67%) to the question “Do you think malignant melanoma is an important disease?” (P = 0.022). Participation rate of women (63.64%) was significantly higher than men (33.33%) to the question “Do you think that sunscreen should be used to prevent malignant melanoma?” (P = 0.000). Correct answer (nodular/smooth-surfaced, slow growing, irregularly shaped, and bronze/brown/black lesions) rate of women (65.58%) were significantly higher than men (52.0%) to the statement “State the clinical features of primary oral melanoma lesion.” (P = 0.048) [Table 1].
Table 1: Evaluation of knowledge level and awareness about malignant melanoma by gender

Click here to view


There was a statistically significant difference between grades in terms of participation rate to the statement “Malignant melanoma ranks third among skin cancers with a rate of 3%.” (P = 0.000). Participation rate of 3rd grades (24.73%) was significantly lower than 4th grades (42.19%) to the question (P = 0.035). The level of significance between the 3rd grade and 5th grade did not yield any results because the sample size of the Chi-square test was <5. Participation rate of 4th grades was significantly lower than 5th grades (63.89%) (P = 0.014) [Table 2].
Table 2: Evaluation of knowledge level and awareness about malignant melanoma according to grades

Click here to view


A statistically significant difference between grades in terms of participation rate to the statement “Oral melanomas are more aggressive than skin involvement” was present in our study (P = 0.000). Participation rate of 3rd grades (30.11%) was significantly lower than 4th grades (45.31%) and 5th grades (48.61%) (P1 = 0.004; P2 = 0.000) [Table 2].

There was a statistically significant difference between grades in terms of participation rate to the statement “Oral melanoma lesions are usually asymptomatic” (P = 0.000). Participation rate of 3rd grades (15.05%) was significantly lower than 4th grades (39.06%) and 5th grades (58.33%) (P1 = 0.002; P2 = 0.000). Participation rate of 4th grades was significantly lower than 5th grades (P = 0.033) [Table 2].

There was a statistically significant difference between grades in terms of participation rate to the statement “Primary treatment for malignant melanoma is surgery” (P = 0.000). Participation rate of 3rd grades (13.98%) was significantly lower than 4th grades (32.81%) and 5th grades (59.72%) (P1 = 0.008; P2 = 0.000). Participation rate of 4th grades was significantly lower than 5th grades (P = 0.003) [Table 2].

There was a statistically significant difference between grades in terms of participation rate to the question “Do you think malignant melanoma is an important disease?” (P = 0.000). Participation rate of 4th grades was significantly lower than 5th grades (94.44%) (P = 0.007) [Table 2].

Moreover, there was a statistically significant difference between grades in terms of participation rate to the question “Do you think that sunscreen should be used to prevent malignant melanoma?” (P = 0.001). Participation rate of 3rd grades (37.63%) was significantly lower than 4th grades (59.38%) and 5th grades (69.44%) (P1 = 0.027; P2 = 0.000). There was no statistically significant difference between 4th grades and 5th grades [Table 2].

A statistically significant difference between grades in terms of correct answer (hard palate and maxillary gingiva) rate to the question “Identify the most common regions of oral melanoma” was portrayed in our study (P = 0.000). Correct answer rate of 3rd grades (6.82%) was significantly lower than 4th grades (22.03%) and 5th grades (37.50%) (P1 = 0.007; P2 = 0.000). There was no statistically significant difference between 4th grades and 5th grades [Table 2].

There was a statistically significant difference between grades in terms of correct answer (superficial spreading melanoma) rate to the question “Identify the most common type of malignant melanoma” (P = 0.018). Correct answer rate of 4th grades (53.13%) was significantly higher than 3rd grades (31.18%) and 5th grades (36.11%) (P1 = 0.006; P2 = 0.046). There was no statistically significant difference between 3rd grades and 5th grades [Table 2].

There was a statistically significant difference between grades in terms of the correct answer (nodular/smooth-surfaced, slow growing, irregularly shaped, and bronze/brown/black lesions) rate to the question “State the clinical features of primary oral melanoma lesion” (P = 0.003). Correct answer rate of 4th grades (45.31%) was significantly lower than 3rd grades (62.37%) and 5th grades (73.61%) (P1 = 0.003; P2 = 0.001) [Table 2].


  Discussion Top


Oral mucosal melanoma is a rare cancer that has a higher proclivity for metastasizing and locally invading tissues than other oral cancers. It is four times more common on the oral mucosa of the upper jaw, most commonly on the palate or alveolar gingiva. In the survey, a study conducted by Ivanov et al.[32] on the knowledge and attitudes of medical students regarding skin cancer and sun protection behaviors, it was stated that the students generally had information about skin cancer and that two-thirds (67.8%) of participants had correctly identified basal cell carcinoma as the most common skin cancer. In our study, there was a statistically significant difference between grades in terms of participation rate to the statement “Malignant melanoma ranks third among skin cancers with a rate of 3%” (P = 0,000). Participation rate of 3rd grades (24.73%) was significantly lower than 4th grades (42.19%) to the question (P = 0.035) and participation rate of 4th grades was significantly lower than 5th grades (63.89%) (P = 0.014).

In another research conducted by Patel et al.[33] on skin cancer between medical students, participation rate of women (85.8%) was significantly higher than men (70.8%) to the statement “Sun exposure is the most important risk factor causing skin cancer,” and it was reported that women used sunscreen at a higher rate than men. In the survey study conducted by Ivanov et al.,[32] a third of medical students (33.1%) reported that they used some form of sunscreen when they were out, usually or all the time. This study stated that this behavior differed between male and female students, and female students (43.8%) used sunscreen more than male students (21.1%) (P = 0.022). Similar to these results, in our study, participation rate of women (63.64%) was significantly higher than men (33.33%) to the question “Do you think that sunscreen should be used to prevent malignant melanoma?” (P = 0,000). The sun protection behaviors of medical students evaluated in many survey studies also confirmed results.[34],[35],[36] These data may be correlated with men being at a higher risk than women for malignant melanoma.[2],[3],[6],[7],[14],[21],[22],[23],[24],[26],[27],[28]

The survey study conducted by Kalil et al.[37] on melanoma awareness between medical students stated that the rate of correct answers given by senior students to the regions where malignant melanoma is most common was higher than the 1st year students. However, when asked about the place where melanoma is seen most frequently, it was observed that 79.66% of 1st year students and 24.59% of final-year students did not know the correct answer. In our study, the correct answer rate of 3rd grades (6.82%) was significantly lower than 4th grades (22.03%) and 5th grades (37.50%) (P1 = 0.007; P2 = 0.000). In the survey study conducted by Kalil et al., 30.51% of 1st-year students and 97.54% of senior students had correct knowledge. According to our study, the correct answer rate of 4th grades (45.31%) was significantly lower than 5th grades (73.61%) to the question “State the clinical features of primary oral melanoma lesion” (P1 = 0.03; P2 = 0.001). The authors also reported that 30.51% of 1st-year students and 97.54% of senior students had correct answers. Similarly, the correct answer rate of 4th grades (45.31%) was significantly lower than 5th grades (73.61%) to the question “State the clinical features of primary oral melanoma lesion” in our study (P1 = 0.03; P2 = 0.001).


  Conclusion Top


Early diagnosis is critical in reducing the mortality rates of oral malignant melanomas that show poor prognosis despite their low prevalence. For that reason, it is essential to include the oral examination in the whole-body examination in addition to the skin examination. To our knowledge, this was the first study assessing the knowledge and awareness of dental students on malignant melanoma in Turkey. Dentistry students play a vital role in the prevention of oral malignant melanoma as future dentists. We hope that the resulting data will be useful in building the existing knowledge base in these areas, identifying knowledge gaps, and in the design and implementation of future oral malignant melanoma lesions reduction and prevention interventions targeting dental students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shangase SL, Zwane NB, Singh S. Oral medicine case book 70: Oral malignant melanoma. S Afr Dent J 2015;70:216-9.  Back to cited text no. 1
    
2.
Sharma K, Mohanti BK, Rath GK. Malignant melanoma: A retrospective series from a regional cancer center in India. J Cancer Res Ther 2009;5:173-80.  Back to cited text no. 2
    
3.
Panda S, Dash S, Besra K, Samantaray S, Pathy PC, Rout N. Clinicopathological study of malignant melanoma in a regional cancer center. Indian J Cancer 2018;55:292-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Zito PM, Mazzoni T. Oral melanoma. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020.  Back to cited text no. 4
    
5.
Neville BW, Damm D, Allenc R, Bouquot JE. Oral and Maxillofacial Pathology. 3rd ed. Philadelphia, PA: WB Saunders; 2009.  Back to cited text no. 5
    
6.
Ashok S, Damera S, Ganesh S, Karri R. Oral malignant melanoma. J Oral Maxillofac Pathol 2020;24:S82-5.  Back to cited text no. 6
    
7.
Kumar V, Vishnoi JR, Kori CG, Gupta S, Misra S, Akhtar N. Primary malignant melanoma of oral cavity: A tertiary care center experience. Natl J Maxillofac Surg 2015;6:167-71.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Bhullar RP, Bhullar A, Vanaki SS, Puranik RS, Sudhakara M, Kamat MS. Primary melanoma of oral mucosa: A case report and review of literature. Dent Res J (Isfahan) 2012;9:353-6.  Back to cited text no. 8
    
9.
Guevara-Canales JO, Gutiérrez-Morales MM, Sacsaquispe-Contreras SJ, Sánchez-Lihón J, Morales-Vadillo R. Malignant melanoma of the oral cavity. Review of the literature and experience in a Peruvian population. Med Oral Patol Oral Cir Bucal 2012;17:e206-11.  Back to cited text no. 9
    
10.
Delgado Azañero WA, Mosqueda Taylor A. A practical method for clinical diagnosis of oral mucosal melanomas. Med Oral 2003;8:348-52.  Back to cited text no. 10
    
11.
Hicks MJ, Flaitz CM. Oral mucosal melanoma: Epidemiology and pathobiology. Oral Oncol 2000;36:152-69.  Back to cited text no. 11
    
12.
Jackson D, Simpson HE. Primary malignant melanoma of the oral cavity. Oral Surg Oral Med Oral Pathol 1975;39:553-9.  Back to cited text no. 12
    
13.
Reddy CR, Rao TR, Ramulu C. Primary malignant melanoma of the hard palate. J Oral Surg 1976;34:937-9.  Back to cited text no. 13
    
14.
Cawson RA, Odell EW. Cawson's Essentials of Oral Pathology and Oral Medicine. 8th ed. London: Elsevier; 2008.  Back to cited text no. 14
    
15.
Ali EA, Karrar MA, El-Siddig AA, Zulfu A. Oral malignant melanoma: A rare case with unusual clinical presentation. Pan Afr Med J 2015;22:113.  Back to cited text no. 15
    
16.
Rapini RP, Golitz LE, Greer RO Jr., Krekorian EA, Poulson T. Primary malignant melanoma of the oral cavity. A review of 177 cases. Cancer 1985;55:1543-51.  Back to cited text no. 16
    
17.
Mohan M, Sukhadia VY, Pai D, Bhat S. Oral malignant melanoma: Systematic review of literature and report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116:e247-54.  Back to cited text no. 17
    
18.
Song H, Wang L, Lyu J, Wu Y, Guo W, Ren G. Loss of nuclear BAP1 expression is associated with poor prognosis in oral mucosal melanoma. Oncotarget 2017;8:29080-90.  Back to cited text no. 18
    
19.
Lens MB, Dawes M. Global perspectives of contemporary epidemiological trends of cutaneous malignant melanoma. Br J Dermatol 2004;150:179-85.  Back to cited text no. 19
    
20.
Wu E, Golitz LE. Primary noncutaneous melanoma. Clin Lab Med 2000;20:731-44.  Back to cited text no. 20
    
21.
Tarakji B, Umair A, Prasad D, Alsakran Altamimi M. Diagnosis of oral pigmentations and malignant transformations. Singapore Dent J 2014;35C: 39-46.  Back to cited text no. 21
    
22.
Rajendran R, Sivapathasundharam B, editors. Shafer's Textbook of Oral Pathology. 7th ed. India: Elsevier; 2012.  Back to cited text no. 22
    
23.
Singh D, Pandey P, Singh MK, Kudva S. Prevalence of malignant melanoma in anatomical sites of the oral cavity: A meta-analysis. J Oral Maxillofac Pathol 2019;23:129-35.  Back to cited text no. 23
[PUBMED]  [Full text]  
24.
Smith MH, Bhattacharyya I, Cohen DM, Islam NM, Fitzpatrick SG, Montague LJ, et al. Melanoma of the oral cavity: An analysis of 46 new cases with emphasis on clinical and histopathologic characteristics. Head Neck Pathol 2016;10:298-305.  Back to cited text no. 24
    
25.
Grosky M, Epstein JB. Melanoma arising from the mucosal surfaces of the head and neck. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:715-9.  Back to cited text no. 25
    
26.
Nwoga MC, Effiom OA, Adeyemi BF, Soyele OO, Okwuosa CU. Oral mucosal melanoma in four Nigerian teaching hospitals. Niger J Clin Pract 2019;22:1752-7.  Back to cited text no. 26
[PUBMED]  [Full text]  
27.
Barker BF, Carpenter WM, Daniels TE, Kahn MA, Leider AS, Lozada-Nur F, et al. Oral mucosal melanomas: The WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:672-9.  Back to cited text no. 27
    
28.
Daley T, Darling M. Nonsquamous cell malignant tumours of the oral cavity: An overview. J Can Dent Assoc 2003;69:577-82.  Back to cited text no. 28
    
29.
D'Silva NJ, Kurago Z, Polverini PJ, Hanks CT, Paulino AF. Malignant melanoma of the oral mucosa in a 17-year-old adolescent girl. Arch Pathol Lab Med 2002;126:1110-3.  Back to cited text no. 29
    
30.
Tanaka N, Mimura M, Ogi K, Amagasa T. Primary malignant melanoma of the oral cavity: Assessment of outcome from the clinical records of 35 patients. Int J Oral Maxillofac Surg 2004;33:761-5.  Back to cited text no. 30
    
31.
Wang R, Jing G, Lv J, Song H, Li C, Wang X, et al. Interferon-α-2b as an adjuvant therapy prolongs survival of patients with previously resected oral muscosal melanoma. Genet Mol Res 2015;14:11944-54.  Back to cited text no. 31
    
32.
Ivanov NN, Swan A, Guseman EH, Whipps J, Jensen LL, Beverly EA. Medical students' knowledge, attitudes, and behaviors with regard to skin cancer and sun-protective behaviors. J Am Osteopath Assoc 2018;118:444-54.  Back to cited text no. 32
    
33.
Patel SS, Nijhawan RI, Stechschulte S, Parmet Y, Rouhani P, Kirsner RS, et al. Skin cancer awareness, attitude, and sun protection behavior among medical students at the University of Miami Miller School of Medicine. Arch Dermatol 2010;146:797-800.  Back to cited text no. 33
    
34.
Isvy A, Beauchet A, Saiag P, Mahé E. Medical students and sun prevention: Knowledge and behaviours in France. J Eur Acad Dermatol Venereol 2013;27:e247-51.  Back to cited text no. 34
    
35.
Rodríguez-Gambetta P, Moscoso-Porras MG, Taype-Rondan A. Factors associated with regular sunscreen use by medical students of a Peruvian university. J Prev Med Hyg 2016;57:E172-7.  Back to cited text no. 35
    
36.
Purim KS, Wroblevski FC. Sun exposure and protection among medical students in Curitiba (PR). Rev Bras Educ Med 2014;38:477-85.  Back to cited text no. 36
    
37.
Kalil LL, Prado EH, Resende RV, Pimenta MR, Wainstein AJ, Drummond-Lage AP. Melanoma awareness among medical students. J Cancer Educ 2021;36:677-81.  Back to cited text no. 37
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed296    
    Printed4    
    Emailed0    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal