Skin Cancer Awareness Research Articles

Abstract 796: Investigating incidence and survival patterns of cutaneous malignant melanoma in the United States from 2006-2017

Abstract Introduction: Skin cancers are one of the most common cancers in the United States with melanoma being the fifth leading cause of cancer. Despite its increasing incidence, there are limited studies on how skin cancer affects different races and ethnicities. Here, we conduct a population-based registry study to derive incidence and survival patterns of cutaneous malignant melanoma (CMM) in the US from 2006-2017. 17 population-based cancer registries from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were reviewed. A total of 58,666 cases with histologically confirmed cases of cutaneous malignant melanoma were evaluated. Surprisingly, the CMM subtype that was predominantly found in the non-Hispanic whites (56%) and Hispanic whites (45%) was acral lentiginous melanoma, while “other” melanomas were predominant in the Asian (54%) and Black (77%) populations. Superficial spreading and lentigo maligna melanomas presented more commonly in men (69% and 63%). In addition, nodular and lentigo maligna melanomas had the poorest survival rates and had a median survival of 26 and 21 months. Methods: The Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute was used to calculate the incidence, proportion, and survival data. 58,66 histologically confirmed CMM cases reported by the 17 cancer registries from 2006-2017 were used. The 17 registries include 14 states (Alaska, greater and California, Connecticut, Georgia, Hawaii, Idaho, Iowa, Kentucky, Louisiana, Massachusetts, New Mexico, New York, Utah, Washington) and 4 standard metropolitan areas (Los Angeles, San Francisco-Oakland, and San Jose-Monterey, California; and Seattle-Puget Sound, Washington). Cases of the 4 major CMM subtypes as well as the “other” subtypes were identified using the World Health Organization's International Classification of Diseases for Oncology (ICD-0-3) morphology code. Conclusion and future direction: CMM has been steadily increasing in incidence within the US. Moreover, the incidence rate of CMM in the Hispanic population has been rising. It is important that we continue to assess the epidemiological characteristics and trends of CMM subtypes in the US and increase awareness of skin cancer and its preventative measures in the Hispanic population. In addition, future studies should analyze the genetic and environmental factors that may be contributing to observed incidence rates in the Hispanic population. Citation Format: Yae Kye, Luis Alvarado, Alok Dwivedi, Jessica Chacon. Investigating incidence and survival patterns of cutaneous malignant melanoma in the United States from 2006-2017 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 796.

Melanoma in Singapore: A 20-year review of disease and treatment outcomes

Melanomas in Asians have different clinicopathological characteristics and prognosis from melanomas in Caucasians. This study reviewed the epidemiology and treatment outcomes of cutaneous melanoma diagnosed at a tertiary referral dermatology centre in Singapore, which has a multiracial population. The study also determined whether Asians had comparable relapse-free and overall survival periods to Caucasians in Singapore. This is a retrospective review of cutaneous melanoma cases in our centre between 1996 and 2015. Sixty-two cases of melanoma were diagnosed in 61 patients: 72.6% occurred in Chinese, 19.4% in Caucasians and 3.2% in Indians, with an over-representation of Caucasians. Superficial spreading melanoma, acral lentiginous melanoma and nodular melanoma comprised 37.1%, 35.5% and 22.6% of the cases, respectively. The median time interval to diagnosis was longer in Asians than Caucasians; median Breslow's thickness in Asians were significantly thicker than in Caucasians (2.6mm versus 0.9mm, P=0.018) and Asians tend to present at a later stage. The mortality rates for Asians and Caucasians were 52% and 0%, respectively. More physician and patient education on skin cancer awareness is needed in our Asian-predominant population for better outcomes.

Association between income and suspected nonmelanoma and melanoma skin cancers among participants of the American Academy of Dermatology's SPOT Skin Cancer screening program: A cross-sectional analysis

To the Editor: Lower income and socioeconomic status (SES) have been associated with a worse prognosis of cutaneous melanoma, partly due to poorer skin cancer awareness and screening, resulting in thicker tumors at diagnosis.1 Meanwhile, higher SES populations in selected European countries (Denmark, the Netherlands, Italy) have a greater incidence of nonmelanoma skin cancer, particularly basal cell carcinoma (BCC). However, no association between SES and survival has been found.2,3 While prior research focused on the American Academy of Dermatology's SPOT skin cancer screening program reported risk factors for suspected melanoma, BCC, and squamous cell carcinoma (SCC),4 income as a proxy for SES has not been studied as an independent predictor of skin cancer risk among this population.

A Cross-Sectional Survey of Knowledge of Skin Cancer in Saudi Arabia.

Skin cancer has become one of the world's leading health problems, and incidence rates are on the rise. The leading causes of skin cancer are sun exposure, family history and sunburn, and the most agreed-upon preventative behaviors are sunscreen application and sun avoidance. This study assessed the knowledge of the causes of skin cancer and awareness of preventative measures in Saudi Arabia. A cross-sectional study was conducted among 529 participants in a WhatsApp group over 3 months. Consenting participants completed a validated, 18-item questionnaire. Of 529 total participants, nearly 55% of participants reported an awareness of skin cancer, 35% understood its metastasis and 55.1% knew about its spread. However, 44% of participants were unaware of the different types of the disease. Social media was reported to be the most common source of information. The majority of participants were able to identify symptoms of skin cancer and had knowledge of risk factors. Most participants understood proper preventative measures, and reported that they use sunscreen regularly. The general knowledge of skin cancer in Saudi Arabia is not high but is increasing. However, sun-protective behaviors are lacking, despite the population's knowledge of the benefits. Awareness campaigns and incentive programs may encourage better preventative behavior. Future studies should explore participants' awareness of more specific aspects of skin cancer using a more diverse and extensive population sample.

Impact of Social Media on Skin Cancer Prevention.

Despite the increasing prevalence of social media usage in health care contexts, its impact on skin cancer prevention and awareness has not been largely investigated. We conducted a review of literature on this topic with the objective of summarizing and analyzing the role of social media in skin cancer and sun damage awareness and to identify the uses, benefits, and limitations of different social media platforms on skin cancer prevention. In today’s technological society, it is critical to understand and study the best form of communication. Specific platforms like Instagram, Twitter, Facebook, YouTube, and TikTok vary in originators of material, target demographics, messaging strategies, and reliability of information with regards to skin cancer, sun, and indoor tanning damage. Our results demonstrate that social media interventions have shown promise in skin cancer prevention and continue to escalate by the day. Dermatologists should keep pace with the latest dermatological content on social media and examine its evolution to target the right audience with the proper messages. Further research is needed to evaluate the effectiveness and true impact of social media on meaningful and lasting behavior change for skin cancer prevention.

Systematic Review of Interventions to Increase Awareness of Ultraviolet Radiation-Induced Harm and Protective Behaviors in Post-Secondary School Adults

College and university students are a group known for excessive sun exposure and indoor tanning. Health education campaigns for avoidance of ultraviolet (UV) radiation have been relatively unsuccessful in this population. This systematic review examines interventions aimed at post-secondary school young adults on college and university campuses for skin cancer awareness, photoprotection, and change in UV-exposure-related behavior. Fifty-nine studies were identified for inclusion according to predetermined criteria. Study heterogeneity was high; methods of intervention were individual or group-based, and were mostly visually delivered and/or passive learning. Most interventions occurred at a single time point. Intervention success was assessed by evaluating subject behavior, intention, attitudes, knowledge, and emotion. Multicomponent interventions, generally consisting of UV photography and a passively delivered educational component, may be more effective than a single component alone. Overall, study quality was poor. Sample size of the majority of studies was <150 subjects. Most studies used self-report of behavior and had a short follow-up time. Generalizability of findings may be impacted as women, particularly white/Caucasian women, were overrepresented in the studies identified by this systematic review. For this specific target population, themes arising from the review include the importance of self-relevance and message framing. Self-affirmation was identified as a potential challenge in designing interventions for this target group, which can lead to defensiveness and a negative reaction to the health message. The findings of this systematic review may inform future research in this field, as well as guide planning of effective interventions in this target population.

Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations.

Malignant melanoma and nonmelanoma skin cancers (NMSC), which include basal cell carcinoma and squamous cell carcinoma, account for 40% of all neoplasms in white patients, making these cancers the most common malignancy in the United States. Given the large number of NMSC cases in white patients, there is a correspondingly large body of literature addressing various aspects of epidemiology, pathogenesis, and treatment. The incidence of both malignant melanoma and NMSC is well established and remains significantly lower in patients with skin of color (SoC) when compared with white patients. Although there is a lower incidence of skin cancer in SoC, there is often a poorer prognosis among this group. There is even more limited data focusing on women of color, making an accurate determination of incidence and mortality difficult. This gender disparity causes decreased skin cancer awareness and index of suspicion among patients and providers, hindering appropriate evaluation and care. Therefore, there is a need for an increased understanding of skin cancer in women of color. In the traditional sense, SoC refers to people of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds. Patients in these ethnic groups have richly pigmented skin that is usually categorized as Fitzpatrick types III through VI and thus have notable differences in skin disease and presentation compared with fair-skinned individuals. We present this review of skin cancer in women of color to give a reasonably comprehensive representation of the literature to advance our understanding and knowledge in this unique population.

Promoting skin cancer awareness

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15483 Low adherence to skin cancer screening recommendations in organ transplant recipients

Skin cancer is the most common malignancy in organ transplant recipients (OTRs). Despite an increased incidence, surveillance in OTRs is underprovided. This study aimed to identify the dermatology follow-up rate of OTRs at a hospital with transplant service as well as demographic characteristics influencing follow-up rates. This study was a retrospective chart review completed at a tertiary care center from 1/2008 to 1/2019. ICD codes for kidney, heart, liver, and bone marrow transplants were used to identify patients. 1153 charts were reviewed; age, sex, race, insurance, and dermatology visits were recorded. 118 (10%) of patients were seen by dermatology. Of those 118 patients, 40 were diagnosed with skin cancer (33.9%). Clinic notes identified an additional 41 patients who were seen by an outside dermatology provider. Overall, only 14% of OTRs were seen by any dermatologist after their transplant. Factors that significantly increased visits to dermatology were male sex (P < .01) and white race (P < .0001). Kidney transplant patients had the lowest rate of dermatology follow-up (11% vs 19.6% in all others; P < .0001). Insurance status did not affect follow-up rates. Only 6.9% of all OTRs saw dermatology without a skin cancer diagnosis, highlighting missed opportunities for screening and education prior to cancer development. OTRs not seen by dermatologists have decreased skin cancer awareness and compliance with photo-protective measures. Our study demonstrates a need for quality improvement measures to improve dermatology follow-up. We encourage other programs to monitor their transplant populations, in hopes of decreasing morbidity and mortality in this population.

SCAN! A pharmacy-based, sun safety feasibility study

ObjectivesSkin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN! MethodsWe conducted pre- and postintervention surveys of the SCAN!, a student pharmacist–led or pharmacy resident–led intervention in community pharmacies (n = 3). ResultsParticipants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P’s < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01). ConclusionThe SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.

Internet search trends and online awareness of skin cancer and melanoma in the Republic of Ireland and the UK.

Internet search trends and online awareness of skin cancer and melanoma in the Republic of Ireland and the UK.

Skin cancer in skin of color: A cross-sectional study investigating gaps in prevention campaigns on social media

Skin cancer in skin of color: A cross-sectional study investigating gaps in prevention campaigns on social media

Non-Melanoma Skin Cancer in Outdoor Workers: A Study on Actinic Keratosis in Italian Navy Personnel.

Occupational exposure to ultraviolet radiation is one of the main risk factors for non-melanoma skin cancer (NMSC) development. The most common variants of NMSC are basal cell carcinomas, squamous cell carcinomas, and actinic keratosis (AK). The latter is nowadays considered by most authors as an early squamous cell carcinoma rather than a precancerous lesion. Outdoor workers have a higher risk of developing NMSC because they spend most of the working day outside. The aim of this descriptive study was to assess the prevalence of skin lesions, especially AK, in a professional category of individuals exposed to ultraviolet (UV) radiation: the Italian Navy. From January to June 2016, a questionnaire and a total skin examination of 921 military personnel were administered by medical specialists (dermatologists) in seven different Italian Navy centres. AK was detected in 217 of 921 (23.5%) workers. Older age, outdoor occupation, longer working life, and fair skin seem to promote the development of AK. Of the 217 workers with AK, 187 (86.2%) had lesions in chronically sun-exposed skin areas. Italian Navy personnel have a high AK prevalence. Further studies are needed to investigate occupational hazards and their health effects among outdoor workers to promote protective behaviour and raise awareness of skin cancer.

Skin Cancer Awareness Among 1 271 Black Africans in South Africa.

Little is known about levels of awareness and perceptions of skin cancer among Africans living in Africa. This study assessed skin cancer awareness among 1271 deeply pigmented South Africans. Participants (n=642 males vs n=629 females) were aware of skin cancer (79%) with more females than males being aware of skin cancer (P=0.02). Majority of all participants had never checked their skin for signs or symptoms of skin cancer (90%). Palms of hands and soles of feet were the least recognized anatomic sites for skin cancer development, despite these sites being the common sites for acral lentiginous melanoma in individuals with deeply pigmented skin. Results suggest a need for targeted skin cancer awareness among population groups with dark skin on identification, screening, and early detection, professional training for healthcare personnel and content on skin cancer in deeply pigmented skin in medical curricula.

Drivers for Sun Protection in Black South Africans.

Sun protection behavior studies are almost exclusively carried out in populations with fair skin for the obvious reason that people with unpigmented skin are more susceptible to the health impacts of excess solar ultraviolet radiation exposure. In a dataset of 1271 Black South Africans, we analyzed factors related to sun protection applied when spending time outdoors including awareness of skin cancer, gender, age and Living Standards Measure (LSM) where 1-4 equate to the lowest, 5-7 intermediate and 8-10 the highest LSM status. The most important driver for Black South Africans to use sun protection was whether they were aware of skin cancer (OR: 2.6 for those who were aware versus those who were not, P<0.0001). Sunscreen was preferred by respondents in LSM 8-10 whereas people in the lowest group (LSM 1-4) favored shade, umbrellas and hats. One in two respondents claimed to use some form of sun protection, which appears to be higher than deeply pigmented populations in other countries.

Improving Skin Cancer Knowledge and Awareness in Cosmetology Students

ABSTRACT Skin cancer is the most common form of cancer in the United States and includes melanoma and nonmelanoma skin cancer. Cosmetologists have reoccurring access to individuals presenting for services, and the clients are seen in good lighting where skin changes in the head and neck could be observed. The purpose of this study was to evaluate an educational intervention to increase cosmetology students’ skin cancer knowledge, personal practices, and client-directed skin observation behaviors. A single-group pretest–posttest design was used to examine knowledge, personal practices, client-directed skin observation behaviors, and confidence. A 20-minute face-to-face presentation and printed educational handouts on skin cancer were provided for participants. Statistically significant increases in knowledge (p &lt; .0001), personal practices (p &lt; .0001), and confidence (p &lt; .025) were found; however, no statistically significant increases were found in client-directed skin observation behaviors (p &lt; .057). The results of this study suggest that an educational intervention can increase cosmetology students’ skin cancer knowledge and awareness. Skin cancer knowledge could be used to increase opportunistic monitoring of customer skin health and early detection of skin changes.

Patients' sun practices, perceptions of skin cancer and their risk of skin cancer in rural Australia.

Skin cancer affects nearly one in three Australians. As a preventable disease there have been many public awareness campaigns targeting skin cancer knowledge and sun protection in Australia in the last 30years to increase knowledge of the disease and how to prevent it. Despite higher incidence and mortality of skin cancer in regional Australia and adults over 65years though, little research exists examining this high-risk population's skin cancer knowledge and sun behaviours, with most previous research conducted in urban Australia or overseas. This study aimed to examine adults' skin cancer knowledge, sun behaviours and demographic factors in a regional Australian town. Cross-sectional study design was utilised. Adult patients of a Mudgee General Practice (n=179, 18-89years) completed a survey based on their skin cancer knowledge and sun behaviours. Chi-squared tests were used to analyse responses. Poor non-melanoma skin cancer awareness, risky sun behaviours and inadequate sun protection behaviours were found. Males and those at greatest current risk of skin cancer in Australia, those over 60years, had the poorest skin cancer knowledge and were least likely to recognise skin cancer or use some sun protection measures. Greater non-melanoma skin cancer and sun protection education and research is needed, particularly targeting older and male Australians. SO WHAT?: The findings suggest rural men and older Australians would benefit from more targeted campaigns and education to increase their skin cancer awareness and use of sun protection in order to minimise future skin cancer.

'Try to make good hay in the shade - it won't work!' A qualitative interview study on the perspectives of Bavarian farmers regarding primary prevention of skin cancer.

Extensive exposure to solar ultraviolet radiation (UVR) is the main risk factor for keratinocyte carcinoma (KC), making outdoor workers, including farmers, a high-risk population for KC. The use of sun protection is crucial for KC prevention but is not typically implemented by outdoor workers during their daily tasks. To explore the attitudes of Bavarian farmers regarding sun-protective measures in their daily work and to understand perceived barriers and unmet needs. Farmers were recruited through the Bavarian Farmers Association in Bavaria, Southern Germany. Qualitative semi structured interviews were conducted with participants between December 2017 and March 2018. Interviews were recorded, transcribed verbatim and analysed using qualitative content analysis. Twenty farmers (11 women, nine men; nine aged 18-30 years, 11 aged > 60 years) participated. Knowledge and awareness of UVR exposure and KC, perceived individual barriers to implementing sun-protective measures, individual experiences and farm life-specific circumstances emerged as key areas influencing the perspectives of farmers regarding the primary prevention of KC. Female farmers tended to take a more positive stance on sun protection, whereas male farmers showed a lower overall interest. Knowledge and awareness of KC and UVR exposure is very limited in Bavarian farmers with serious perceived barriers due to the demands of daily agricultural work. Further qualitative studies are needed to identify intervention options that can increase skin cancer awareness and that can successfully overcome real barriers to implementing sun protection.

Mobile teledermatology for melanoma detection: Assessment of the validity in the framework of a population-based skin cancer awareness campaign in northern Italy

Mobile teledermatology for melanoma detection: Assessment of the validity in the framework of a population-based skin cancer awareness campaign in northern Italy

Variable potential for social media platforms in raising skin cancer awareness

Social media plays an important role in public health outreach, given its ability to connect virtual communities. Examples include campaigns for smoking cessation, breast cancer awareness, and emergency relief [1]. Few studies have investigated the utility of social media in skin cancer awareness, though the potential has been demonstrated [2]. We sought to evaluate current differential social media platform use in skin cancer awareness.