Risk Factor For Skin Cancer Research Articles

The Role of the Global Solar UV Index for Sun Protection of Children in German Kindergartens.

More than twenty-five years ago, the Global Solar UV index (UVI) was introduced as a simple means of visualizing the intensity of ultraviolet radiation and to alert people to the need for sun protection. In our survey, among directors of 436 kindergartens in southern Germany we investigated the level of awareness and knowledge about the UVI as well as the practical consequences for sun protection in kindergartens. Less than half of the directors (n = 208, 47.7%) had ever heard of the UVI, and only a small minority of them (n = 34, 8.7%) used the daily UVI information to adapt sun protective measures in their kindergartens. Detailed knowledge about the UVI was a rarity among the respondents. The proportion of respondents with self-perceived detailed UVI knowledge was five times higher than the actual knowledge assessed by an in-depth structured interview using open-ended questions about the UVI (14.2% vs. 2.8%). No clear relationship between UVI awareness, knowledge, and use and directors’ age and gender was found. The UVI-related variables also showed no association with directors’ knowledge of risk factors for skin cancer and their attitudes towards tanned skin. Overall, the results paint a sobering picture regarding the penetration of the UVI into sun protection policies of German kindergartens. Future public health campaigns should aim to increase the awareness and understanding of the UVI as well as its relevance for sun protection of children.

Skin Cancer Risk Factors and Screening Among Asian American Individuals

Asian American individuals are the fastest growing racial group in the US but remain underrepresented in health disparities research, including research on skin cancer risk factors and screening. Improved understanding of preventable skin cancer risk factors and screening may demonstrate unmet needs among Asian American individuals. To examine sunburns, sun-protective behaviors, indoor tanning, and total body skin examinations (TBSEs) for skin cancer screening among Asian American subgroups compared with non-Hispanic White individuals. The National Health Interview Survey is a nationally representative cross-sectional survey in the US that assesses health behaviors. Self-identified Asian Indian, Chinese, Filipino, non-Hispanic White, and other Asian respondents from survey years 2000, 2005, 2010, and 2015 were included. Data were analyzed from July to November 2021. Any sunburn within the last year; sun-protective behaviors included applying sunscreen, staying under shade, wearing long-sleeved shirts, wearing long clothing to the ankles, wearing hats, and wearing caps most of the time or always when out in the sun; any indoor tanning within the last year; any TBSE ever. Of 84 030 participants, 5694 were Asian American (6.8%) and 78 336 (93.2%) were Non-Hispanic White; of these individuals, 1073 (weighted prevalence, 21.0%) were Asian Indian, 1165 (19.4%) Chinese, 1312 (23.5%) Filipino, and 2144 (36.1%) Other Asian. All Asian American subgroups were more likely to seek shade, wear long clothing to the ankles, and wear long-sleeved shirts but less likely to sunburn, apply sunscreen, tan indoors, and receive TBSE than Non-Hispanic White individuals. Asian Indian individuals were less likely than Chinese participants to apply sunscreen (adjusted odds ratio [aOR], 0.55; 95% CI, 0.41-0.74) or wear a hat (aOR, 0.53; 95% CI, 0.37-0.76) and more likely to wear long-sleeved shirts (aOR, 1.89; 95% CI, 1.52-2.33) or long clothing to the ankles (aOR, 1.56; 95% CI, 1.28-1.90). The results of this cross-sectional study found that disaggregated comparisons among Asian American individuals demonstrated differences in skin cancer risk factors that may be used to identify high-risk subgroups and inform culturally aware counseling when indicated. Future studies should further sample Asian American individuals to evaluate for potential masked health disparities through disaggregated analysis.

Moderators of the Effects of mySmartSkin, a Web-Based Intervention to Promote Skin Self-examination and Sun Protection Among Individuals Diagnosed With Melanoma.

Identifying the characteristics of persons who benefit more from behavioral interventions can help health care providers decide which individuals should be offered particular interventions because this is the subgroup of persons who are more likely to derive greater benefit from the intervention and refine the underlying constructs of the model guiding the intervention. This study evaluated possible demographic, medical, knowledge and attitudinal, and psychosocial variables that may moderate the impact of an online intervention, called mySmartSkin (MSS), on engagement in skin self-examination (SSE) and sun protection behaviors among melanoma survivors. Participants completed a baseline survey and were then randomized to the MSS condition or usual care. Follow-up surveys were completed by participants at 8-, 24-, and 48-week postrandomization. A greater impact of MSS on SSE was illustrated among participants with more phenotypic skin cancer risk factors and participants reporting lower baseline self-efficacy in conducting SSE. A more favorable response of MSS on sun protection behaviors was shown when initial knowledge about abnormal lesions and sun protection barriers were high. Greater use of MSS and more favorable evaluations of it were also associated with higher intervention response. Future studies seeking to improve SSE and sun protection among melanoma survivors might benefit from focusing on survivors who report more skin cancer risk factors, lower self-efficacy in conducting SSE, less knowledge about what abnormal skin lesions look like, more perceived barriers to sun protection behaviors, and less worry about recurrence and cancer-related distress.

Role of occupational and recreational sun exposure as a risk factor for keratinocytic non-melanoma skin cancers: an Italian multicenter case-control study.

Sun exposure is the main external risk factor for keratinocytic non-melanoma skin cancer (NMSC). Outdoor workers are at increased risk, but the relationship of NMSC with occupational solar exposure is often confounded by concurrent recreational sun exposure. We compared the percentage of outdoor workers in NMSC patients versus controls without history of NMSC and assessed occupational and recreational sun exposure in both groups, evaluating also other risk factors and use of protective measures. Adult NMSC patients and controls without history of NMSC or actinic keratoses, matched for sex and age range, were recruited in the Departments of Dermatology of seven Italian University Hospitals, with a 1:2 patient/control ratio whenever possible. Data were collected using specifically designed questionnaires. Eight hundred thirty-four patients and 1563 controls were enrolled. History of outdoor work was significantly (P=0.033) more frequent in patients. Patients were more sun exposed from outdoor leisure activities (P=0.012) and sunbathed for longer periods (P=0.13) and between 12 pm and 3.30 pm (P=0.011). Cumulative sun exposure during hobbies was similar between patients and controls in outdoor workers, higher (P<0.05) in patients among indoor workers. Patients and controls with history of outdoor work were more sun exposed at work than during leisure activities (P<0.001). Use of sunscreens by outdoor workers was very low, particularly at work (19.9%). Patients used sunscreens more than controls (P=0.002). Occupational and recreational sun exposure are relevant risk factors for outdoor and indoor workers respectively. Sunscreens are alarmingly underused, particularly at work, and are used mainly by patients.

Factors Associated with Non-Regular Use of Sunscreens in Southern Brazil

Introduction: The southern region of Brazil leads the statistics of skin cancer in Brazil, and multiple factors are related to this predisposition, such as low phototypes and excessive sun exposure. Ultraviolet radiation is the main modifiable risk factor for melanoma and non-melanoma skin cancer, and the regular use of sunscreens has been shown to be effective in reducing the risk of developing these diseases, as well as other photomediated dermatoses. Despite this, the prevalence of non-regular use of sunscreens in cities in Paraná and Rio Grande do Sul proved to be above the desired level. In Santa Catarina cities, this prevalence was still undetermined. Objective: To identify the prevalence of non-use of sunscreen regularly and relate it to demographic, socioeconomic, behavioral and health variables. Method: A population-based cross-sectional study carried out in 2019 with individuals aged 18 years or older residing in the urban area of a large municipality in southern Brazil. Crude and adjusted analyzes were performed, using Poisson regression with a significance level of 5%, to assess the association between non-regular use of sunscreen and sociodemographic, behavioral and health variables. Results: 820 individuals were studied. The prevalence of not using sunscreen regularly was 52.8%. Factors associated with increased risk were: male sex (PR 1.57; 95%CI 1.39-1.77); smoking (PR 1.19; 95%CI 1.03-1.37); age, showing a direct linear trend; and schooling, showing an inverse linear trend. Having a supplementary health plan (PR 0.84; 95%CI 0.71-0.99) and walking during leisure time (PR 0.76; 95%CI 0.64-0.90) proved to be protective factors. Conclusion: This study allowed us to identify the profile of individuals at greater risk of not using sunscreen regularly and who, consequently, are at greater risk of developing photo-related skin diseases. It represents a potential benefit to public health insofar as it allows better targeting of prevention strategies.

Factors Associated with Skin Cancers in People with Albinism in Togo.

Objective The aim of this study was to identify the factors associated with skin cancers in people with albinism (PWA) in Togo. Method This is a retrospective analytical study of the records of PWA examined during five dermatological consultation campaigns from 2019 to 2021. Results During the study period, 517 PWA were seen. Sixty-four (12.3%) of these PWA had presented with 137 cases of skin cancer. The sex ratio (M/F) was 0.9. The average age of PWA with skin cancer was 39.69 ± 15.61 years and that of PWA without skin cancer was 19.17 ± 15.24 years (p ≤ 0.001). The 137 cases of skin cancers were dominated by basal cell carcinomas (45.9%). These skin cancers were located preferentially in the cephalic region (77 cases; 56.2%), followed by the upper limbs (33 cases; 24.1%). In multivariate analysis, the risk factors for skin cancers in PWA were age over 39 years (p ≤ 0.001) and the presence of actinic keratoses (p ≤ 0.001). In contrast, the presence of ephelides (p=0.018) was a protective factor. Conclusion This study confirms that advanced age and actinic keratoses are risk factors for skin cancer in PWA, in connection with the cumulative role of solar radiation. Its originality lies in the identification of ephelides as a protective factor. The knowledge and consideration of these risk factors will make it possible to optimise strategies for the prevention of skin cancers in PWA.

Sun Protective Behaviors and Attitudes of Runners.

Sun exposure is a risk factor for skin cancer. Knowledge and behaviors around sun exposure protective measures are poorly described in athletes including runners. Our primary objective was to describe sun exposure behaviors and knowledge in a population of runners. A cross-sectional online survey was administered to 697 runners to measure the frequency of seven sun protective behaviors: sunscreen use on the face or body; wearing a hat, sunglasses, or long sleeves; running in shade; and avoidance of midday running. Between 54% and 84% of runners reported that they engaged in these behaviors at least sometimes, but only 7% to 45% reported frequent use. Of 525 runners who gave a primary reason for not using sunscreen regularly, 49.0% cited forgetfulness; 17.3% cited discomfort; and only a small percentage cited maintaining a tan (6.1%) or optimizing vitamin D (5.1%). Of 689 runners who responded to a question about what factor most influences their overall sun exposure habits, 39.2% cited fear of skin cancer, 28.7% cited comfort level, and 15.8% cited fear of skin aging. In addition to the seven individual behaviors, we also asked runners how frequently they took precautions to protect against the sun overall. We explored associations between participant characteristics and the overall use of sun protection using ordinal logistic regression. Overall, sun protection was used more frequently in runners who were female, older, or had a history of skin cancer. Runners appear to recognize the importance of sun protection and the potential consequences of not using it, but report forgetfulness and discomfort as the biggest barriers to consistent use. Interventions using habit-formation strategies and self-regulation training may prove to be most useful in closing this gap between knowledge and practice.

The Clinical Utility of a Handheld Elastic Scattering Spectroscopy Tool and Machine Learning in the Diagnosis and Referral Management of Skin Cancer by Primary Care Physicians

Background Elastic scattering spectroscopy (ESS) is a noninvasive optical biopsy technique that can distinguish between normal and abnormal tissue in vivo. The handheld device measures ESS spectra of skin lesions and classifies lesions with an output of “Investigate Further” or “Monitor.” The algorithm was trained and validated with over 11,000 spectral scans from over 3500 skin lesions. The device performance was also evaluated in an associated clinical study. Objective The aim of this paper was to establish whether the use of a handheld ESS tool can improve the detection of skin malignancies by evaluating clinical performance while emulating a real-world telemedicine clinical care setting. Methods The associated clinical study examined an independent test set of 332 lesions in a prospective multicenter study that compared algorithm performance to biopsy results for diagnosing malignant lesions. A total of 50 cases were randomly selected from the study data base (25 malignant and 25 benign lesions). Device performance on these lesions had a 96% sensitivity. High-resolution digital images and the patient’s clinical information including prior skin cancer history, risk factors, and physical examination results were available for evaluation. A total of 57 primary care physicians participated in this study in 2 phases, the first phase with their standard-of-care diagnostic and the second phase regarding their evaluation with the device output. The physicians were educated on the ESS device before evaluating the cases in a random order. Case evaluation included the physician reporting their diagnosis, management decision, and confidence level without the device output in the first phase and with the device output in the second phase. The results were evaluated for sensitivity and specificity with confidence intervals. Results The diagnostic sensitivity of the readers without and with the use of the handheld ESS device increased significantly from 67% to 88% (P&lt;.001). There was no significant difference in specificity at 40% and 53% (P=.05). The management sensitivity of the readers increased significantly with and without the use of the device, which, respectively, was 94% (91%-96%) and 81% (77%-85%) (P&lt;.001), suggesting that the use of the device may reduce false negatives by 68%. Specificity was comparable for management decisions (P=.36) at 31% compared to 36% without the device. Conclusions The use of the handheld ESS device significantly improved diagnostic and management sensitivity over standard-of-care, with comparable specificity. While telemedicine has shown promise in many fields, studies have shown that in-person skin evaluation is superior to telemedicine evaluations; however, integration with this type of tool has the potential to improve early detection.

A single dose of Ultraviolet-A induces proteome remodeling and senescence in primary human keratinocytes

Epidermal photoaging contributes to skin fragility over time and it is a risk factor for skin cancer. Photoaging has been associated for a long time with exposure to Ultraviolet-A (UVA) light, the predominant component of the solar ultraviolet radiation. While the cellular mechanisms underlying UVA-induced photoaging in the dermis have been well characterized, UVA’s action on the epidermis remains elusive. Here, proteomic analysis was conducted to derive the cellular responses induced by an environmentally relevant dose of UVA in primary human keratinocytes. We also investigated the effects of UVA on non-transformed immortalized keratinocytes (HaCaT cells), bearing potentially oncogenic mutations. We showed that UVA induces proteome remodeling and senescence in primary keratinocytes, eliciting potent antioxidant and pro-inflammatory responses. Additionally, we showed that UVA modulates the secretory phenotype of these cells to the extent of inducing paracrine oxidative stress and immune system activation in pre-malignant keratinocytes. These observations offer insights into the cellular mechanisms by which UVA drives photoaging in the skin.

Statin Use and Skin Cancer Risk: A Prospective Cohort Study

Epidemiological studies on statin use in relation to skin cancer risk are scarce and yielded conflicting results. We explored this association in Etude Epidémiologique auprès de femmes de l'Education Nationale, a prospective cohort of French women born in 1925-1950. Health and lifestyle data were self-reported biennially and matched with drug reimbursement data, allowing the identification of participants' statin use since 2004. Multivariable cause-specific hazards regression models adjusted for skin cancer risk factors estimated hazard ratios with 95% confidence intervals. Over 2004-2014, 455 cutaneous melanoma, 1,741 basal cell carcinoma, and 268 squamous cell carcinoma cases were ascertained among 62,473 women. Compared with never use, there were no associations between ever use of statins and melanoma (hazard ratio= 1.16, 95% confidence interval= 0.94-1.44) or squamous cell carcinoma (hazard ratio= 0.89, 95% confidence interval= 0.66-1.19) risks and a decrease in basal cell carcinoma risk with ever use of statins (hazard ratio= 0.89, 95% confidence interval= 0.79-0.996). We found no trend of increasing or decreasing risks with dose, duration of use, time since first use, or age at first use and no statistically significant effect modification by pigmentary traits or residential UVR exposure. Because of the limited number of studies evaluating the associations between the use of statins and the risks of melanoma, basal cell carcinoma, and squamous cell carcinoma, these findings would deserve further investigation in other settings.

Ageing research: rethinking primary prevention of skin cancer.

Ageing research: rethinking primary prevention of skin cancer.

“Repeatability of Repeatability”: the stability of self‐reported melanoma risk factors in two independent samples

ObjectiveTo determine the test‐retest repeatability of a self‐completed survey with items capturing skin cancer risk factors. MethodsWe invited 238 randomly selected participants of the QSkin II cohort to complete the baseline survey a second time. Responses were compared using kappa statistics and intraclass correlation coefficients to quantify agreement for categorical and continuous variables, respectively. We compared the performance of key items with that observed in an earlier repeatability study using the same survey instrument in an independent cohort. ResultsMeasures of phenotypic characteristics had moderate to almost‐perfect test‐retest repeatability (e.g. eye colour weighted kappa (κw) = 0.87, 95% confidence interval [CI]: 0.81, 0.92). Items measuring sun exposure showed lower agreement (κw range 0.36‐0.54) compared with phenotypic characteristics (κw range 0.59‐0.87). Items relating to treatment of skin cancers demonstrated almost‐perfect test‐retest repeatability (e.g. excisions for skin cancers κw 0.85, 95%CI: 0.80, 0.89). In aggregate, the repeatability of key items was very similar across the two independent repeatability samples. ConclusionFair to almost‐perfect repeatability for self‐reported skin cancer risk factors was robust across independent and temporally distant cohorts. Implications for public healthThese self‐assessed risk factors for skin cancer are repeatable and suitable for use in clinical practice and research.

Difference in Sun Exposure Habits Between Individuals with High and Low Risk of Skin Cancer.

Skin cancer incidence is rapidly increasing. The main risk factor, sun exposure, can be modified. Informational campaigns can be effective in raising skin cancer awareness and target the high-risk population. Still, sun exposure habits in people at high risk of skin cancer are not well-known. To investigate if and how sun exposure habits differ between low-risk and high-risk individuals. During the Swedish Euromelanoma campaign of 2018, questionnaires were collected containing information regarding sun exposure habits and risk factors for skin cancer. Data on 4,141 participants was used to investigate the association between risk factors and sun exposure habits. A fair skin type and a previous history of skin cancer were significantly associated with enhanced sun protective behavior. Family history of skin cancer, childhood sunburns and the presence of large/atypical nevi had no effect on sun exposure habits. Going on sunny holidays were particularly unaffected by being at high risk of skin cancer. Individuals at high risk of developing skin cancer showed suboptimal sun exposure habits and harmful traveling behaviors. We suggest that future skin cancer campaigns inform on accurate sun protection behavior during sunny holidays and associated risk factors. Risk factors such as childhood sunburns, numerous common and large/atypical nevi, as well as family history of skin cancer seem to be less recognized by the population.

The Role of p53 in Progression of Cutaneous Squamous Cell Carcinoma.

Simple SummarySkin cancers are the most common types of cancer worldwide, and their incidence is increasing. Epidermal keratinocyte-derived cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer, and it is associated with poor prognosis in the advanced stage. The most important risk factor for cSCC is long-term exposure to solar ultraviolet radiation, which induces oncogenic mutations in epidermal keratinocytes. The most common mutations are inactivating mutations in tumor suppressor p53, which result in accumulation of additional mutations. Recently, the role of p53 in the progression and invasion of cSCC has also been elucidated. In this review we will discuss the role of p53 in development of cSCC and as a potential new therapeutic target in advanced cSCC.Skin cancers are the most common types of cancer worldwide, and their incidence is increasing. Melanoma, basal cell carcinoma (BCC), and cutaneous squamous cell carcinoma (cSCC) are the three major types of skin cancer. Melanoma originates from melanocytes, whereas BCC and cSCC originate from epidermal keratinocytes and are therefore called keratinocyte carcinomas. Chronic exposure to ultraviolet radiation (UVR) is a common risk factor for skin cancers, but they differ with respect to oncogenic mutational profiles and alterations in cellular signaling pathways. cSCC is the most common metastatic skin cancer, and it is associated with poor prognosis in the advanced stage. An important early event in cSCC development is mutation of the TP53 gene and inactivation of the tumor suppressor function of the tumor protein 53 gene (TP53) in epidermal keratinocytes, which then leads to accumulation of additional oncogenic mutations. Additional genomic and proteomic alterations are required for the progression of premalignant lesion, actinic keratosis, to invasive and metastatic cSCC. Recently, the role of p53 in the invasion of cSCC has also been elucidated. In this review, the role of p53 in the progression of cSCC and as potential new therapeutic target for cSCC will be discussed.

LB750 Clinical and demographic characteristics of encounters with sunburn in claims data

Sunburn is a preventable risk factor for skin cancer. Prior investigations of sunburn in healthcare settings have focused on emergency department visits. More epidemiologic information on patients presenting with sunburns is important to inform public health initiatives and further research. Here we characterize the clinical settings and demographic characteristics of patients who receive a sunburn diagnosis. We used Truven MarketScan, a national deidentified commercial insurance database, from 2008-2018.

LB799 Role of mitochondria in keratinocyte responses to acute UVB irradiation

Solar ultraviolet B (UVB) radiation is the major environmental risk factor for skin cancers. In order to develop new strategies to prevent and treat those malignant tumors, a better understanding of the different pathways involved in the cellular responses to UVB radiation is needed. The study of the energy metabolism is essential by its central function in many cellular processes like cell cycle, autophagy, senescence and apoptosis. In this study, we examined the contribution of the mitochondrial metabolism in the keratinocyte responses to acute UVB radiation.

Behavioral and Psychological Outcomes Associated with Skin Cancer Genetic Testing in Albuquerque Primary Care.

Simple SummaryGenetic information is publicly available but research examining the best use of such information has not engaged diverse members of the public. We examined public reactions to melanoma genetic testing (using the melanocortin-1 receptor [MC1R] gene) in a study randomizing (like the flip of a coin) 600 diverse primary care patients to a MC1R test offer or usual care. We found that testing did not improve sun protection and skin cancer screening, nor did it lead worry to increase. However, groups less aware of their skin cancer risk, including those who thought their risk was “unlikely” at the start of the study, showed significant improvements in sun protection at three months. In conclusion, testing might be very helpful for certain people who have the most to learn about their risk, who may become motivated to protect themselves from the damaging effects of the sun as a result of skin cancer genetic testing.Public availability of genetic information is increasing; thus, efforts to improve diversity in basic and translational research in genomics is a top priority. Given the increasing U.S. incidence and mortality of melanoma, and the prevalence of common melanocortin-1 receptor (MC1R) gene melanoma risk variants in the general population, we examined genomic testing of MC1R for skin cancer risk in a randomized controlled trial in Albuquerque, New Mexico primary care. Participants were 48% Hispanic and were randomized 5:1 to a MC1R test invitation or usual care. We assessed 3 month sun protection, skin cancer screening, and skin cancer worry outcomes associated with testing, and key effect moderators (e.g., cancer risk perceptions, and skin cancer risk factors). Our findings indicate that the primary outcomes were unchanged by the MC1R test offer, test acceptance, and level of risk feedback. Moderator analyses showed that those with lower risk perception, and those with skin that readily tans, significantly increased their sun protection in response to higher than average risk feedback. Risk feedback did not prompt cancer worry, and average risk feedback did not erode existing sun protection. This study paves the way for the development of tailored strategies to address low skin cancer risk awareness in this understudied context of public health genomics.

26293 Gender, race, and dermatologic history affect knowledge and attitudes towards sunscreen usage

Background: Excessive sun exposure is a major risk factor for sunburns, skin cancer, and photoaging; however, studies repeatedly demonstrate that most patients do not apply sunscreens appropriately. This study investigated the level of knowledge, attitudes, and behaviors regarding sun protection.

27194 Lifetime history of total body skin examinations in patients with disabilities: Examining for differences in skin cancer screening

Total body skin examinations (TBSE) are recommended in high-risk populations. People with disabilities are less likely to receive examinations/screenings. We examined whether individuals with disabilities, adjusting for skin cancer risk factors, differed from those without disabilities in ever receiving a physician-administered TBSE. Using the National Health Information Survey (2010 and 2015), our outcome of interest was lifetime history of physician-administered TBSE, defined as answering “yes” to “Have you ever had all of your skin from head-to-toe checked for cancer by a dermatologist/other doctor?” We examined the following disabilities: mobility, vision, hearing, cognition, communication, and self-care.

Results of a 10-year web-based health promotion campaign against skin cancer in Switzerland.

Skin cancer is the most common malignancy with rising incidence. Although early detection can be lifesaving, prevention programmes are under-utilized. In 2008, a group of board-certified dermatologists in Switzerland established a website aimed at educating about skin cancer risk factors and providing guidance on self-assessment. To present the data of this programme over the last 10 years with regards to representation of the targeted groups and sustained impact on primary skin cancer prevention. A comprehensive web-based health promotion campaign was established for education and guidance on self-assessment. Teledermatological evaluation was offered and participants were then interviewed. In total, 11,171 digital photos were evaluated during 2008-2018; 54.3% (n = 6,067) from females and 45.7% (n = 5,104) from males. In 26.7% (n = 2,983), clinical examination was recommended. Of the participants, 1,874 replied revealing 103 malignancies (9.2% of the lesions were presented to a physician): 34 melanomas in situ, six squamous cell carcinomas, 53 basal cell carcinomas and 10 malignant lesions (not further specified). Of the participants, 40.5% (n = 683) changed their attitude towards sun exposure, 48.7% (n = 820) used more sunscreen, and 57.5% (n = 966) improved sunscreen measures. Web-based educational programmes raise public awareness, enhance prevention, and support early diagnosis of skin cancer. Teledermatology might contribute to reducing skin cancer mortality rates.