Skin Cancer Prevention Programs Research Articles

Challenges and lessons learned in recruiting participants for school-based disease prevention programs during COVID-19

Schools provide an ideal setting for delivery of disease prevention programs due to the ability to deliver health education and counseling, including health behavior interventions, to large numbers of students. However, the remote and hybrid learning models that arose during the coronavirus (COVID-19) pandemic created obstacles to these efforts. In this article, we provide insights on collaborating with schools to deliver disease prevention programming during the height of the COVID-19 pandemic, and in subsequent years. We illustrate these strategies by drawing upon our firsthand research experiences engaging high schools in a school-based cancer prevention trial focused on sun safety. Delivery of a cluster-randomized trial of a school-based skin cancer prevention program was initiated in the spring of 2020 at the onset of the COVID-19 pandemic in the U.S. We present multilevel evaluation data on strategies used to reach schools remotely and share lessons learned that may inform similar approaches moving forward during times of crises. Although the COVID-19 pandemic interrupted school-based recruitment for this trial, enrollment improved one year later and did not appear to differ between rural and urban schools. Recruitment strategies and trial-related procedures were modified to address new challenges brought about by the pandemic. Despite the COVID-19 crisis altering US classrooms, disease prevention programming can continue to be offered within schools, given close community partnerships and new adaptations to the ways in which such programming and research are conducted.

52281 Stopping Skin Cancer: Evaluating the effectiveness of a school-based skin cancer prevention program in changing adolescents’ behaviors

52281 Stopping Skin Cancer: Evaluating the effectiveness of a school-based skin cancer prevention program in changing adolescents’ behaviors

Skin cancer risk behaviors in sexual minority men: A mixed methods approach.

Sexual minority men experience disproportionately elevated rates of skin cancers, likely driven by excess ultraviolet radiation exposure-namely through tanning behaviors. However, limited integrated theoretical models exist to explain sexual minority men's elevated skin cancer risk. The aim of the current study is to further test and refine an integrated theory of skin cancer risk behaviors among sexual minority men by incorporating minority stress into the integrated health behavior model of tanning. The study employed a parallel mixed methods design, with a Phase 1 qualitative stage (N = 30) and a Phase 2 quantitative stage (Model 1: N = 320; Model 2: N = 319). In both phases, participants were sexual minority men, equally stratified as those with versus without recent tanning exposure and were recruited from across the United States. Qualitative and quantitative data supported the overall integrated model, with some quantitative paths varying depending on the tanning behavior outcome. Overall, appearance-related motives to tan and beliefs that tanning regulates affect emerged as the most consistent proximal predictors. Minority stress significantly predicted holding more positive attitudes toward tanning as an effective affect regulation strategy. The results from this mixed methods study support the inclusion of minority stressors into the adapted integrative health behavior model of tanning. Replication within prospective designs would strengthen the evidence for this model, which may be helpful in guiding future skin cancer prevention programs tailored to sexual minority men. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality.

whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear. in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989-1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison. in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49-3.41, and IRR 4.13, 95%-CI 3.53-4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59-3.52, and HR 3.90, 95%-CI 3.30-4.61, respectively). Breslow thickness and Clark's level at time of invasive diagnosis were significantly lower in 1989-2019, but the tumor characteristics of the melanomas diagnosed during 1989-1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00-2.75 vs. the general population, HR 2.12, 95%-CI 1.25-3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly. given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives.

Redefine photoprotection: Sun protection beyond sunburn.

Excessive exposure to ultraviolet (UV) light leads to acute and chronic UV damage and is the main risk factor for the development of skin cancer. In most countries with western lifestyle, the topical application of sunscreens on UV-exposed skin areas is by far the most frequently used preventive measure against sunburn. Further than preventing sunburns, increasing numbers of consumers are appreciating sunscreens with a medium- to high-level sun protective factor (SPF) as basis for sustainable-skin ageing or skin cancer prevention programs. However, recent investigations indicate that clinically significant DNA damages as well as a lasting impairment of cutaneous immunosurveillance already occur far below the standard of one minimal erythema dose (MED) sunburn level, which contributes to the current discussion of the clinical value of high-protective SPF values. Exvivo investigations on human skin showed that the application of SPF30 reduces DNA damage for a day long sun exposure (24 MED) drastically by about 53% but is significantly surpassed by SPF100 reducing DNA damage by approx. 73%. Further analysis on different SPF protection levels in UV-exposed cell culture assays focusing on IL-18, cell vitality and cis/trans-urocanic acid support these findings. Whereas SPF30 and SPF50+ sunscreens already offer a solid UVB cover for most indications, our results indicate that SPF100 provides significant additional protection against mutagenic (non-apoptotic-) DNA damage and functional impairment of the cutaneous immunosurveillance and therefore qualifies as an optimized sunscreen for specifically vulnerable patient groups such as immunosuppressed patients, or skin cancer patients.

Evaluating How a School-Based Skin Cancer Prevention Program Can Change Behavior Among North Carolina Highschoolers.

The incidence of skin cancer has risen steadily over recent decades. Childhood and adolescent sun exposure remains a critical risk factor in skin cancer development, making education of high schoolers imperative for promoting sun-safe behaviors. Medical students in North Carolina recognized this need and designed a skin cancer education program focused on portraying skin cancer in individuals with all Fitzpatrick skin phototypes. Eighty-seven students completed the pre-survey, and 84 completed the post-session survey. In the post-survey, 88% of students listed actionable behavioral changes they plan to make following the presentation. Following an educational session, students were able to demonstrate their new knowledge and provide meaningful behavioral changes. This program navigated challenges posed by COVID-19 and addressed the need for more inclusive skin cancer educational material.

BI10 ‘I never thought it would happen to me’. Photoprotection and skin cancer education: a qualitative study of the experiences of Irish postrenal transplant patients. Why the ‘personal touch’ is so important

Abstract Renal transplant recipients (RTRs) are at an increased risk of skin cancer (SC), especially squamous cell carcinoma (SCC). As the number of successful transplant recipients increases, pressure on dermatology services increases. The focus has shifted from simply screening RTRs for SC to implementing preventive measures, including SP education programmes. Sun exposure is a modifiable risk, yet RTRs are known to adopt sun-protective (SP) behaviour only partially. There is a dearth of research on why this is. We performed an in-depth qualitative study using inductive thematic analysis of 14 semistructured interviews of seven male RTRs to assess the impact of the current SP education and explore their current SP behaviour. Participants included those with SC, premalignant skin disease and no SC. Two themes were constructed. Each theme had two subthemes. The first theme was ‘Timing it Right—Skin cancer information’, with the subthemes of ‘A time of great emotion’ and ‘Providing knowledge—learning needs differ’. Choosing a suitable time to impart information on SC is important. Immediately prior to and on receiving a kidney transplant was not felt by patients to be the most appropriate time. Most felt unable to consider perceived future risks to their health during this critical period. When delivered, recipients expressed preference for an ‘in-person’ approach with supplementary information available (online and written). The second theme was ‘The person within the patient’, with the subthemes of ‘What matters to the patient’ and ‘Authentic engagement’. It is important to see the person within the patient. Each brought with them different worries and requirements, sometimes feeling guilty when expressing them as they had received a new ‘gift of life’. Participants knew what constituted a good health education experience for them. The healthcare professional who was compassionate and listened was valued and more likely to influence behaviour. Interviewees spoke about the strong bond they form with their renal teams and how they trust them. Misconceptions were also uncovered such as the belief that the Irish sun differed from that experienced abroad and that SP was just for ‘sunny days’. An overriding concern for developing melanoma rather than cutaneous SCC was evident, as was the lack of confidence in ability to self-monitor skin. SC prevention programmes are becoming increasingly well established; our study identified gaps in the knowledge of RTRs and highlighted some key areas and approaches to improve the impact of educational interventions. To maximize the impact, it is important to consider patient perspectives, cultural context and the key role our renal colleagues play in patients’ lives. Funding: support was received from The City of Dublin Skin and Cancer Hospital Charity (registered Charity Number: 20004620).

The economics of skin cancer prevention with implications for Australia and New Zealand: where are we now?

The incidence of skin cancer, including melanoma, continues to climb in white populations around the world, imposing a large and growing burden on health systems and individuals. Harmful exposure to ultraviolet (UV) radiation, mostly solar UV, is the most avoidable cause of skin cancer risk and mortality. Many economic evaluations attest to the favourable benefits for governments and citizens from skin cancer prevention programs. This overview presents the current 'state of play' of the economics of skin cancer prevention. More research is required to document contemporary costs of managing skin cancer in Australia and New Zealand to accurately assess the true savings from primary prevention. New directions are proposed for ways that economics could contribute to the investment case for prevention. The majority of skin cancers are avoidable and curable, yet cost the Australian health economy A$1.7 billion each year. Therefore primary prevention of skin cancers must remain high on the public health agenda.

High regional mortality due to malignant melanoma in Eastern Finland may be explained by the increase in aggressive melanoma types

BackgroundA regional skin cancer prevention program in Eastern Finland revealed a relatively high age-standardized mortality due to malignant melanoma during 2013–2017. An explanation for this is needed.PurposeTo analyse the 543 melanoma samples in 524 subjects collected during 2000–2013 at Kuopio University Hospital and reposited in the Biobank of Eastern Finland. A focus was directed to factors related to metastasis.MethodsThe samples were analysed anonymously by examining the histopathological report, referral text and the list of diagnoses. A possible state of immunosuppression was evaluated.ResultsThe mean age at the diagnosis of malignant melanoma (MM), lentigo maligna (LM) and melanoma in situ was relatively high, i.e., 66.2, 72.1 and 63.3, respectively. Especially the MM type increased markedly during 2000–2013. In further analyses of a representative cohort of 337 samples, the proportion of nodular melanoma and LM/LMM melanoma was relatively high, 35.6 and 22.0%, respectively, but that from superficial spreading melanoma relatively low (33.8%). Metastasis correlated with immunosuppression, male gender, Clark level, Breslow thickness, ulceration, mitosis count, invasion into vessels and/or perineural area, microsatellites, melanoma subtype, body site, recidivism, and the absence of dysplastic nevus cells.ConclusionThe marked increase in aggressive melanomas with associated metastasis, and the relatively high age at diagnosis, can partially explain the mortality.

Use of Electronic UV Dosimeters in Measuring Personal UV Exposures and Public Health Education

The performance limits of electronic ultraviolet (EUV) dosimeters, which use AlGaN Schottky photodiodes as the ultraviolet radiation (UVR) sensing element to measure personal erythemally weighted UVR exposures, were investigated via a direct comparison with meteorological-grade reference instruments. EUV dosimeters with two types of AlGaN Schottky photodiode were compared to second-generation ‘Robertson–Berger type’ broadband erythemal radiometers. This comparison was done by calculating correction factors for the deviations of the spectral responsivity of each instrument from the CIE erythemal action spectrum and for deviations in their angular response from the ideal cosine response of flat surfaces and human skin. Correction factors were also calculated to convert the output of these instruments to vitamin D-weighted UV irradiances. These comparisons showed that EUV dosimeters can be engineered with spectral responsivities and cosine response errors approaching those of Robertson–Berger type radiometers, making them very acceptable for use in human UVR exposure and sun safety behaviour studies, provided appropriate side-by-side calibrations are performed. Examples of these calibrations and the effect of EUV dosimeter sampling rates on the calculation of received erythemal UVR doses and erythemal UVR dose rates are provided, as well as brief descriptions of their use in primary skin cancer prevention programmes, handheld meters, and public health displays.

Declining incidence of keratinocyte carcinoma in organ transplant recipients.

All organ transplant populations are predisposed to increased rates of keratinocyte carcinoma (KC). Since this increased risk was first appreciated, immunosuppressive regimens have changed and organ transplant recipients (OTRs) have been aggressively screened for KC. There is a perception that these measures have impacted on KC incidence but there is a paucity of population-based studies on post-transplant rates of basal cell carcinoma (BCC). To identify trends in incidence rates for KC following solid organ transplantation over the past two decades. This nationwide, population-based study included all solid OTRs transplanted between 1994 and 2014. Patient data were matched to national cancer registry data to determine the standardized incidence ratio (SIR) of KC in solid OTRs compared with the general population. In total 3580 solid OTRs were included. The total follow-up time was 28407 person-years (median follow-up 7·11 years). The overall SIRs for squamous cell carcinoma (SCC) and BCC were 19·7 and 7·0, respectively. Our study documents a progressive fall in the SIRs for SCC and BCC from peak SIRs (95% confidence intervals) in 1994-1996 of 26·4 (21·5-32·4) and 9·1 (7·4-11·3) to 6·3 (2·3-16·7) and 3·2 (1·4-7·1) in 2012-2014, respectively. The ratio of SCC to BCC has remained at 3 to 1 over the last two decades. Our study is the first to demonstrate a significant reduction over the past two decades in the incidences of both SCC and BCC following solid organ transplantation. The SCC-to-BCC ratio was maintained, demonstrating that both are reducing equally. This trend coincided with temporal changes in immunosuppressive protocols and the introduction of skin cancer prevention programmes. What's already known about this topic? Prior studies have shown that the risk of cutaneous squamous cell carcinoma (SCC) has declined over recent decades following solid organ transplantation. It is not known whether the risk of basal cell carcinoma (BCC) has reduced in line with this. What does this study add? Our study documents a progressive fall in the risk of SCC and BCC following solid organ transplantation over the last two decades. The SCC-to-BCC ratio was maintained, demonstrating that both are reducing equally. The trends observed in our study coincided with temporal changes in immunosuppressive protocols and the introduction of cancer prevention programmes, suggesting that these factors have positively impacted on the risk of keratinocyte carcinoma in this cohort.

Implementation of the SunSmart program and population sun protection behaviour in Melbourne, Australia: Results from cross-sectional summer surveys from 1987 to 2017.

BackgroundAustralia has one of the highest skin cancer rates in the world. ‘SunSmart’ is a multi-component, internationally recognised community-wide skin cancer prevention program implemented in Melbourne, Australia, since summer 1988–1989. Following recent reductions in melanoma rates among younger Australian cohorts, the extent of behaviour change and the potential contribution of prevention programs to this decline in melanoma rates are of interest. Sun protection is a multifaceted behaviour. Measures previously applied to monitor change over time in preventive behaviour for this population focused on individual behaviours. The omission of multiple behaviours that reduce exposure to ultraviolet radiation (UV) may have led to underestimates of behaviour change, meriting further analysis of long-term trends to contribute to this debate.Methods and findingsA population-based survey was conducted in Melbourne in the summer before SunSmart commenced (1987–1988) and across summers in 3 subsequent decades (1988–2017). During summer months, residents (14–69 years) were recruited to cross-sectional weekly telephone interviews assessing their tanning attitudes, sun protection behaviour, and sunburn incidence on the weekend prior to interview. Quotas were used to ensure the sample was proportional to the population by age and sex, while younger respondents were oversampled in some years. The majority of the respondents reported their skin was susceptible to sunburn. Changes in sun protection behaviour were analysed for N = 13,285 respondents in multivariable models, cumulating surveys within decades (1987–1988: N = 1,655; 1990s: N = 5,258; 2000s: N = 3,385; 2010s: N = 2,987) and adjusting for relevant ambient weather conditions and UV levels on weekend dates. We analysed specific and composite behaviours including a novel analysis of the use of maximal sun protection, which considered those people who stayed indoors during peak UV hours together with those people well-protected when outdoors. From a low base, use of sun protection increased rapidly in the decade after SunSmart commenced. The odds of use of at least 1 sun protection behaviours on summer weekends was 3 times higher in the 1990s than pre-SunSmart (adjusted odds ratio [AOR] 3.04, 95% CI 2.52–3.68, p < 0.001). There was a smaller increase in use of maximal sun protection including shade (AOR = 1.68, 95% CI 1.44–1.97, p < 0.001). These improvements were sustained into the 2000s and continued to increase in the 2010s. Inferences about program effects are limited by the self-reported data, the absence of a control population, the cross-sectional study design, and the fact that the survey was not conducted in all years. Other potential confounders may include increasing educational attainment among respondents over time and exposure to other campaigns such as tobacco and obesity prevention.ConclusionsWith an estimated 20-year lag between sun exposure and melanoma incidence, our findings are consistent with SunSmart having contributed to the reduction in melanoma among younger cohorts.

Analysis of a decade of skin cancer prevention using a mobile unit in Brazil.

For the past 10 years, skin cancer has been the most frequent malignant neoplasm in Brazil and worldwide. Each year, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. There were an estimated 188 000 new cases of skin cancer in Brazil in 2016. The prevention department of Barretos Cancer Hospital (BCH) runs some prevention programs for cancer such as breast, prostate, cervical, oral, colon and skin cancers. The skin cancer prevention program comprises educational activities and medical assistance conducted at the hospital and at a mobile unit (MU). The objective of this study is to evaluate the use of the MU as part of a skin cancer prevention program, 10 years after the implementation of this prevention program, using an MU in remote areas of Brazil. The database of the BCH was used. These data refer to data collected by the BCH Prevention MU. A total of 45 872 patients with suspected skin cancer were evaluated at the MU from 2004 to 2013. Of these, 8954 surgical procedures (excisions and/or biopsy) were performed. This study demonstrated a significant number of skin cancer cases diagnosed and treated by the MU. This study showed that the MU positively contributes to the early diagnosis and treatment of skin cancer among populations residing in remote areas of Brazil.

Trends in Melanoma Incidence Rates in Eight Susceptible Populations through 2015

Trends in Melanoma Incidence Rates in Eight Susceptible Populations through 2015

Capturing Ultraviolet Radiation Exposure and Physical Activity: Feasibility Study and Comparison Between Self-Reports, Mobile Apps, Dosimeters, and Accelerometers.

BackgroundSkin cancer is the most prevalent cancer in Australia. Skin cancer prevention programs aim to reduce sun exposure and increase sun protection behaviors. Effectiveness is usually assessed through self-report.ObjectiveIt was the aim of this study to test the acceptance and validity of a newly developed ultraviolet radiation (UVR) exposure app, designed to reduce the data collection burden to research participants. Physical activity data was collected because a strong focus on sun avoidance may result in unhealthy reductions in physical activity. This paper provides lessons learned from collecting data from participants using paper diaries, a mobile app, dosimeters, and accelerometers for measuring end-points of UVR exposure and physical activity.MethodsTwo participant groups were recruited through social and traditional media campaigns 1) Group A—UVR Diaries and 2) Group B—Physical Activity. In Group A, nineteen participants wore an UVR dosimeter wristwatch (University of Canterbury, New Zealand) when outside for 7 days. They also recorded their sun exposure and physical activity levels using both 1) the UVR diary app and 2) a paper UVR diary. In Group B, 55 participants wore an accelerometer (Actigraph, Pensacola, FL, USA) for 14 days and completed the UVR diary app. Data from the UVR diary app were compared with UVR dosimeter wristwatch, accelerometer, and paper UVR diary data. Cohen kappa coefficient score was used to determine if there was agreement between categorical variables for different UVR data collection methods and Spearman rank correlation coefficient was used to determine agreement between continuous accelerometer data and app-collected self-report physical activity.ResultsThe mean age of participants in Groups A (n=19) and B (n=55) was 29.3 and 25.4 years, and 63% (12/19) and 75% (41/55) were females, respectively. Self-reported sun exposure data in the UVR app correlated highly with UVR dosimetry (κ=0.83, 95% CI 0.64-1.00, P<.001). Correlation between self-reported UVR app and accelerometer-collected moderate to vigorous physical activity data was low (ρ=0.23, P=.10), while agreement for low-intensity physical activity was significantly different (ρ=-0.49, P<.001). Seventy-nine percent of participants preferred the app over the paper diary for daily self-report of UVR exposure and physical activity.ConclusionsThis feasibility study highlights self-report using an UVR app can reliably collect personal UVR exposure, but further improvements are required before the app can also be used to collect physical activity data.

Current and ideal skin tone: Associations with tanning behavior among sexual minority men

Sexual minority men have high rates of skin cancer, yet little is known about skin cancer risk behaviors in this population. It was hypothesized that current skin tone would moderate the association between darker ideals and tanning behaviors. Data were collected online from 231 sexual minority men in San Diego, United States of America, with a mean age of 24.66 (SD = 5.44). Ideal and current skin tone ratings and indoor and outdoor tanning behaviors were assessed. Darker ideals were significantly associated with increased indoor and outdoor tanning. The effect of darker ideals on tanning was strongest among individuals with lighter current skin tone, indicating a significant interaction. Sexual minority men whose perceived skin tone did not match their ideal were more likely to engage in skin cancer risk behaviors. Future skin cancer prevention programs aimed at sexual minority men may consider techniques that modify ideal skin tone internalization.

Depressive symptoms and indoor tanning among U.S. Hispanic adolescents: Results from a nationally representative sample.

To examine the association between depressive symptoms and indoor tanning among U.S. Hispanic adolescents. Data were collected from the 2015 Youth Risk Behavior Survey (YRBS). In the current study, only Hispanic adolescents were included, which yielded a total weighted sample of 2,667 (men: N = 1,368; women: N = 1,299). Gender was also explored as a moderator in the association between depressive symptoms (sadness or hopelessness and suicidality) and indoor tanning. Logistic regressions were used, with past 12 month indoor tanning behavior (0 vs. 1 or more sessions) entered as the dependent variable. Across gender, sadness or hopelessness was associated with increased odds of indoor tanning (OR = 1.8, 95% CI [1.2, 3.0], p = .01); however, gender significantly moderated the association between suicidality and indoor tanning. Simple slope analyses revealed that suicidality was significantly associated with increased odds of indoor tanning only among boys (OR = 4.0, 95% CI [2.1, 7.5], p = .001) whereas a nonsignificant association was found among girls (OR = 0.8, 95% CI [0.4, 1.8], p = .65). Results suggest there is a differential relationship between suicidality and indoor tanning as function of gender among U.S. Hispanic adolescents. Skin cancer prevention programs for Hispanic youth may wish to consider the role of gender and negative affect in targeted campaigns. (PsycINFO Database Record

Evaluation of the National Swiss Skin Cancer Screening Campaign 2013: Do We Do the Right Thing

Background: Skin cancer prevention and screening programs are performed in many countries. Their benefit is discussed controversially. Objective: Our aim is to evaluate the Skin Cancer Screening Program 2013 in Switzerland by following up screenees upon interventions. Methods: Quality was assessed by personal follow-up via phone/e-mail of every patient that had been screened during this campaign and histological follow-up of all participants with suspicious skin lesions. Results: Of the 1,087 screenees requiring interventions, 263 agreed to participate in the follow-up. We were able to obtain 66 histology reports. During this campaign 33 malignant lesions (8 melanomas) were removed. Conclusion: The overall melanoma detection rate in our free Skin Cancer Screening Program is comparable to those in European public activities. The costs of free screening programs compare favorably with the prevented potential therapeutic costs of late-stage melanoma. The low response rate of screenees agreeing to be followed up limits conclusions of this study.

Implementation of Project Students Are Sun Safe (SASS) in Rural High Schools Along the Arizona-Mexico Border.

The incidence of skin cancer is raising in Hispanics/Latinos, which is a concern for Hispanics/Latinos living in Arizona, a state with a high amount of ultraviolet radiation exposure. There is a dearth of research on skin cancer prevention education for Hispanic/Latino adolescents in high school. Using a community-based participatory research (CBPR) framework, academic and community partners conducted a project to adapt an existing efficacious skin cancer prevention program, Project Students are Sun Safe (SASS) and the current SASS online training model, for dissemination to predominantly Hispanic/Latino students attending high schools in rural southeastern Arizona, located along the Arizona-Mexico border. We assessed the feasibility of training some of these students as peer educators (n = 16) to implement the "Border SASS" lesson to their peers in high school classrooms (n = 198). Border SASS training and the classroom lesson were feasible for, and highly acceptable to, peer educators and classroom students. These students significantly improved skin cancer prevention knowledge scores and self-reported skin cancer prevention behaviors over a 3- to 4-month period post training and the intervention implementation. Here we report on the following: (1) academic-community partnership and adaptation of the SASS training model for rural Hispanic high school students, (2) training of the high school peer educators, (3) administration of the SASS lesson by the trained peer educators to high school students, and (4) further evaluation of peer educator training and classroom student outcomes.

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

Non-melanoma skin cancers (NMSCs) are the most common malignancy worldwide, of which 99% are basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) of skin. NMSCs are generally considered a curable diseases, yet they currently pose an increasing global healthcare problem due to rising incidence. This has led to a shift in emphasis on prevention of NMSCs with development of various skin cancer prevention programs worldwide. This article aims to summarize the most recent changes and advances made in NMSC management with a focus on prevention, screening, diagnosis, and staging.