Skin Checks Research Articles

Prevalence of skin examination behaviours among Australians over time

BackgroundWe aimed to examine the prevalence and correlates of opportunistic skin check behaviours among Australians and whether changes over time might explain increasing underlying rates of melanoma in situ. MethodsThe National Sun Protection Survey involved periodic telephone-based cross-sectional surveys during summer since 2003. Skin checks by a doctor in the past 12 months was asked in four summers over 2006–2017, and responses from 23,374 Australians aged 12–69 years were analysed. Prevalence estimates were weighted to be representative of the Australian population. Chi-square tests compared the prevalence over time and by characteristics. ResultsThe overall proportion reporting whole-body skin checks in the past 12 months was 20 % in 2006−07 and 2010−11, 21 % in 2013−14, and 22 % in 2016−17; but increased from 29 % in 2006−07 to 37 % in 2016−17 for those aged 45–69 years (p < 0.0001). In 2016−17, 5% reported a skin check of part-body and 9% for a specific mole or spot. The proportion reporting no skin checks increased from 61 % to 64 % over time (p < 0.0001). Whole-body skin checks were more common among older respondents, females, and also varied by residence location, skin sensitivity, skin colour, risk perception, and socio-economic index (all p < 0.001). ConclusionApproximately one third of Australians had their skin checked by a doctor within a 12-month period, but this varied across population sub-groups. Skin check behaviours were relatively stable over time, with modest increases in the prevalence of skin checks for those aged 45–69 years. These findings do not explain underlying large increases in rates of melanoma in situ.

Effects of Green Tea on Various Types of Indolent Low Grade B-Cell Lymphomas

Low grade B cell neoplasms, such as chronic lymphocytic leukemia (CLL), usually are asymptomatic when diagnosed and undergo close observation. Many patients with low grade B cell lymphomas and leukemias (LGBCL) appreciate reassurance that not treating at time of diagnosis is the appropriate management. Society has long focused on diet and lifestyle changes as an alternative to medication; however, there is limited data to which these changes can assist with hematologic disorders. Green tea (GT) has been studied in regard to its effects on longevity and health. A cohort study followed 52,000 adults over 13 years and found that the frequency of GT consumption was inversely associated with risk of total hematologic neoplasms (Takada M, et al., 2019). There are several other studies that report key oncologic pathways are disrupted by a compound found in GT called epigallocatechin-gallate (EGCG) (Farooqi A, et al., 2020). Following a case series publication by Dr. Shanafelt, the National Cancer Institute sponsored clinical trials through the Mayo Clinic, evaluating EGCG in 42 patients with asymptomatic CLL. Patients received 2000mg EGCG twice daily for 6 months. Results showed 69% of patients had a biological response with greater than 20% reduction in absolute leukocyte count (ALC) and/or greater than 30% in reduction in size of the lymph node area utilizing standard assessment criteria (Shanafelt T. et al. 2013). This data encouraged our practice to recommend to patients to drink two bags of GT in steamy hot water daily. We studied 11 patients with indolent CLL, follicular lymphoma (FL), Waldenstrom macroglobulinemia (WM), monoclonal gammopathy of undetermined significance (MGUS), and splenic Marginal zone lymphoma (MZL). No patient was symptomatic. Disease makers were recorded over time during their routine visits for observation. The markers used were ALC for CLL and MZL, standardized uptake value (SUV) on PET scan for lymph node detection for FL, immunoglobulin level as well as monoclonal protein (M-protein) measured by SPEP for MGUS, and IgM and M-protein for WM. One patient with extensive cutaneous plaque psoriasis had routine skin checks. The results were recorded in the electronic health record over varying time periods based on patient presentation and follow up. Six patients with CLL responded to GT, with reductions in ALC. In patient 1, ALC decreased by 37% over 48 months. Patient 2's ALC decreased by 68% over 102 months. Patient 3's ALC decreased by 74% in 96 months. Patient 4 had a drastic increase in ALC from 23,900 to 72,400 over three years before GT. Once starting GT, his ALC plateaued at 72,000 and has remained stable for 65 months. Patient 5 had decrease ALC of 66% over 99 months. Patient 6 with WM had a 79% decrease in IgM over 65 months drinking GT. M-protein decreased by 81%. Patient 7 had a decrease in IgM by 26% and a 24% decrease in M-protein over 36 months. Patient 8 with MGUS had a decrease in IgG by 25% over 77 months. Patient 9 had a decrease in IgG by 23% with M-protein reduction of 43%. Due to compliance issues, duration of therapy was unknown. Patient 10 with ZL had an ALC reduction of 73% over 95 months. Lastly, patient 11 with FL and psoriasis was treated with GT for 23 months. There was a reduction of external iliac and inguinal lymph node SUV by 38% and 83% over 23 months, respectively. It was also noted of a significant improvement of extensive plaque psoriasis during this time on GT (Table 1). The 11 patients highlighted in the practice had improvement in biomarkers and lymphadenopathy during the time they took daily GT. The EGCG study at Mayo Clinic, in which CLL patients took up to 4,000mg of EGCG per day, had significant responses as well as adverse effects including transaminitis. This compares to the population in our study, which includes various types of LGBCL and MGUS that were taking at most 200mg of EGCG per day and had significant responses with no adverse effects. The use of low dose EGCG for inducing clinical improvement of these types of LGBCL and MGUS may be used to delay the onset of starting therapy, thus forestalling immunosuppressive treatment and associated toxicities. Larger randomized control trials involving other forms of indolent LGBCL and MGUS would be significant for the potential of GT being a safe, non-toxic lifestyle change that could benefit patients who do not require aggressive medical therapy for their neoplastic processes. Disclosures No relevant conflicts of interest to declare.

Cancer information overload: Association between a brief version of the CIO scale and multiple cancer risk management behaviours

ObjectivesTo demonstrate the best psychometric properties of the revised 5-item Cancer Information Overload (CIO) scale over the 10- and 8-item versions, for both English and French native speakers, and to explore the relationships between CIO and several cancer risk management behaviours in a large sample of caregivers, cancer survivors and healthy subjects. Methods2809 participants (2568 from France, 241 from Australia) from two cancer survivor networks answered a self-administered questionnaire. After assessing the psychometric properties we studied the impact of CIO on health behaviours using multivariate logistic regression. ResultsInternal consistency assessment and Confirmatory Factor Analysis (CFA) showed satisfactory results (α = 0.87 and 0.83, ω = 0.87 and 0.83, RMSEA = 0.078 and 0.081 for the 8-item and 5-item versions respectively), as well as multi-group CFA where measurement invariance was partial for one item only in each version. CIO was independently associated with smoking, sunburns, and rare skin checks, but not with alcohol misuse. ConclusionThe 5-item version of the CIO scale showed adequate psychometric properties and discriminant association with multiple prevention behaviours. Practice implicationsThe 5-item CIO scale is valid and can help push research forward in the domain of disease prevention and message acceptance. Its role in clinical practice remains to be determined.

Cancer information overload and multiple prevention behaviors

Abstract Background Many people feel overwhelmed by the increasing amount of cancer-related material available in the information environment. Our aims was to evaluate the psychometric properties of the brief version of the cancer information overload (CIO) scale and to examine the association between CIO and multiple cancer prevention behaviors. Methods A large survey using a self-administered online questionnaire was proposed to all adult members of the Seintinelles, a French national non-profit organization. The psychometric properties of the CIO scale were evaluated. Measurement invariance across French and English languages was studied using an additional sample of 224 Australian cancer survivors from Register4. We also collected functional, communicative, and critical health literacy (FCCHL), deprivation (EPICES index), current smoking, alcohol misuse, frequent sunburns, and rare skin self-examination. Results Between June 16th and 30th 2016, 2 363 French participants answered the online questionnaire. The five-item CIO scale demonstrated the best balance between psychometric properties and number of items. It showed satisfactory internal consistency and adequate fit. No measurement invariance issue was found across age, gender, education level, and language groups. CIO was increased among people with higher deprivation, lower education and a cancer information avoidant profile. In multivariate analyses, CIO was associated with tobacco use (OR = 1.05, 95%CI [1.00-1.10]), rare skin checks (OR = 1.05 [1.01-1.08]) and frequent sunburns (OR = 1.04 [1.01-1.07]), but not with alcohol misuse. Conclusions The 5-item CIO scale is ready to be used in French and English-speaking countries. The links observed between CIO and multiple prevention behaviors encourage further research in order to better characterize the psycho-cognitive and environmental phenomena at play. Efforts are needed to communicate adequately and empower citizens to limit the growing burden of cancer. Key messages The 5-item CIO scale is ready to be used in French and English-speaking countries. Efforts are needed to communicate adequately and empower citizens to limit the growing burden of cancer.

Gamification improves melanoma visual identification among high school students: Results from a randomized study.

Identification of melanoma or worrisome moles is often taught as an important part of routine skin checks. We sought to evaluate the efficacy of gamified education vs. traditional ABCDEs education on melanoma identification and self-confidence in identifying worrisome moles. We report that in our cohort (n=271), participants randomized to the gamified intervention were more likely to correctly identify melanoma and non-melanoma skin lesions than those randomized to the ABCDE control cohort (74.2% vs 63.5% correct, P<.0001) and perceived confidence in self-identifying worrisome lesions was slightly higher in the gamified group than the traditional group, though the trend was not significant. These novel findings have significant implications on improved ways to educate young patients on the visual identification of melanoma and worrisome moles.

Machine Learning Algorithms based Skin Disease Detection

Skin disease recognition and observing is a major challenge looked by the medical industry. Because of expanding contamination and utilization of lousy nourishment, the tally of patients experiencing skin related issues is expanding at a quicker rate. Well-being isn’t the main concern, however unfortunate skin hurts our certainty. Customary and appropriate skin checking is a significant advance towards early discovery of any destructive or starting changes in skin that may bring about skin disease. Machine learning methods can add to the improvement of capable frameworks which can order various classes of skin illnesses. To identify skin maladies, first, it is required to separate the skin and non-skin. In this paper, five diverse machine learning algorithms have been chosen and executed on skin infection data set to anticipate the exact class of skin disease. Out of a few machine learning algorithms, we have worked on Random forest, naive bayes, logistic regression, kernel SVM and CNN. A similar examination dependent on confusion matrix parameters and training accuracy has been performed and delineated utilizing graphs. It is discovered that CNN is giving best training precision for the right expectation of skin diseases among all selected.

Frequency of 'regular' skin checks by dermatologists for melanoma survivors.

Frequency of 'regular' skin checks by dermatologists for melanoma survivors.

A precancerous skin lesion that is often misdiagnosed.

Disseminated superficial actinic porokeratosis (DSAP) is a precancerous skin condition often seen by dermatologists that is characterised bymultiple annular hyperkeratotic lesions on sun-exposed areas. In Australia, DSAP is not a rare condition, possibly owing to Australia's high levels of sun exposure, and patients with DSAP often initially present to general practitioners (GPs). Alack of awareness about DSAP may result in misdiagnosis and inappropriate management of the condition. The aim of this article is to provide an overview of DSAP relevant to GPs to better facilitate diagnosis, management and referral to a dermatologist. The underlying pathophysiological mechanism of DSAP is unknown. Although there is currently no effective standardised treatment, ongoing management is warranted, given the potential for malignant transformation. Suggested strategies include frequent full skin checks, patient education about sun protection and ablative treatment (such as cryotherapy) if indicated. Suspicious lesions require excision and histopathology.

Pressure ulcer knowledge, beliefs and practices in a group of South Africans with spinal cord injury.

A quantitative, descriptive study using a cross-sectional survey. To describe the pressure ulcer knowledge, beliefs and practices amongst persons with SCI, who received rehabilitation at a Cape Town rehabilitation centre. A rehabilitation centre for clients with physical disabilities in Cape Town, South Africa. A quantitative, descriptive study, that employed consecutive sampling, was done. Participants included inpatients (n = 30), outpatients (n = 33) and peer supporters (n = 8). Data were collected during April and March 2015 with a questionnaire developed through collating existing questionnaires and adapting it for the study context. This rendered a knowledge score and data on beliefs and practices. The Fisher's exact test was used for comparative analysis (p < 0.05). The mean combined knowledge score was 42.7%. The majority of participants (88.7%) believed pressure ulcers to be serious and 45% thought they were likely to develop a PU. They believed daily skin checks (80.3%), weight shifting (86%) and limiting sitting time (80.3%) could prevent PU development. Study participants indicated that they did not regularly follow guideline recommended practices like regular pressure relief (51%) (36 participants) or daily skin inspection (38%) (27 participants) and 37% (26 participants) reported being current smokers. Participants showed a lack of knowledge, which might have affected their pressure ulcer prevention practices negatively. The study findings can be used to assist with the development of a contextually relevant training programme on pressure care.

Atopic dermatitis shows significant cutaneous comorbidity: results from large-scale investigations in the working population.

Atopic dermatitis (AD) is one of the most common chronic inflammatory diseases of the skin. Rare large-scale data have been published on the prevalence of concomitant dermatoses. To analyse the prevalence and cutaneous comorbidity of AD in Germany. A cross-sectional study on voluntary whole-body skin checks by trained dermatologists in over 400 companies throughout Germany reflecting the adult working population was conducted. Prevalence ratios (PR) were calculated to compare dermatological comorbidity in employees with and without current AD. A logistic regression analysis controlling for age, sex and skin type revealed odds ratios (OR) of the occurrence of skin diseases in AD. A total of N=118939 people were examined between 2006 and 2017 (43.2% female, mean age 43.2±10.7years, min. age 16years, max. age 70years). AD (point prevalence) was identified in 1.45% (men: 1.50%, women 1.39%) and decreased significantly with age. Self-reported lifetime prevalence of AD was 4.95% (men: 3.72%, women: 6.55%). The following skin diseases were significantly more frequent in people with current AD: Contact dermatitis (PR: 3.38), hand eczema (PR: 4.62), exsiccation dermatosis (PR: 2.19), folliculitis (PR: 1.95) and port-wine stains (PR: 1.49). Among those, folliculitis was the most frequent (prevalence in AD 16.42%). Controlled for age, sex and skin type, AD was significantly associated with - among others - hand eczema (OR: 3.96; 95% CI: 2.95-5.32), contact dermatitis (OR: 2.97; 95% CI: 1.50-5.88) and exsiccation dermatosis (OR: 1.78; 95% CI: 1.30-2.44). Psoriasis was significantly less frequent in people with AD (OR: 0.61; 95% CI: 0.39-0.94). In summary, cutaneous comorbidity is frequent and of great importance in people with AD, suggesting the need for comprehensive, dermatologically guided diagnostics in AD.

Skin checks in primary care

The incidence of skin cancers in Australia continues to rise. Early detection and timely management arerequired. This article presents a framework for skin examinations in primary care and outlines the various measures available to facilitate early skin cancer detection. Common characteristics of malignant cancers are also discussed. Skin cancer awareness campaigns encourage patients to see their general practitioners (GPs) for complete skin examination. GPs are expected to correctly identify benign and malignant skin lesions and understand their high risk patients. A systematic approach to the skin examination combined with knowledge and awareness of diagnostic tools can aid in the early detection of skin malignancies, and prompt escalation as necessary.

General practice registrars' use of dermoscopy: Prevalence, associations and influence on diagnosis and confidence.

Dermoscopy increases accuracy for melanoma diagnosis by trained primary care physicians. We aimed to establish prevalence of dermatoscope use by general practice registrars, and identify factors associated with dermatoscope use and the implications of dermatoscope use for diagnosis and confidence in diagnosis. This was a cross-sectional study nested within the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing multi-site cohort study of general practice registrars' consultations. The study was conducted during two six-monthly rounds of ReCEnT data collection in four regional training providers in2014. Forty-nine per cent of registrars reported having dermoscopy training. Dermoscopy was used in 61% of consultations involving skin or pigmented lesion checks. Dermatoscope use changed provisional diagnosis in 22% of instances and increased diagnostic confidence in 55%. Dermoscopy is performed by general practice registrars in a modest proportion of skin and pigmented lesion checks. Its use influences registrars' diagnoses and increases their confidence in their diagnoses.

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population-based study in 161 269 employees.

Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. In total, 161269 participants were included (men 55·5%, mean age 43·2±10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

Total body skin examination increases squamous cell carcinoma detection: a retrospective cohort study.

Squamous cell carcinomas (SCCs) have the potential for local tissue destruction and metastasis. The risk of complications increases if the lesion is not diagnosed and excised in a timely manner. Total body skin examination (TBSE) has been reported to increase melanoma detection; the objective of this study was to determine if it also increases SCC detection. Analysis of 469 SCCs diagnosed at a UK tertiary centre showed that 6.8% of these were detected incidentally and not from the index lesion that prompted referral. These incidentally detected SCCs tended to represent early disease, and therefore carried lower risk of complications. Our findings suggest that full skin checks may increase the number of SCCs detected, and at an earlier stage of disease. Therefore, we encourage the use of TBSE in all dermatology outpatient appointments, and make suggestions as to how to incorporate it into the limited time available in dermatology clinics.

Occupational exposure: rural Australian farmers’ sun-protective behaviours

Australia has one of the highest rates of melanoma in the world. Farmers are a high-risk population due to mainly outdoor work and subsequent overexposure to ultraviolet radiation (UVR). The aim of this study was to evaluate farmers’ and farm workers’ personal sun-protection behaviours and their perception of the importance of sun protection. Farmers and farm workers (n = 243) were surveyed at rural and regional shows and agricultural events in New South Wales between November 2017 and August 2018. The sun-protective behaviours most frequently reported as always practised were wearing a shirt with a collar (44.8%), wearing a wide-brimmed hat (33.9%), and wearing a long-sleeved shirt (29.6%). Although less than half always practised these behaviours, the majority of farmers ranked these behaviours as very or extremely important: wearing a wide-brimmed hat (89.6%), wearing a shirt with a collar (89.5%), and wearing a long-sleeved shirt (82.3%). Sex (female) and higher level of education was associated with greater sun-protective behaviour. Higher income and health insurance were associated with more positive perceptions of the importance of sun-protective behaviour. Potential skin cancers were detected on 30% of participants who underwent a partial skin check. These results indicate a need for appropriate and targeted primary prevention health education messages to encourage farmers to improve their sun-protection practices and undertake annual skin checks to enable early detection of skin cancers.

Management of invasive melanoma.

Maximising survival for patients with invasive melanoma hinges on early diagnosis of primary melanoma and appropriate management. Despite well-documented guidelines, many patients with melanoma have not been managed ideally. The aim of this paper is to identify suboptimal aspects of melanoma management. Delayed or erroneous diagnosis is more likely to occur when a shave or punch biopsy is used to obtain histopathology. Wherever feasible, local excision with a narrow margin is the preferred biopsy choice for a suspected melanoma. The Breslow thickness of the primary melanoma remains the greatest predictor of outcome. Ulceration is associated with a poorer prognosis. Most invasive melanomas are managed with a margin of ≥10 mm of normal tissue. Patients who have developed one primary melanoma are at high risk of a second tumour. Ongoing management includes regular lifelong skin checks. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet radiation are useful. Imaging is largely used when metastases are suspected on the basis of clinical symptoms or signs.

Human Facial Disease Diagnosis System Using Dempster Shafer Method

Skin is a very important and sensitive part of the human body. It is directly related to the outside world. In everyday life, the skin plays an important role. One of its functions is to remove waste substances. The lack of knowledge and limited sources of information causes low public awareness of skin health as well as not seeing a doctor. Regular skin checks can overcome the beginning of skin diseases that might trigger other more dangerous diseases. The system in this study is designed to detect and to know the symptoms of facial skin diseases that are felt. This knowledge-based system design was developed to diagnose human facial skin disease using the dempster shafer method. The results can help detecting earlier facial skin diseases and overcoming them.&#x0D; Key words : diagnosis system, facial skin disease, dempster-shafer

222 Decreasing Hospital Acquired Pressure Injuries (HAPI) with the Implementation of a Two Registered Nurse (RN) Skin Check during Hydrotherapy

222 Decreasing Hospital Acquired Pressure Injuries (HAPI) with the Implementation of a Two Registered Nurse (RN) Skin Check during Hydrotherapy

Comparing artificial intelligence algorithms to 157 German dermatologists: the melanoma classification benchmark

BackgroundSeveral recent publications have demonstrated the use of convolutional neural networks to classify images of melanoma at par with board-certified dermatologists. However, the non-availability of a public human benchmark restricts the comparability of the performance of these algorithms and thereby the technical progress in this field. MethodsAn electronic questionnaire was sent to dermatologists at 12 German university hospitals. Each questionnaire comprised 100 dermoscopic and 100 clinical images (80 nevi images and 20 biopsy-verified melanoma images, each), all open-source. The questionnaire recorded factors such as the years of experience in dermatology, performed skin checks, age, sex and the rank within the university hospital or the status as resident physician. For each image, the dermatologists were asked to provide a management decision (treat/biopsy lesion or reassure the patient). Main outcome measures were sensitivity, specificity and the receiver operating characteristics (ROC). ResultsTotal 157 dermatologists assessed all 100 dermoscopic images with an overall sensitivity of 74.1%, specificity of 60.0% and an ROC of 0.67 (range = 0.538–0.769); 145 dermatologists assessed all 100 clinical images with an overall sensitivity of 89.4%, specificity of 64.4% and an ROC of 0.769 (range = 0.613–0.9). Results between test-sets were significantly different (P < 0.05) confirming the need for a standardised benchmark. ConclusionsWe present the first public melanoma classification benchmark for both non-dermoscopic and dermoscopic images for comparing artificial intelligence algorithms with diagnostic performance of 145 or 157 dermatologists. Melanoma Classification Benchmark should be considered as a reference standard for white-skinned Western populations in the field of binary algorithmic melanoma classification.

New Approaches to Skin Cancer Prevention: Can Encouraging Skin Checking Increase Engagement in Sun Protection Behaviours?

Background: Skin cancer is one of the most common types of cancer in the world and incidence rates are increasing globally. Efforts to encourage individuals to engage in sun protection behaviors that minimize their risk of skin cancer are therefore urgently needed. In Australia, the context of the current study, UV radiation levels are particularly intense and public health campaigns have been successful in encouraging behaviors such as using sunscreen and wearing a hat. However, recent years have seen a plateau in engagement in such behaviors and new approaches are required to facilitate further gains. Encouraging people to check their skin for signs of skin cancer may be one such approach as it has the potential to increase the salience of skin cancer and the need to protect oneself from UV radiation. Aim: To assess the relationship between skin checking and sun protection behaviors to inform skin cancer prevention campaigns. Methods: Computer-assisted telephone interviewing was used to survey nearly 700 adults. Frequency of engagement in various sun protection behaviors (wearing a hat, wearing protective clothing, using sunscreen) was assessed. Respondents were also asked whether they had checked their skin for skin cancer and how confident they were in their ability to spot the signs of skin cancer. Results: Path analysis revealed greater confidence in one's ability to detect the signs of skin cancer to be associated with skin checking. In turn, skin checking was found to be associated with more frequent engagement in all of the assessed sun protection behaviors. Conclusions: Public health campaigns that increase people's confidence in their ability to detect the signs of skin cancer have the potential to encourage skin cancer reduction behaviors in the form of both skin checking and sun protection and perhaps shift the plateau in engagement of sun protection behaviors observed in recent years.