Skin Self-examination Behaviors Research Articles

MySmartCheck, a Digital Intervention to Promote Skin Self-examination Among Individuals Diagnosed With or at Risk for Melanoma: A Randomized Clinical Trial

Regular skin self-examination (SSE) reduces melanoma mortality but is not often conducted. To promote SSE performance in individuals at increased risk for melanoma. One hundred sixteen individuals at heightened risk for development of melanoma (i.e., personal/family history of melanoma, high-risk mole phenotype) who did not conduct a thorough SSE during in the prior 3 months were randomly assigned to receive either an automated internet-based intervention (mySmartCheck) or usual care (UC). One hundred sixteen participants completed surveys before random assignment and 99 completed the follow-up survey 13-weeks afterward. The primary outcome was participant self-reported examination (SSE) of all 15 parts of the body in the last 3 months. Secondary outcomes were SSE of any part of the body in the last 3 months and number of body parts examined during the last SSE. More mySmartCheck participants examined all 15 body parts (32.6% vs. 7.1%, p = .001). More individuals in mySmartCheck reported conducting SSE on any body part than those in UC (81.4% vs. 62.5%, p = .04). Effect sizes were large (d = 1.19 all 15 body parts) to moderate (d = 0.55 for any body part). mySmartCheck participants examined more body areas than UC participants (12.7 vs. 10.3, p = 0.003) during the last SSE. Participants in mySmartCheck reported higher levels of knowledge of suspicious lesions, SSE benefits, SSE self-efficacy, and planning for SSE, and lower SSE barriers, than those assigned to UC. mySmartCheck had a significant positive impact on SSE performance and behaviors. Additional research with a larger sample size, a longer follow-up, and more varied clinical settings is needed. ClinicalTrials.gov registration # NCT03725449 (https://clinicaltrials.gov/ct2/show/NCT03725449).

Randomized controlled trial of the mySmartSkin web-based intervention to promote skin self-examination and sun protection among individuals diagnosed with melanoma.

Adherence to regular, thorough skin self-examination (SSE) and consistent sun protection behaviors among melanoma survivors is relatively low. This study reports on the impact of an online intervention, called mySmartSkin (MSS), on engagement in SSE and sun protection behaviors among melanoma survivors, as well as the mediators of the intervention effects. The intervention was compared with usual care (UC), and primary outcomes were assessed at 24 and 48 weeks. Short-term outcomes were also evaluated at 8 weeks postbaseline. Results demonstrate a significant effect on SSE and sun protection. At all three follow-up assessments, the proportion of participants reporting conducting a thorough SSE in the time since the previous assessment was significantly greater in MSS than in UC. In addition, both multivariate and univariate analyses indicated that engagement in sun protection behaviors was significantly higher in MSS than UC at 24 weeks, but the effect on sun protection at 48 weeks was significant only in multivariate analyses. Beneficial effects of MSS were significantly mediated by knowledge about melanoma and characteristics of suspicious lesions, as well as self-efficacy. Participant engagement in MSS was satisfactory, with approximately two-thirds of participants completing at least two of the three core components. Content was rated as highly trusted, easy to understand, easy to navigate, and helpful. In conclusion, MSS illustrated significant and durable effects on SSE and mixed results on sun protection. Future studies should consider ways to further enhance treatment effects and engagement in MSS.

The impact of physician support on skin self-examination among melanoma patients: A serial mediation model with self-efficacy and intentions to perform skin exams

ObjectiveMelanoma is the most lethal of skin cancers; however, survival rates are excellent if the tumor is detected early. Clinical practice guidelines for melanoma follow-up care recommend regular skin self-examination (SSE) for individuals at high risk for melanoma. The current analyses tested whether self-efficacy for SSE and intention to perform SSE mediate the relationship between physician support for SSE and SSE behavior among a sample of melanoma patients. Methods: We ran a serial mediation model on a cross-sectional sample of melanoma patients (n = 154) drawn from an observational study with longitudinal follow-up. Results: Self-efficacy and intention to perform SSE sequentially mediated the relationship between physician support and SSE behaviors (β = .31, t(152) = 3.61, p < .001 without mediators versus β = .11, t(150) = 1.50, p = .14 with mediators), as supported by a significant total indirect effect (β = .21, [95 % CI = .08–.35]). ConclusionSelf-efficacy for SSE and intention to perform SSE together explain the link between perceived physician support for SSE and the practice of SSE. Practice ImplicationsPhysician communication about the importance of SSE plays an important role in encouraging patient adherence to SSE recommendations and, thus, supporting early detection efforts.

Does it matter if a story character lives or dies?: a message experiment comparing survivor and death narratives

Objective In narratives, characters often face threats where they either live (survivor narratives) or die (death narratives). Both outcomes have the potential to persuade, and are frequently utilised in mass communication campaigns, yet more research is needed examining the relative effectiveness and underlying mechanisms of each strategy. Design U.S. adults (N = 1010) were randomly assigned to a 2 (survivor, death) × 2 (non-foreshadowed, foreshadowed) × 2 (within-study replication: narrative 1, narrative 2) between-participants experiment with melanoma stories as stimuli. Main Outcome Measures Intentions to engage in sun safe behaviour and skin self-examination behaviour were assessed in the pre- and posttest, and then transformed into change scores. Results Death narratives increased sun safe behaviour intentions. Consistent with the entertainment overcoming resistance model, foreshadowed death narratives were found to increase sun safe behaviour intentions via increased transportation and decreased counterarguing. Conclusion Compared to survivor narratives, death narratives increase intentions to engage in sun safe behaviour. The findings offer support for character death as a key feature of narrative persuasion, and narrative transportation and counterarguing as important mediational pathways.

Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review.

Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).

Skin self-examination behaviors among individuals diagnosed with melanoma.

Many melanoma patients do not regularly perform thorough skin self-examinations. We examined the extent to which melanoma patients conduct thorough skin self-examination, how they perform skin self-examination, and their related knowledge and self-efficacy. A sample of 176 individuals (61.5% response rate) diagnosed with primary pathologic stage 0-III cutaneous malignant melanoma at a single cancer center completed a written or telephone survey regarding their skin self-examination behaviors and associated factors. Almost all participants (98.9%) reported their race as white. Almost three-quarters (71.6%) of participants reported doing an examination in the past 2 months. However, only 14.2% had examined all areas of the body in the past 2 months. Few participants reported always using a full-length mirror (13.4%), hand-held mirror (11.3%), or having someone help (9.2%) when doing an examination. Having a higher level of education, greater knowledge of the ABCDE rule for detecting potential melanoma, higher skin self-examination self-efficacy, being shown how to do skin self-examination, and being shown what a suspicious mole would look like were all significantly associated with conducting more thorough skin self-examination. Most melanoma patients do not engage in regular, thorough skin self-examination, and when they do examine their skin they typically do not sufficiently utilize tools and techniques to facilitate a thorough examination and tracking of potentially suspicious moles. Efforts to promote skin self-examination among melanoma patients should focus on increasing knowledge and self-efficacy and providing education about the why, when, and how of conducting self-examination and mole tracking.

Skin care behaviors among melanoma survivors

Clinical recommendations for survivors of melanoma generally include skin care behaviors, including regular physician and skin self-examination to identify any recurrences or second primary disease early, as well as sun protection. We measured skin care behaviors in a population-based sample of melanoma survivors. Melanoma survivors were approached through the regional National Cancer Institute-funded cancer registry (Surveillance, Epidemiology, and End Results) and recruited to this study with a response rate of approximately 75%, for a total sample of n = 313. The sample was 99% Caucasian, 56% female, 44% male, 81% married, 62% college educated, and 48% with an income over 70 K annually, with an average age of 56 years. Over the last 7 days, a total of 45% reported wearing sunscreen, 59% reported wearing long sleeves, 80% reported wearing pants, 35% reported wearing something on the head, and 36% stayed in available shade. Skin self-examination behaviors were reported at relatively low frequencies, with only 22% performing a thorough check on skin. A total of 88% of survivors reported that their physician checked their skin in the past few years by having all clothes removed. A multivariate analysis using logistic regression indicated that perceived risk was positively related to having the skin checked by a medical provider but no other skin protection behaviors. Gender effects were also detected for wearing sunscreen and wearing a hat or scarf. Data indicate that melanoma survivors are performing sun protection behaviors to a moderate extent. Future studies can address barriers to consistent use of these behaviors in melanoma survivors.

Impact of a Video-Based Intervention to Improve the Prevalence of Skin Self-examination in Men 50 Years or Older

To improve the proportion of men 50 years or older who conduct a thorough whole-body skin self-examination (SSE), because these men are at increased risk of being diagnosed as having thick melanomas and dying of melanoma. Randomized trial of a video-based intervention to increase whole-body SSE compared with brochures-only control. Men from an Australian population register. The study included 930 men 50 years or older. The men were randomly assigned to receive either written materials only (control) or written materials along with a DVD or video and 2 postcard reminders (intervention). Telephone interviews were conducted at baseline and at 7 and 13 months. The proportion of men who conducted a whole-body SSE with the help of 2 mirrors and/or a person to assist with difficult-to-see areas. Compared with baseline (10%), by 13 months both groups had increased their whole-body SSE behaviors similarly (36% intervention and 31% control) (P = .85). At 7 months, the intervention group was significantly more likely to examine at least 1 part of their back (P < .001) and to examine a greater number of body sites (P < .001). At 7 months, the proportion of men conducting any SSE increased by 28% in the intervention group compared with 13% in the control group (P < .001), but at 13 months, the prevalence of any self-examination (83% vs 80%) was again similar. While men 50 years or older are responsive to appropriately targeted intervention materials to increase their SSE behaviors, the addition of a video or DVD to written materials had only a transient advantage for optimal SSE practices. anzctr.org.au Identifier: 12608000384358.

Skin cancer screening behaviours among individuals with a strong family history of malignant melanoma

Background:This study examined the prevalence and correlates of skin cancer screening behaviours among individuals at high risk of developing melanoma due to strong family history.Methods:A total of 120 individuals with a known family-specific CDKN2A mutation (72% response rate) completed a self-report questionnaire assessing annual frequency of skin self-examination (SSE), clinical skin examination (CSE) and a variety of potential demographic, clinical and psychosocial correlates.Results:In the past 12 months, 50% of participants reported engaging in SSE at least four times, and 43% of participants had undergone at least one CSE. Engagement in SSE was associated with doctor recommendation (β=1.77, P=0.001), confidence in one's ability to perform SSE (β=1.44, P<0.0001), positive beliefs about melanoma treatment (β=0.77, P=0.002) and intention to perform SSE in the future (β=1.69, P<0.0001). These variables accounted for 59% of the variance in SSE behaviour. Further, information-seeking style moderated the relationship between anxiety and SSE (β=1.02, P=0.004). Annual uptake of CSE was associated with doctor recommendation (β=2.21, P<0.0001) and intention to undergo CSE in the future (β=1.19, P=0.001).Conclusion:In comparison with clinical guidelines, it appears that individuals at high risk of developing melanoma engage in suboptimal levels of skin surveillance. Improved doctor–patient communication, as well as psycho-education and behavioural support, may be viable means of improving early skin cancer detection behaviours in this high-risk population.

A Randomized Trial of Tailored Skin Cancer Prevention Messages for Adults: Project SCAPE

We evaluated the impact of a mailed, tailored intervention on skin cancer prevention and skin self-examination behaviors of adults at moderate and high risk for skin cancer. Adults at moderate and high risk for skin cancer were recruited in primary health care settings in Honolulu, HI, and Long Island, NY. After completing a baseline survey, participants were randomized to 2 groups. The treatment group received tailored materials, including personalized risk feedback, and the control group received general educational materials. Multivariate analyses compared sun protection and skin self-examination between groups, controlling for location, risk level, gender, and age. A total of 596 adults completed the trial. The tailored materials had a significant effect on overall sun-protection habits, the use of hats, the use of sunglasses, and the recency of skin self-examination. Some effects were moderated by location and risk level. Tailored communications including personalized risk feedback can improve sun-protection behaviors and skin self-examination among adults at increased risk for skin cancer. These convenient, low-cost interventions can be implemented in a variety of settings and should be tested further to assess their long-term effectiveness.

Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

Although skin self-examination (SSE) may increase rates of early melanoma detection, the efficacy of different SSE practices has not been thoroughly studied. We examined associations between SSE practices and tumor thickness in patients with recently diagnosed melanoma. 321 melanoma patients at three hospitals completed questionnaires on demographics and SSE practices. Patient-reported SSE was measured by routine examination of 13 specific body areas, frequency of mole examination, and use of a melanoma picture aid to assist with SSE. Histologic diagnoses and Breslow depth were confirmed by dermatopathologists. Regression analyses were used to calculate ratios of geometric mean tumor thickness and odds ratios for having thicker versus thinner tumors for different SSE behaviors. Rates of SSE varied considerably by SSE item. Patients routinely examining at least some of their skin had thinner melanomas [adjusted geometric mean tumor ratio, 0.73; 95% confidence interval (95% CI), 0.50-0.94]. Frequency of mole examination did not predict tumor thickness. Using a melanoma picture as a SSE aid was strongly associated with reduced tumor thickness (adjusted ratio, 0.75; 95% CI, 0.66-0.85 for ever versus never use). A composite measure of thoroughness of SSE was the best predictor of thickness (adjusted ratio, 0.58; 95% CI, 0.36-0.75) for high versus low thoroughness. SSE was associated with decreased tumor thickness by most measures. However, the diverse rates of SSE practices and the distinct associations between these practices and melanoma thickness suggest a complexity in SSE that should be addressed in future studies. SSE should be evaluated by more than one measure.

Efficacy of a Partner Assistance Intervention Designed to Increase Skin Self-examination Performance

To examine the role of partner assistance in learning and implementation of an intervention designed to promote skin self-examination (SSE) behaviors in persons at risk of developing melanoma. Randomized controlled trial with immediate and 4-month follow-up visits. Clinical offices in the ambulatory care area of a hospital. Patients The study included 130 participants and their cohabiting partners drawn from a melanoma registry. Intervention The subjects were randomly assigned to receive the intervention either as solo learning or as dyadic learning. The intervention consisted of a 10-minute demonstration of the ABCDE (asymmetry of shape, border irregularity, color variegation, diameter > or =6 mm, and evolution of the lesion) rule and skills training. Behavioral measures included self-reported performance of SSE and use of a body map designed to record areas of concern found during SSE. Intentions, along with attitudinal measures such as perceived importance of SSE and self-efficacy in performing SSE, were also assessed at the 4-month follow-up visit. The participants in the dyadic learning group were significantly more likely to report engaging in SSE behaviors (P<.05). The dyadic learning group also exhibited greater intentions to perform future SSE (P<.01), higher perceived importance of SSE (P<.01), and higher perceived self-efficacy (P<.01). Dyadic learning may be more effective than solo learning in regard to interventions designed to teach and promote health behaviors, such as SSE.