Skin Self-examination Research Articles

Skin Cancer Prevention Education for Kidney Transplant Recipients: A Systematic Evaluation of Internet Sites

Repeated patient education about skin cancer prevention is important to self-care after transplant. Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results-Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (kappa = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n=4). Few sites recommended using protective clothing (n=5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n=1). Five sites recommended skin self-examination. Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.

Skin cancer prevention education for kidney transplant recipients: a systematic evaluation of Internet sites

Repeated patient education about skin cancer prevention is important to self-care after transplant. Examine educational materials for kidney transplant recipients available on the Internet that address sun protection and skin self-examination for early detection of squamous cell carcinoma. Systematic review of Web sites for kidney transplant recipients endorsed by transplant physicians and dermatologists. An expert panel of 8 dermatologists providing care for kidney transplant recipients and 1 research medical anthropologist. Reading grade level, inclusion of people with skin of color, sufficient content to support effective sun protection, and description of 4 sun-protection strategies and skin self-examination. Results-Of the 40 sites identified, 11 contained information about sun protection or increased risk of any type of cancer. The Web sites had a ninth-grade median reading level (range, seventh grade to college senior). Interrater reliability for the 25-item assessment tool was assessed by Fleiss' kappa (kappa = 0.87). Skin cancer risk was presented as relevant to those with fair skin. Sites recommended regular use of sunscreen with sun-protection factor of 15 or greater (n=3) to reduce the risk of skin cancer (n=4). Few sites recommended using protective clothing (n=5), seeking shade (n=4), and avoiding deliberate tanning with indoor or outdoor light (n=1). Five sites recommended skin self-examination. Because many patients seek self-management information from the Internet, Web sites must provide more thorough educational information about skin cancer prevention and health promotion at a lower reading grade level.

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.

Revised UK guidelines for the management of cutaneous melanoma 2010

These guidelines for the management of cutaneous melanoma present an evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiology, diagnosis, investigation, and follow-up.

An Internet-Delivered Video Intervention for Skin Self-examination by Patients With Melanoma

An Internet-Delivered Video Intervention for Skin Self-examination by Patients With Melanoma

Fotoproteção e exercício físico

As medidas de fotoproteção são divulgadas como procedimentos essenciais na prevenção de doenças cutâneas e manutenção da saúde e beleza. Os exercícios físicos regulares também são indicados para alcançar o estilo de vida saudável; no entanto, a prática esportiva expõe a maior radiação solar. O objetivo deste artigo é revisar as medidas fotoprotetoras na prevenção dos danos causados pelo Sol na pele dos desportistas. Abordam-se o histórico da fotoproteção, o espectro eletromagnético, os efeitos das radiações e os riscos de exposição durante as atividades físicas. Implementar estratégias, como a escolha do horário, local, roupas e acessórios, complementados pelo uso de filtros solares, minimizam os riscos decorrentes das radiações ultravioletas A e B (UVA e UVB) durante a prática esportiva ao ar livre. Dentre os produtos disponíveis no mercado, devem-se preferir aqueles que ofereçam segurança, ampla proteção, boa cosmética, estabilidade química em diferentes condições de calor e umidade, fotoestabilidade e baixo custo. O atleta deve ser orientado pelos profissionais da área da saúde sobre os riscos inerentes às suas atividades cotidianas e esportivas. O autoexame de pele é parte essencial na prevenção dos problemas dermatológicos, pois auxilia na detecção precoce. O futuro da fotoproteção no esporte está no investimento em medidas educativas desde a infância, reduzindo assim os danos solares cumulativos. A exposição solar deve ocorrer de modo cauteloso e com o mínimo de sequelas, mediante comportamento de fotoproteção, para proporcionar melhor qualidade de vida.

Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin

Among patients with melanoma, ethnic minorities are 1.96 to 3.01 times as likely to die from melanoma as Caucasians of the same age and sex. We sought to assess the effectiveness of a melanoma early detection educational intervention among those with ethnic skin. A consecutive convenience sample of patients received instruction on the ABCDEs of melanoma and skin self-examination. Self-report questionnaires assessing knowledge, attitudes, and behaviors were completed before, and immediately and 3 months after, the intervention. Among the 71 participants, 21% reported a skin phenotype with at least sometimes burning. Knowledge that melanoma is a skin cancer and of the warning signs of melanoma significantly increased after the intervention and was retained at 3 months. The perception of being at risk to develop a melanoma significantly increased after the intervention and was retained at 3 months (P < .001). Monthly checking of the skin, especially acral sites (palms, soles, periungual), increased significantly immediately after the intervention. A limitation is accrual from dermatology patients, who may be more inclined to perform skin self-examination compared with the general minority population. People of color benefit from specific physician recommendations explaining their risk to develop melanoma and which anatomic sites to check. Acral lentiginous melanoma among ethnic minorities tends to present in non-sun-exposed but visible areas, particularly volar and subungual sites; therefore, skin self-examination educational materials for minority populations should incorporate these anatomic sites.

Self-efficacy moderates message-framing effects: The case of skin-cancer detection

Health-promoting messages can be framed in terms of the gains associated with healthy behaviour, or the losses associated with unhealthy behaviour. Studies show inconsistent results as to which type of framing is more effective. In this study, we examined the influence of self-efficacy to perform skin self-examination on the effects of gain- and loss-framed skin-cancer detection messages among 124 university students. For participants with high self-efficacy, a loss-framed message resulted in a higher intention to perform skin self-examination than a gain-framed message. For participants with low self-efficacy, there were no differences in intention between the gain- and loss-framed message conditions. Our results suggest that self-efficacy levels play an important role in message-framing effects. For health communication strategies promoting the active detection of skin-cancer symptoms, messages stressing losses may be more effective than messages stressing gains, but only in persons with high self-efficacy. In addition, our results suggest that health promoting messages can be framed to match recipients’ self-efficacy levels.

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 for the early detection of melanoma

The National Cancer Institute's "Melanoma Action Plan" calls for reduction of melanoma mortality through early detection. Routine skin self-examination (SSE) has the potential to increase chances of early detection and treatment and may be the key to melanoma survival. We provide a focused review of the accuracy of SSE for detecting premalignant lesions and cutaneous risk factors for melanoma, with suggestions for future directions for enhancing measurement of SSE accuracy and ways in which to improve the public's perceptions of melanoma efficacy. We examined published data on the efficacy of skin self-examination for the early detection of melanoma. We searched the MEDLINE database for publications between January 1, 1987 and June 1, 2007 using search terms for "melanoma" and "self-examination." We found that sensitivity of skin self-examination is low, ranging from 25% to 93%, while specificity is generally higher (83% to 97%). Attempts to increase improve the lay public's perceptions of the early signs of melanoma have proved effective, while those aimed at increasing accuracy of SSE with targeted interventions have been moderately successful. SSE's insensitivity for detection of pigmented lesions should prompt further investigation of educational interventions to enhance its accuracy and lead to its adoption as a cheap, simple screening tool. Assessment of the accuracy and efficacy of SSE should proceed using standardized definitions and measurements such that it is easier to pool data on the overall value of SSE as a screening modality.

Visual feedback of individuals' medical imaging results for changing health behaviour

Feedback of medical imaging results can reveal visual evidence of actual bodily harm attributable to a given behaviour. This may offer a particularly promising approach to motivating changes in health behaviour to decrease risk. Applicable behaviours include smoking cessation, skin self-examination, sun protection behaviour, dietary intake, physical activity and medication usage. The current review assembles and evaluates the evidence concerning the behavioural impact of showing and explaining images, in order to determine whether their communication is an effective intervention approach. To assess the extent to which feedback to individuals of images of their own bodies created during medical imaging procedures increases or decreases a range of health behaviours. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3 2009), MEDLINE (1950 to 14 September 2009), EMBASE (1980 to 14 September 2009), CINAHL (1982 to 9 October 2009), PsycINFO (1806 to 14 September 2009) and reference lists of articles. We also contacted authors of selected papers, and searched the ProQuest Dissertations and Theses database on 1 October 2009 for grey literature. Randomised or quasi-randomised controlled trials involving adult (18 years and over) non-pregnant individuals undergoing medical imaging procedures assessing risk of disease or of an existing condition, for which personal risk may be reduced by modification of behaviour. The sole or principal component of included interventions is visual feedback of individuals' medical imaging results, defined as individuals being shown, and having explained, source images (still or moving images) of their bodies generated by the procedure. Two authors searched for studies and independently extracted data from included studies, with disagreements resolved by consensus and a third author acting as arbiter. The risk of bias of included studies was assessed and reported in accordance with the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a narrative synthesis of the included studies, dividing them into clinical and non-clinical population groups and presenting major characteristics and results. Where the studies were sufficiently similar in terms of population, inclusion criteria, interventions and/or outcomes, we pooled the data statistically. We included nine trials involving 1371 participants. Overall, results were mixed. Regarding five trials in clinical populations, three assessed smoking cessation behaviours, all featuring arterial scanning procedures to assess cardiovascular risk, and reported a statistically significant effect favouring the intervention, producing a pooled odds ratio (OR) of 2.81 (95% confidence interval (CI) 1.23 to 6.41, P = 0.01). One of these trials also measured physical activity and reported no statistically significant difference between the groups. A further trial measured skin examination behaviour following a skin photography procedure for assessing moles, and reported a statistically significant increase in favour of the intervention, with an OR of 4.86 (95% CI 1.95 to 12.10, P = 0.0007). The final clinical population trial measured a range of dietary intake and medication usage behaviours and featured an arterial scanning procedure assessing cardiovascular risk, and reported no statistically significant effects.Among the four trials in non-clinical populations, all featuring ultraviolet (UV) photography to highlight UV-related skin damage, a statistically significant result favouring the intervention was found in one trial for reducing tanning booth use, producing a mean difference (MD) of -1.10 (95% CI -1.90 to -0.30, P = .007) and one trial reported an outcome on which the control condition was favoured, with an MD of 0.45 (95% CI 0.04 to 0.86, P = 0.03) on intentional hours spent in the sun. In two further trials, no statistically significant behavioral effects were reported regarding time spent in the sun or sun protection behaviours.There was no evidence of significant adverse effects in the included trials, although this was not well reported. Due to the limited nature of the available evidence and the mixed results that were found, no strong statements can be made about the effectiveness of communicating medical imaging results to change health behaviour. Only three trials in clinical populations were similar enough in term of setting, intervention and outcome to allow meta-analysis. We suggest, however, that targeted interventions using medical imaging technologies may be effective in certain contexts, or as applied to certain behaviours, but that this should be considered on an intervention by intervention basis, and not assumed as a general principle.

Abstract B34: An internet-delivered video intervention improves skin cancer detection behavior in melanoma patients

Abstract Introduction: Melanoma patients are at high risk of recurrence or additional primary lesions. Although early detection may prolong melanoma survival, few patients report engaging in early detection behaviors. Little is known about the types of interventions, including video, that affect skin cancer risk reduction behavior in this population. We found no studies of Internet-delivered video to facilitate skin cancer early detection behavior change. The purpose of this study was to: (1) develop and test a video intervention for skin cancer early detection; specifically to measure changes in self-reported melanoma awareness, melanoma attitudes and beliefs, and thorough skin self-examination (TSSE); (2) assess the feasibility of delivering and testing the intervention via the Internet. Methods: Using concepts from social cognitive theory as a foundation, a team of researchers and media specialists developed a 13 minute evidence-based video, which addresses the seriousness of skin cancer, includes testimonials from patients and demonstrates TSSE. A technology specialist adapted an existing survey for the Internet to measure the main variables and created a study Website. To measure knowledge, participants answered ten items about warning signs of melanoma; possible scores ranged from 0 to 10. Skin cancer attitudes and beliefs (seriousness, self-efficacy, perceived risk) were measured by two 6-item scales that had acceptable internal consistency estimates (Cronbach' alpha = 0.70; 0.79). The TSSE measure was Weinstock' method to query how often during the previous two months participants examined seven specific parts of the body. We recruited adult patients with melanoma from a skin cancer specialty clinic. Shortly after enrollment, participants received an encrypted email with unique login information to access the pre-intervention survey. After completing the survey, participants could access the link to view the video. Three months later, they completed an identical post-intervention survey on the Internet. Data were stored in the Microsoft SQL server. Results: 41 of 85 participants (mean age 61 years, 58% men, 42% women) completed both surveys. The video intervention significantly improved melanoma awareness (p=0.002) and self-reported TSSE performance (p=0.007), but did not change attitudes or beliefs. Contributing to attrition (failure to complete the second survey) were several issues related to use of the Internet; e.g. opening the video and surveys, nonfunctional email addresses. Characteristics of participants who completed the first survey and did not complete the second survey were similar, the only difference was that significantly more noncompleters had higher education levels. Conclusion: Internet delivery of a video intervention is effective for short-term improvement of skin cancer knowledge and TSSE. Attitudes and beliefs about skin cancer remain stable. Using the Internet to deliver and test an intervention presents some challenges that merit careful consideration for future research. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B34.

Tailored versus generic interventions for skin cancer risk reduction for family members of melanoma patients.

Improving strategies for risk reduction among family members of patients with melanoma may reduce their risk for melanoma. To evaluate the effects of two behavioral interventions designed to improve the frequency of total cutaneous skin examination by a health provider (TCE), skin self-examination (SSE), and sun protection among first degree relatives of patients with melanoma; and to evaluate whether increased intentions, increased benefits, decreased barriers, and improved sunscreen self-efficacy mediated the effects of the tailored intervention, as compared with the generic intervention on TCE, SSE, or sun protection. Four hundred forty-three family members (56 parents, 248 siblings, 239 children) who were nonadherent with these practices were randomly assigned to either a generic (N = 218) or a tailored intervention (N = 225) which included 3 print mailings and 1 telephone session. Participants completed measures of TCE, SSE, and sun protections at baseline, 6 months, and 1 year, and measures of intentions, benefits, barriers, and self-efficacy at baseline and 6 months. Those enrolled in the tailored intervention had almost a twofold increased probability of having a TCE ( p < .0001). Treatment effects in favor of the tailored intervention were also noted for sun protection habits ( p < .02). Increases in TCE intentions mediated the tailored intervention's effects on TCE. Increases in sun protection intentions mediated effects of the tailored intervention's effect on sun protection. Tailored interventions may improve risk reduction practices among family members of patients with melanoma.

Use of Photographs Illustrating ABCDE Criteria in Skin Self-examination

Use of Photographs Illustrating ABCDE Criteria in Skin Self-examination

Comparing the Efficacy of an In-Person Intervention With a Skin Self-examination Workbook

From 1992 to 2004, melanoma incidence for all categories of tumor thickness increased 3.1% annually, and there was a 3.8% annual increase in the thickest cancers (Breslow depth, >4 mm), which have the least favorable prognosis.1–3 Since most melanomas are discovered by the patient or a partner, skin self-examination (SSE) with the assistance of a partner has the potential to improve long-term survival.4–6 Given the challenge of examining difficult-to-see body areas (eg, the back), partner assistance is important.7 By creating a workbook from our experience with 130 in-person interventions that increased SSE and partner-assisted skin examination (PASE),7–9 we extend our group's previous research. The workbook codifies the dialog of the in-person intervention with exercises that amplify skills and provide a framework for the patient and partner to understand the significance of melanoma by “story telling” about other people with melanoma in a way that is a call to action. Herein, we compare the efficacy of the workbook with that of in-person training.

The skin awareness study: Promoting thorough skin self-examination for skin cancer among men 50 years or older

Background Incidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancer outcomes. Objectives To develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older. Methods Pilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months. Results Randomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline. Conclusions Men 50 years or older can successfully be recruited to a video-based intervention trial with the aim to reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior.

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.

Squamous Cell Carcinoma in Solid Organ Transplant Recipients: Influences on Perception of Risk and Optimal Time to Provide Education

Squamous cell carcinoma (SCC) has a mortality rate of up to 8% in solid organ transplant recipients (OTRs), and the risk of OTRs developing SCC is up to 250-fold greater than that of the general population.1-3 Despite these risks, patients commonly do not seek health care for skin checks, nor do they routinely perform skin self-examinations (SSEs). Moreover, although patients in 1 study recalled being told to use sunscreen, few were aware that their immunosuppressive medication increased skin cancer risk.4 The present study assesses (1) the optimal time after transplantation to deliver SSE educational intervention; (2) the relationship between lifetime sun exposure and OTRs’ perception of SSE importance; and (3) the impact of SCC discussion with a health care worker on the likelihood of SSE performance.

Thoroughness of skin examination by melanoma patients: Influence of age, sex and partner

The aim of this study was to determine the thoroughness of deliberate skin examination by people with a history of melanoma. Patients were randomized into one of two conditions: either to receive the brief educational and skills training intervention alone or as a couple with their spouse or cohabiting partner. Subjects recorded concerning lesions on body maps. At the 4-month visit, a total body skin examination was performed by a dermatologist blinded to the subjects' condition and to their recorded responses. The skin surface was divided according to the region's visibility during skin self-examination and sexual connotations: visible/not sexually sensitive, non-visible/not sexually sensitive and sexually sensitive. The primary point of comparison was missed lesions, defined as the difference between lesions recorded by the subjects and their partners and those recorded by the dermatologist. Among 130 participants, 56 subjects reported partner assistance while performing SSE. Participants missed more lesions in sexually sensitive areas than in the other regions. With the increasing age of the patient, the number of missed lesions in non-visible/not sexually sensitive and sexually sensitive areas decreased. Male patients assisted by female partners missed fewer lesions in all three regions than female patients assisted by male partners. In easily visible areas, male patients missed significantly fewer lesions than female patients (P = 0.01). Older couples performed more thorough partner-assisted skin examinations in non-visible and sexually sensitive areas than younger couples. Male patients who were assisted by female partners performed more thorough partner-assisted skin examinations than female patients assisted by male partners.

Melanoma Is Up: Are We Up to This Challenge?

Linos and colleagues provide important evidence that the increasing incidence of melanoma is not solely from increases in thin melanomas discovered by more intensive screening. This underscores the inadequacy of primary prevention to date, and the importance of early detection for reducing mortality in the near future. The US Preventive Services Task Force finds insufficient evidence to recommend for or against skin self-examination and clinician skin examination. Neither is commonly practiced now, but both are required for effective early detection. Evidence regarding benefits, harms, and costs of melanoma screening will help in securing widespread endorsement of these activities.