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Trepanowski N, Hathaway CA, Chang MS, Hay JL, Samatham R, Geller AC, Swetter SM, Tworoger SS, Kanetsky PA, Leachman SA, Hartman RI. Influence of the COVID-19 pandemic on sun habits of patients with melanoma: a cross-sectional study. Arch Dermatol Res 2024; 316:221. [PMID: 38787523 DOI: 10.1007/s00403-024-02952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/04/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Nicole Trepanowski
- Boston University School of Medicine, Boston, MA, USA
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, USA
| | - Cassandra A Hathaway
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael S Chang
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ravi Samatham
- Department of Dermatology at Oregon Health & Science University, Portland, OR, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan M Swetter
- Department of Dermatology/Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Palo Alto, CA, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sancy A Leachman
- Department of Dermatology at Oregon Health & Science University, Portland, OR, USA
- Knight Cancer Institute at Oregon Health & Science University, Portland, OR, USA
| | - Rebecca I Hartman
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA, USA.
- Department of Dermatology, VA Integrated Service Network (VISN-1), Jamaica Plain, Boston, MA, USA.
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2
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Navarro-Bielsa A, Gracia-Cazaña T, Almagro M, Fuente-Meira SDL, Florez Á, Yélamos O, Montero-Vilchez T, González-Cruz C, Diago A, Abadías-Granado I, Fuentelsaz V, Colmenero M, Bañuls J, Arias-Santiago S, Buendía-Eisman A, Almenara-Blasco M, Gil-Pallares P, Gilaberte Y. A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:457-465. [PMID: 37130164 DOI: 10.1111/phpp.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. OBJECTIVE To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. METHODS Multicentre case-control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. RESULTS Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p < .05), whereas those with BCC and SCC reported greater use of head coverings (p = .01). BCC and SCC groups reported greater sun exposure 15 years prior, whereas controls reported greater use of sunscreen. However, at the time of this study all groups reported using SPF ≥ 21, and the majority SPF > 50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. CONCLUSIONS We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation.
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Affiliation(s)
- Alba Navarro-Bielsa
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Tamara Gracia-Cazaña
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Manuel Almagro
- Department of Dermatology, Complejo Hospitalario Universitario, A Coruña, Spain
| | | | - Ángeles Florez
- Department of Dermatology, University Hospital of Pontevedra, Pontevedra, Spain
| | - Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carlos González-Cruz
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Adrián Diago
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | | | | | - María Colmenero
- Department of Dermatology, Hospital Costa del Sol, Marbella, Spain
| | - José Bañuls
- Departmment of Dermatology, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | | | | | - Manuel Almenara-Blasco
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Pedro Gil-Pallares
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain
| | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
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3
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McKenzie C, Nahm WJ, Kearney CA, Zampella JG. Sun-protective behaviors and sunburn among US adults. Arch Dermatol Res 2023; 315:1665-1674. [PMID: 36790452 PMCID: PMC9930066 DOI: 10.1007/s00403-023-02547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 02/16/2023]
Abstract
Individuals can reduce the risk of developing skin cancer by minimizing ultraviolet sunlight exposure, though recent trends in sun-protective behaviors remain to be investigated. To evaluate sun-protective behaviors and sunburn among US adults. We analyzed data from the 2010, 2015, and 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey conducted by the US Census Bureau. Multivariable regression models were stratified by demographic variables and constructed to evaluate sun-protective behaviors and sunburn avoidance across time. From 2010 through 2020, US adults had significantly increased prevalence of seeking shade (p value, 0.003), wearing wide-brimmed hats (< 0.001), wearing long-sleeved shirts (< 0.001), using sunscreen (< 0.001), and avoiding sunburns (< 0.001) and significantly decreased prevalence of sun avoidance (< 0.001). Disparities in sun-protective behaviors also exist among different sexes, ages, education levels, and those reporting higher sun sensitivity. This cross-sectional study found that by 2020, US adults had an increased prevalence of wearing sun-protective clothing and sunscreen use, though decreased prevalence of sun avoidance. Although certain sun-protective behaviors have become more prevalent, the incidence of skin cancer continues to rise. Efforts to understand drivers of sun-protective behaviors and targeted intervention efforts are needed.
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Affiliation(s)
- Costner McKenzie
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 555 Madison Ave, New York, NY, 10022, USA
| | - William J Nahm
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - John G Zampella
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 555 Madison Ave, New York, NY, 10022, USA.
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4
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Assessing individual patients’ knowledge of benign versus malignant skin lesions in the dermatology clinic population. Int J Womens Dermatol 2022; 8:e032. [PMID: 35923587 PMCID: PMC9324629 DOI: 10.1097/jw9.0000000000000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Skin cancer education targeted to patients’ needs is a goal of practicing dermatologists. Data regarding dermatology patients’ baseline knowledge regarding skin cancer could aid clinicians in tailoring education efforts.
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5
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Berman-Rosa M, Logan J, Ghazawi FM, Le M, Conte S, Netchiporouk E, Mukovozov IM, Cyr J, Mourad A, Miller WH, Claveau J, Salopek TG, Gniadecki R, Sasseville D, Rahme E, Lagacé F, Litvinov IV. Analysis of Geographic and Environmental Factors and Their Association with Cutaneous Melanoma Incidence in Canada. Dermatology 2022; 238:1006-1017. [PMID: 35679838 PMCID: PMC9677843 DOI: 10.1159/000524949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over 90% of skin cancers including cutaneous melanoma (CM) are related directly to sun exposure. Despite extensive knowledge on ultraviolet radiation's (UVR) detrimental impact, many still fail to implement sun protection/sun avoidance. Human behavior, attitudes, and cultural norms of individuals and communities heavily depend on the surrounding climate/environment. In many instances, the climate shapes the culture/norms of the society. Canada has vast geographic/environmental differences. METHODS In the current ecological study, we sought to examine the relationship between various geographic and environmental factors and the distribution of CM incidence by Forward Sortation Area (FSA) postal code across Canada. CM incidence data were extracted from the Canadian Cancer Registry, while environmental data were extracted from the Canadian Urban Environmental Health Research Consortium (greenspace, as measured by the normalized difference vegetation index; annual highest temperature; absolute number and average length of yearly heat events; annual total precipitation [rain and snow]; absolute number and average length of events with precipitation [rain and snow]; and summer UVR index). The above geographic/environmental data by FSA were correlated with the respective CM incidence employing negative binomial regression model. RESULTS Our analysis highlights that increases in annual average temperature, summer UVR, and greenspace were associated with higher expected incidence of CM cases, while higher number of annual heat events together with highest annual temperature and higher average number of annual rain events were associated with a decrease in CM incidence rate. This study also highlights regional variation in environmental CM risk factors in Canada. CONCLUSIONS This national population-based study presents clinically relevant conclusions on weather/geographic variations associated with CM incidence in Canada and will help refine targeted CM prevention campaigns by understanding unique weather/geographic variations in high-risk regions.
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Affiliation(s)
| | - James Logan
- Independent Consultant, MGIS, Ottawa, Ontario, Canada
| | - Feras M. Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montreal, Québec, Canada
| | - Santina Conte
- Division of Dermatology, McGill University, Montreal, Québec, Canada
| | | | - Ilya M. Mukovozov
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janelle Cyr
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Ahmed Mourad
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Wilson H. Miller
- Department of Medicine and Oncology, McGill University, Montreal, Québec, Canada
| | - Joël Claveau
- Division of Dermatology, Laval University, Quebec City, Québec, Canada
| | - Thomas G. Salopek
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montreal, Québec, Canada
| | - François Lagacé
- Division of Dermatology, McGill University, Montreal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, McGill University, Montreal, Québec, Canada
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6
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Rojas KD, Perez ME, Marchetti MA, Nichols AJ, Penedo FJ, Jaimes N. Skin Cancer: Primary, Secondary, and Tertiary Prevention. Part II. J Am Acad Dermatol 2022; 87:271-288. [DOI: 10.1016/j.jaad.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
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7
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Tabatabaie S, Litt JS, Crane LA. The experience of outdoor physical activity for skin cancer survivors: understanding the importance of the built and natural environments. J Cancer Surviv 2020; 14:739-756. [PMID: 32506221 DOI: 10.1007/s11764-020-00889-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Cancer patients are encouraged to do more physical activity (PA). Exercising in outdoor settings, however, may expose people to UV radiation, which is the main risk factor of melanoma. This study aimed to understand how melanoma diagnoses affect people's perception of the outdoor environment for PA. METHOD In-depth interviews were conducted among 19 individuals (20-85 years) with a history of melanoma at a skin cancer clinic in the Denver metropolitan area. Transcribed interviews were coded for emergent themes. The coding framework included topics related to PA behavior, sun protection, and perceptions of outdoor environment. RESULTS Respondents reported no change in their level of outdoor activity after the melanoma diagnosis; they tried to reduce the risk of sun exposure by using sunscreen and sun-protective clothing. They also reported seeking shade, trees, and groundcover along urban corridors, in order to avoid sun exposure, reflective surfaces, and heat while being active outdoors. CONCLUSION Given the public health significance of UV exposure and extreme heat, further investments should be made to craft streetscape design guidelines and implement sun-proof spaces across public facilities, including parks, schools, and sport fields in order to ameliorate environmental risks for skin cancer survivors, to prevent future cancers among those that are vulnerable to the hazards of excessive UV exposure and extreme heat, and to promote outdoor PA. IMPLICATIONS FOR CANCER SURVIVORS Skin cancer survivors and other vulnerable population subgroups will benefit from discussions around neighborhood-based design interventions that promote PA while accounting for sun safety.
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Affiliation(s)
- S Tabatabaie
- The Program in Environmental Design, University of Colorado Boulder, Boulder, CO, USA.
| | - J S Litt
- The Environmental Studies Program, University of Colorado Boulder, Boulder, CO, USA
| | - L A Crane
- Colorado School of Public Health, Boulder, CO, USA
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8
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Alshurafa N, Jain J, Stump TK, Spring B, Robinson JK. Assessing recall of personal sun exposure by integrating UV dosimeter and self-reported data with a network flow framework. PLoS One 2019; 14:e0225371. [PMID: 31800626 PMCID: PMC6892536 DOI: 10.1371/journal.pone.0225371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Melanoma survivors often do not engage in adequate sun protection, leading to sunburn and increasing their risk of future melanomas. Melanoma survivors do not accurately recall the extent of sun exposure they have received, thus, they may be unaware of their personal UV exposure, and this lack of awareness may contribute towards failure to change behavior. As a means of determining behavioral accuracy of recall of sun exposure, this study compared subjective self-reports of time outdoors to an objective wearable sensor. Analysis of the meaningful discrepancies between the self-report and sensor measures of time outdoors was made possible by using a network flow algorithm to align sun exposure events recorded by both measures. Aligning the two measures provides the opportunity to more accurately evaluate false positive and false negative self-reports of behavior and understand participant tendencies to over- and under-report behavior. METHODS 39 melanoma survivors wore an ultraviolet light (UV) sensor on their chest while outdoors for 10 consecutive summer days and provided an end-of-day subjective self-report of their behavior while outdoors. A Network Flow Alignment framework was used to align self-report and objective UV sensor data to correct misalignment. The frequency and time of day of under- and over-reporting were identified. FINDINGS For the 269 days assessed, the proposed framework showed a significant increase in the Jaccard coefficient (i.e. a measure of similarity between self-report and UV sensor data) by 63.64% (p < .001), and significant reduction in false negative minutes by 34.43% (p < .001). Following alignment of the measures, under-reporting of sun exposure time occurred on 51% of the days analyzed and more participants tended to under-report than to over-report sun exposure time. Rates of under-reporting of sun exposure were highest for events that began from 12-1pm, and second-highest from 5-6pm. CONCLUSION These discrepancies may reflect lack of accurate recall of sun exposure during times of peak sun intensity (10am-2pm) that could ultimately increase the risk of developing melanoma. This research provides technical contributions to the field of wearable computing, activity recognition, and identifies actionable times to improve participants' perception of their sun exposure.
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Affiliation(s)
- Nabil Alshurafa
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, Illinois, United States of America
| | - Jayalakshmi Jain
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Computer Science, Northwestern University, Evanston, Illinois, United States of America
| | - Tammy K. Stump
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United States of America
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - June K. Robinson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States of America
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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9
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Xu S, Stump TK, Jain J, Alshurafa N, Robinson JK. Variation in daily ultraviolet radiation exposure and sun protection behaviours of melanoma survivors: an observational single-arm pilot study with a wearable sensor. Br J Dermatol 2018; 180:413-414. [PMID: 30207589 DOI: 10.1111/bjd.17196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, #1050, Chicago, IL, 60611, U.S.A.,Center for Bio-Integrated Electronics, Northwestern University, Chicago, IL, U.S.A
| | - T K Stump
- Department of Preventive Medicine, Northwestern University, Chicago, IL, U.S.A.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, U.S.A
| | - J Jain
- Department of Preventive Medicine, Northwestern University, Chicago, IL, U.S.A
| | - N Alshurafa
- Department of Preventive Medicine, Northwestern University, Chicago, IL, U.S.A.,Department of Electrical Engineering and Computer Science, Northwestern University, Chicago, IL, U.S.A
| | - J K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, #1050, Chicago, IL, 60611, U.S.A.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, U.S.A
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10
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Cheng J, Widjajahakim R, Rajanala S, Maymone MBC, Secemsky E, Vashi NA. Effect of stimuli on sun protective habits: A randomized double-blind controlled study. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:17-23. [PMID: 30058182 DOI: 10.1111/phpp.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Visual imagery has been shown to improve adherence to health messages but has scarcely been investigated in sun protection campaigns. OBJECTIVE To determine the effectiveness of pictorial- and textual-based sun protective messages in a largely Hispanic population. METHODS One hundred and forty-five participants received standard of care (SOC) as defined as sun protective counseling and were then randomized to receive either (a) images of sun damage, (b) a textual pamphlet about sun damage, or (c) no further messages. Analysis-of-variance tests for repeated measures were used to estimate the effects of the different stimuli on participants' knowledge and intention to sun protect. RESULTS All stimulus groups demonstrated an improvement in perceived effectiveness of sun protective habits (p < 0.05). However, pictorial and textual stimuli were both more effective than SOC in improving intentions to sun protect (p < 0.05), but there was no differential effect between the two. CONCLUSIONS Both pictorial and textual stimuli were more effective than SOC in improving intentions to sun protect, but there was no differential effect between the two.
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Affiliation(s)
- Judy Cheng
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Rafael Widjajahakim
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Mayra B C Maymone
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Eric Secemsky
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Neelam A Vashi
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
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11
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Fischer AH, Wang TS, Yenokyan G, Kang S, Chien AL. Sunburn and sun-protective behaviors among adults with and without previous nonmelanoma skin cancer (NMSC): A population-based study. J Am Acad Dermatol 2016; 75:371-379.e5. [PMID: 27198078 DOI: 10.1016/j.jaad.2016.02.1236] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with previous nonmelanoma skin cancer (NMSC) are at increased risk for subsequent skin cancer, and should therefore limit ultraviolet exposure. OBJECTIVE We sought to determine whether individuals with previous NMSC engage in better sun protection than those with no skin cancer history. METHODS We pooled self-reported data (2005 and 2010 National Health Interview Surveys) from US non-Hispanic white adults (758 with and 34,161 without previous NMSC). We calculated adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (CI), taking into account the complex survey design. RESULTS Individuals with previous NMSC versus no history of NMSC had higher rates of frequent use of shade (44.3% vs 27.0%; aPOR 1.41; 95% CI 1.16-1.71), long sleeves (20.5% vs 7.7%; aPOR 1.55; 95% CI 1.21-1.98), a wide-brimmed hat (26.1% vs 10.5%; aPOR 1.52; 95% CI 1.24-1.87), and sunscreen (53.7% vs 33.1%; aPOR 2.11; 95% CI 1.73-2.59), but did not have significantly lower odds of recent sunburn (29.7% vs 40.7%; aPOR 0.95; 95% CI 0.77-1.17). Among those with previous NMSC, recent sunburn was inversely associated with age, sun avoidance, and shade but not sunscreen. LIMITATIONS Self-reported cross-sectional data and unavailable information quantifying regular sun exposure are limitations. CONCLUSION Physicians should emphasize sunburn prevention when counseling patients with previous NMSC, especially younger adults, focusing on shade and sun avoidance over sunscreen.
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Affiliation(s)
- Alexander H Fischer
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Timothy S Wang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna L Chien
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Nahar VK, Allison Ford M, Brodell RT, Boyas JF, Jacks SK, Biviji-Sharma R, Haskins MA, Bass MA. Skin cancer prevention practices among malignant melanoma survivors: a systematic review. J Cancer Res Clin Oncol 2015; 142:1273-83. [PMID: 26642962 DOI: 10.1007/s00432-015-2086-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 11/21/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE This systematic review was conducted to evaluate and summarize the existing literature on prevalence of ultraviolet radiation (UVR) exposure, sun protection, and screening behaviors among individuals diagnosed with malignant melanoma (MM). METHODS The search was performed in PubMed, CINAHL, PsycINFO, ScienceDirect, EMBASE, and ERIC from inception of each database through July 2014. Studies were included if (1) individuals diagnosed with MM were the primary sample, (2) measured UVR exposure, primary and secondary preventive behaviors, (3) original research communication that constitutes an entire set of empirical data, (4) observational design, and (5) English peer-reviewed. Studies were excluded if (1) all of the inclusion criteria were not met and (2) duplicates, conference abstracts, editorials, news, letters to the editor, comments, reviews, feature articles, white papers, and guidelines. RESULTS The search resulted in 255 articles that were screened for relevance; however, only 15 articles met all of the inclusion criteria. Most of the studies were cross-sectional (n = 10), used self-administered surveys (n = 8), and were conducted in North America (n = 10). The sample sizes ranged considerably, but were mostly Caucasian (n = 6) and included a higher proportion of women (n = 8). Evidence demonstrated that individuals with MM still engaged in sunbathing, indoor tanning, and reported sunburns. Moreover, survivors reported inadequate levels of both sun protection and skin self-examinations. CONCLUSIONS The findings highlight the need for intensifying intervention strategies to reduce the risk of new primary MMs in this group. Future research should increase in rigor and include more diverse populations and regions.
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Affiliation(s)
- Vinayak K Nahar
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA. .,Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.
| | - M Allison Ford
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
| | - Robert T Brodell
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.,Department of Pathology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA.,Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Javier F Boyas
- Department of Social Work, University of Mississippi, 208 Longstreet Hall, PO Box 1848, Oxford, MS, 38677, USA
| | - Stephanie K Jacks
- Department of Dermatology, University of Mississippi Medical Center, 2500 N., State St., Jackson, MS, 39216, USA
| | - Rizwana Biviji-Sharma
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, IUPUI, 714 N. Senate Ave, Suite 250, Indianapolis, IN, 46202, USA
| | - Mary A Haskins
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
| | - Martha A Bass
- Department of Health, Exercise Science and Recreation Management, The University of Mississippi, 215 Turner Center, PO Box 1848, University, MS, 38677, USA
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Gould Rothberg BE, Bulloch KJ, Fine JA, Barnhill RL, Berwick M. Red meat and fruit intake is prognostic among patients with localized cutaneous melanomas more than 1mm thick. Cancer Epidemiol 2014; 38:599-607. [PMID: 25194935 PMCID: PMC4229370 DOI: 10.1016/j.canep.2014.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND As the 10-year mortality for localized cutaneous melanoma more than 1.00 mm thick approaches 40% following complete resection, non-therapeutic interventions that can supplement recommended active surveillance are needed. Although guidelines recommending nutrition, physical activity and tobacco cessation for cancer survivors have been published, data describing their associations with melanoma survivorship are lacking. METHODS Analysis of modifiable lifestyle behaviors collected on the 249 cases with melanomas more than 1.00 mm thick enrolled in the Connecticut Case-Control Study of Skin Self-Examination study was conducted. Independent associations with melanoma-specific survival were evaluated through Cox proportional hazards modeling adjusting for age, gender, Breslow thickness, ulceration and the presence of microsatellites. Independently significant variables were then combined into a single model and backwards elimination was employed until all remaining variables were significant at p<0.05. RESULTS Following adjustment for age, Breslow thickness and anatomic site of the index melanoma, daily fruit consumption was associated with improved melanoma-specific survival (HR=0.54; 95% CI: 0.34-0.86) whereas at least weekly red meat consumption was associated with worse outcomes (HR=1.84; 95% CI: 1.02-3.30). Natural red (HR=0.44; 95% CI: 0.22-0.88) or blond (HR=0.52; 95% CI: 0.29-0.94) hair were also favorably prognostic. Higher fish consumption was of borderline significance for improved survival only when considered independently (HR=0.65; 95% CI: 0.40-1.05); no association was seen following adjustment for red meat and fruit consumption (p>0.10). CONCLUSIONS Dietary choices at the time of diagnosis are associated with melanoma-specific survival in patients with melanomas more than 1.00 mm thick. Further validation of our findings in larger cohorts with repeated post-diagnostic measures is warranted to further evaluate whether dietary modification during the survivorship period can improve melanoma-specific survival.
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Affiliation(s)
- Bonnie E Gould Rothberg
- Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA; Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA; Department of Pathology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA.
| | - Kaleigh J Bulloch
- Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520-8028, USA.
| | - Judith A Fine
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - Raymond L Barnhill
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA; Department of Dermatology, University of New Mexico, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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Mrazek AA, Chao C. Surviving cutaneous melanoma: a clinical review of follow-up practices, surveillance, and management of recurrence. Surg Clin North Am 2014; 94:989-1002, vii-viii. [PMID: 25245963 DOI: 10.1016/j.suc.2014.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The number of melanoma survivors in the United States continues to steadily increase 2.6% per year, while death rates have remained stable over time. Although controversy exists regarding optimal surveillance strategies, recommendations for clinical monitoring are based on tumor stage, tumor phenotype, likelihood of recurrence, prognosis, risk factors, psychosocial impact of disease, and patient well-being. Management guidelines for recurrent disease depend on the type of recurrence: local, satellite/in-transit, regional, or distant metastasis. This article is a current review of the literature concerning melanoma survivorship.
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Affiliation(s)
- Amy A Mrazek
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Route 0534, Galveston, TX 77555, USA
| | - Celia Chao
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Route 0737, Galveston, TX 77555, USA.
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15
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Diao DY, Lee TK. Sun-protective behaviors in populations at high risk for skin cancer. Psychol Res Behav Manag 2013; 7:9-18. [PMID: 24379732 PMCID: PMC3873203 DOI: 10.2147/prbm.s40457] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Over 3 million new cases of skin cancer are diagnosed in the US annually. Melanoma, a subtype of skin cancer that can be fatal if the disease is not detected and treated at an early stage, is the most common cancer for those aged 25–29 years and the second most common cancer in adolescents and young adults aged 15–29 years. The primary carcinogen for the genesis of skin cancers is ultraviolet light from solar radiation and tanning beds. In spite of massive health campaigns to raise public awareness on ultraviolet radiation, sun-protective practices still fall behind. A plausible explanation is the lack of behavioral change in the populations at risk; in this review article, we examine sun-protective behavior in the four high-risk skin cancer groups: skin cancer survivors, individuals with a family history of melanoma, individuals with physical characteristics associated with skin cancer risk, and organ transplantation patients. Findings in the literature demonstrate that increased knowledge and awareness does not consequently translate into behavioral changes in practice. Behavior can differ as a result of different attitudes and beliefs, depending on the population at risk. Thus, intervention should be tailored to the population targeted. A multidisciplinary health team providing consultation and education is required to influence these much needed changes.
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Affiliation(s)
- Diana Y Diao
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim K Lee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada ; Cancer Control Research Program, BC Cancer Agency, Vancouver, British Columbia, Canada
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Idorn L, Datta P, Heydenreich J, Philipsen P, Wulf H. Sun behaviour after cutaneous malignant melanoma: a study based on ultraviolet radiation measurements and sun diary data. Br J Dermatol 2013; 168:367-73. [DOI: 10.1111/bjd.12066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Mayer D, Layman A, Carlson J. Sun-protection behaviors of melanoma survivors. J Am Acad Dermatol 2012; 66:e9-10. [PMID: 22177654 DOI: 10.1016/j.jaad.2010.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/29/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022]
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18
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Oliveria SA, Shuk E, Hay JL, Heneghan M, Goulart JM, Panageas K, Geller AC, Halpern AC. Melanoma survivors: health behaviors, surveillance, psychosocial factors, and family concerns. Psychooncology 2011; 22:106-16. [PMID: 23296633 DOI: 10.1002/pon.2059] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 07/26/2011] [Accepted: 08/02/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little research has been conducted on melanoma survivors and important opportunities exist for research in this understudied population. The study objective was to examine experiences of melanoma survivors regarding sun protection, surveillance practices, psychosocial and family concerns using focus groups. METHODS We identified patients (≥ 18 years) treated at Memorial Sloan-Kettering Cancer Center (USA) during 1996-2005 with invasive primary cutaneous melanoma, stages I-III. We stratified focus groups by age (<50 vs ≥ 50 years) and years since diagnosis (1 to <5 years vs 5-10 years). We performed qualitative thematic text analysis, which involved independent data review by multiple analysts (n = 2) followed by interpretation of key findings via consensus work. RESULTS Forty-eight survivors composed the final sample. Most did not conduct routine skin self-examinations. Survivors became more conscious of sun exposure and expanded their sun protection; some experienced anxiety if caught unprotected in the sun. Survivors were aware of the increased melanoma risk for family members, yet many did not discuss risk reduction. Melanoma diagnosis elevated the importance of retaining health insurance and purchasing life insurance for younger survivors. We did not identify significance difference between those diagnosed more or less recently. CONCLUSIONS We identified areas of high priority to melanoma survivors: skin self-examination, anxiety associated with sun exposure, familial risk communication, and maintaining health insurance benefits. The implications for cancer survivors are that these behavioral data will help to design health promotion and prevention programs that are tailored to melanoma survivors' risk status.
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Affiliation(s)
- Susan A Oliveria
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA.
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Idorn L, Philipsen P, Wulf H. Sun exposure before and after a diagnosis of cutaneous malignant melanoma: estimated by developments in serum vitamin D, skin pigmentation and interviews. Br J Dermatol 2011; 165:164-70. [DOI: 10.1111/j.1365-2133.2011.10348.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Živković M, Dediol I, Ljubičić I, Šitum M. Sun behaviour patterns and perception of illness among melanoma patients. J Eur Acad Dermatol Venereol 2011; 26:724-9. [DOI: 10.1111/j.1468-3083.2011.04154.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Chiarugi A, Nardini P, Crocetti E, Carli P, De Giorgi V, Borgognoni L, Brandani P, Pimpinelli N, Manganoni A, Quaglino P. Familial and sporadic melanoma: different clinical and histopathological features in the Italian population - a multicentre epidemiological study - by GIPMe (Italian Multidisciplinary Group on Melanoma). J Eur Acad Dermatol Venereol 2011; 26:194-9. [DOI: 10.1111/j.1468-3083.2011.04035.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Gómez-Moyano E, de Ramón E, Martínez-García S, Gómez R, Crespo-Erchiga V, Crespo A, Ojeda A. Impacto del diagnóstico de melanoma sobre la fotoprotección. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2009.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Behavioral factors of patients before and after diagnosis with melanoma: a cohort study - are sun-protection measures being implemented? Melanoma Res 2010; 20:147-52. [PMID: 20224304 DOI: 10.1097/cmr.0b013e328328f802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Melanoma is the deadliest form of all skin cancers and is highly linked to sun-related behavior in patients. However, sun-protection behavior to prevent melanoma in this population has been shown to be inadequate to date. The objective of this study was to compare changes in sun protection habit before and after patients' diagnosis with malignant melanoma. The study also seeks patients' advice on how to improve public education on melanoma prevention. A retrospective survey study was conducted on 68 respondents of patients diagnosed with melanoma from six different dermatologic practices in various boroughs of New York and Long Island in the state of New York by telephone interviews. There was a significant positive change in patients' sun-protection behavior after they were diagnosed with melanoma. Various methods of sun protection, such as avoiding sun exposure, applying and reapplying sunscreen, and wearing protective clothing were practiced more frequently after diagnosis. In addition, the frequency of sunbathing decreased drastically. Most patients were aware about the dangers of sun exposure before their diagnosis. They, however, did not feel the need to adopt sun-protection measures before their diagnosis. Respondents advised that education on dangers to excess sun exposure should be provided at an early age through multiple venues. The study reflected that 71% of diagnosed patients who completed the survey were informed about sun protection before their diagnosis. Many patients did not follow strict guidelines to prevent sun damage as shown by their behaviors before diagnosis. Diagnosis of the disease was apparently the main motivating factor to initiate challenging behavioral changes.
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Zahnd WE, Goldfarb J, Scaife SL, Francis ML. Rural-urban differences in behaviors to prevent skin cancer: An analysis of the Health Information National Trends Survey. J Am Acad Dermatol 2010; 62:950-6. [DOI: 10.1016/j.jaad.2009.08.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 07/10/2009] [Accepted: 08/14/2009] [Indexed: 11/15/2022]
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Mujumdar UJ, Hay JL, Monroe-Hinds YC, Hummer AJ, Begg CB, Wilcox HB, Oliveria SA, Berwick M. Sun protection and skin self-examination in melanoma survivors. Psychooncology 2010; 18:1106-15. [PMID: 19142859 DOI: 10.1002/pon.1510] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Patients diagnosed with melanoma are at risk for developing recurrent and second primary disease. Skin self-examination (SSE) and sun protection are standard clinical recommendations to minimize risk. In this study we examined performance of these behaviors in individuals with melanoma drawn from the general population. METHODS Potential participants (N=148) with a first primary melanoma diagnosed in 2000 were identified through a population-based cancer registry in New Jersey, USA. One hundred and fifteen individuals participated in a 30 min telephone interview concerning behavioral adherence with SSE and sun protection, self-efficacy for performing these behaviors, and perceived risk of developing another skin cancer. We utilized logistic regression to estimate potential associations of demographic, medical, and psychosocial factors with SSE and sun protection, respectively. RESULTS Seventeen percent of subjects reported performing comprehensive SSE at least once every two months and 23% engaged in regular sun protection. Utilization of SSE was related to the presence of moles (OR=4.2, 95% CI: 1.1-15) and higher SSE self-efficacy (OR=14.4, 95% CI: 1.9-112). Regular sun protection was related to older age (>60 years; OR=3.3, 95% CI: 1.3-8.7), being female (OR=2.8, 95% CI: 1.1-7.3), and higher sun protection self-efficacy (OR=5.0, 95% CI: 1.4-18). These factors remained significant in multivariate models. CONCLUSION In this group of primary melanoma survivors, the rates of SSE and sun protection are comparable to, but do not exceed, general population estimates. This study provides justification for further research to address barriers to prevention and control behaviors in melanoma survivors.
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Affiliation(s)
- Urvi J Mujumdar
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Aspinwall LG, Leaf SL, Kohlmann W, Dola ER, Leachman SA. Patterns of photoprotection following CDKN2A/p16 genetic test reporting and counseling. J Am Acad Dermatol 2009; 60:745-57. [PMID: 19278751 DOI: 10.1016/j.jaad.2008.12.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/12/2008] [Accepted: 12/18/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The impact of melanoma genetic testing and counseling on photoprotective behaviors is unknown. OBJECTIVE To determine if genetic testing and counseling alter compliance with photoprotection recommendations. METHODS Reported use of sunscreen, protective clothing, and sun avoidance by 59 members of CDKN2A/p16-mutation positive pedigrees was assessed as a function of mutation status and melanoma history, before, immediately after, and 1 month following test reporting. RESULTS Intentions to practice all photoprotective behaviors increased in all participant groups (P < .0001). At 1 month, 33% of participants reported the adoption of a new photoprotective behavior. Subpopulation analyses identified different patterns of change in photoprotection relative to baseline (P < .005), with no net decline in any group. LIMITATIONS This initial study of CDKN2A/p16 families is small and awaits replication in a larger sample. CONCLUSION Melanoma genetic testing and counseling enhanced intentions to implement photoprotective strategies and did not result in reduced compliance in the CDKN2A/p16-subpopulation.
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Affiliation(s)
- Lisa G Aspinwall
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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Renzi C, Mastroeni S, Mannooranparampil TJ, Passarelli F, Caggiati A, Pasquini P. Skin Cancer Knowledge and Preventive Behaviors among Patients with a Recent History of Cutaneous Squamous Cell Carcinoma. Dermatology 2008; 217:74-80. [DOI: 10.1159/000127389] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 11/27/2007] [Indexed: 11/19/2022] Open
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