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.
"According to an Australian study, although a higher proportion of skin cancer survivors perform SSE than the general population, only less than half of melanoma survivors (42%) and non-melanoma skin cancer patients (46%) performed SSE within the past year.50 Of the melanoma survivors who do perform SSEs, only 13.7%–22% of these individuals reported performing thorough SSEs.34,39,44 This means that over 75% of people in this high-risk group could be missing potential malignancies if SSEs were the only form of secondary prevention, highlighting the importance of two things: 1) the need for increased education on how to conduct proper and thorough SSEs, as only half of melanoma survivors reported having received education on how to do a SSE;44 and 2) the establishment that skin cancer survivors are to receive regular TBSEs performed by physicians. "
[Show abstract][Hide abstract] 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.
Psychology Research and Behavior Management 12/2013; 7:9-18. DOI:10.2147/PRBM.S40457
[Show abstract][Hide abstract] ABSTRACT: Background: A major goal of predictive genetic testing for melanoma is to promote early detection to reduce mortality. This study evaluated the long-term impact of melanoma genetic test reporting and counseling on screening adherence. Methods: This study assessed adherence to recommendations for annual total body skin examinations (TBSEs) and monthly skin selfexaminations (SSEs) among 37 members of Utah CDKN2A/p16 kindreds (10 unaffected carriers, 11 affected carriers, 16 unaffected noncarriers; response rate=64.9% of eligible participants). Results: Two years following test reporting, adherence to annual TBSE among unaffected carriers increased from 40% to 70%. However, unaffected noncarriers' adherence decreased from 56% to 13%. Affected carriers reported TBSEs at both assessments (91% and 82%, respectively). Monthly SSE frequency remained highly variable in all patient groups: at 2 years, 29.7% reported monthly SSEs, 27.0% reported more frequent self-examinations, and 43.2% reported underscreening. However, SSE quality improved significantly: participants checked more body sites at 2 years than at baseline, especially feet, shoulders, legs, and genitals. Perceived logistic barriers to TBSEs (e.g., expensive, inconvenient) and SSEs (hard to remember, time-consuming) predicted lower adherence. Conclusions: Unaffected carriers reported increased TBSE adherence and thoroughness of SSEs 2 years following melanoma genetic test reporting, suggesting clinical benefit in this modest sample. Unaffected noncarriers reported comparable gains in SSE thoroughness, but decreased TBSEs. Impact: Melanoma genetic counseling and test reporting may improve adherence among unaffected carrier members of p16 families. Further interventions to reduce logistic barriers and to promote continued screening adherence among unaffected noncarrier family members may be needed.
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