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Background Compared with other cancers, melanoma has the longest delays measured as the median time to patient presentation for care from symptom onset. Time to presentation for care is a key determinant of outcomes, including disease stage, prognosis, and treatment. Methods Melanoma survivors with localized disease and their skin check partners enrolled in two sequential randomized control trials of skin self‐examination (SSE) training. In Phase 1, the pair read a workbook in the office and had quarterly total body skin examinations with a study dermatologist. In Phase 2, materials were mailed to pairs, whose surveillance was with a community physician. SSE knowledge, performance (frequency and extent), and identification of concerning moles were compared between phases. Results Among 341 patients, 197 received the workbook and the others were controls. Knowledge in performing SSE was higher for the workbook relative to controls in both phases. The SSE frequency ranged from 2.38 to 5.97 times in 9 months. Patients randomized to the workbook in both phases performed significantly more SSE than controls at 9 months (P, The flexibility of remote training allowed greater participation than in‐person training with scheduled skin examinations with the doctor. Common patient follow‐up burdens such as difficulties scheduling appointments, time away from work and family, transportation constraints, and the cost of the physician visit were reduced by remote education. Both types of training resulted in greater detection of suspicious lesions and melanomas by trained melanoma survivors than by controls. Figure A shows SSE of the abdomen, B SSE of the scalp.

Background: Physician appointments for non-essential care ceased during COVID-19. Objective: To pilot test a telehealth solution for patients to rule out melanomas and need for surgical biopsies based on genomic analyses of pigmented lesion samples obtained via adhesive patches. Methods: Surveys assessed SSE anxiety. Under remote clinician guidance, patients or partners obtained samples using adhesive patches (DermTech, La Jolla, CA). Results: SSE anxiety increased. Guided self-sampling led to molecular risk factor analyses in 7/7 (100%) of cases compared to 9/10 (90%) randomly selected physician-sampled control cases. Conclusions: Adhesive patch self-sampling under remote physician guidance is a viable specimen collection option.

Background During the last 20 years, 50% of adults with sun-sensitive skin have sunburned annually. Reducing the proportion of people who sunburn requires understanding the circumstances and outdoor activities during which at-risk people sunburn. Methods A 7-day observational study of melanoma survivors (n = 20) and young adult first-degree relatives of melanoma survivors (FDRs) (n = 20) captured daily UV exposure, sun protection, and sunburns during spring and summer in the Midwest of the United States (latitude 41.8°N). Participants wore UV and physical activity sensors and completed a daily self-reported survey of sun protection, sunburn, and physical activities. The estimated protection-adjusted UV dose was calculated for each body area by integrating self-reported sun protection with UV sensor dose. Results In 254 days, at least one body area in 9 of 20 (45%) melanoma survivors and 11 of 20 (55%) FDRs was sunburned (erythema at 24 hours). Sunburns were associated with spring and walking for transportation or leisure, especially walking the dog. Melanoma survivors used sunscreen daily on the face; however, forearms and lower legs were not protected during walking. Young adults did not use sun protection on the face, forearms or lower legs during walking for transportation and use was ineffective during sports. Conclusion The sun protection patterns of daily living identified in this study may promote recognition of erythema as sunburn and inform the development of tailored sun protection mobile applications promoting self-monitoring with wearable UV sensors.

Histopathologic assessment of melanocytic neoplasms is the current gold standard of diagnosis. However, there are well recognized limitations including inter-observer diagnostic discordance. This study aimed to determine if integrating dermoscopy with histopathology of melanocytic neoplasms impacts diagnosis and improves inter-observer agreement. We conducted a prospective cohort study in a pigmented lesion clinic. Consecutive melanocytic lesions were identified for biopsy based on atypical gross or dermoscopic features. Standardized immunohistochemistry and levels were ordered on each specimen. The cases were randomized. Three dermatopathologists blinded to the clinical impression assessed each lesion. The cases were then re-randomized and re-assessed with addition of gross clinical and dermoscopic images. Inter-rater reliability (IRR) using Fleiss' kappa statistic revealed an increase from 0.447 without to 0.496 with dermoscopy amongst all dermatopathologists. The kappa increased from 0.495 before to 0.511 with dermoscopy in separating high-grade atypia or melanoma from moderate atypia or less. In 16 of 136 cases, at least 2 of 3 dermatopathologists favored a diagnosis of melanoma only after dermoscopy. In total, the consensus grade of atypia changed in 24.3% (33/ 136) of cases thereby representing changes to excisional margins and patient follow up. This study is limited by the cohort size. Dermoscopy significantly impacts diagnosis and improves identification of early melanomas in high risk populations and improves inter-observer agreement.

OBJECTIVE: Identification of barriers to seeking health care for a concerning mole found during skin self-examination (SSE) by women educated during screening mammography. METHODS: In this sequential mixed methods research, interviews with women who found a concerning mole and did not have health care follow-up were analyzed and a survey was created. One year after SSE education, barriers to having health care for a self-identified concerning mole were assessed. The electronic medical records for all participants, who received education, were reviewed to ascertain who received health care related to a concerning mole or a screening mammogram. RESULTS: Among the 280 women who performed SSE, 85 found a concerning mole. Nine months later 51 women did not receive health care for the mole. Barriers were the burden of other medical concerns, fear of what the doctor will find, feeling like nothing is wrong, and being too busy. A positive screening mammogram (Fisher’s two-sided exact test, p

ObjectiveAlthough black patients are more likely to have advanced melanomas at diagnosis, with a 5-year survival rate among black patients of 70% compared with 92% for white patients, black people are generally not the focus of melanoma public health campaigns. We sought to explore awareness and perspectives of melanoma among black people to inform the development of relevant and valued public health messages to promote early detection of melanoma.DesignInductive thematic analysis of in-depth semistructured interviews.SettingInterviews were conducted with participants via video software or telephone in the USA.ParticipantsParticipants were adults from the USA who self-identified as African American or black. Recruitment flyers were posted around the San Francisco Bay Area and shared on our team Facebook page, with further participants identified through snowball sampling.ResultsWe interviewed 26 participants from 10 different states. Overall, 12 were men and 14 were women, with a mean age of 43 years (range 18–85). We identified five key themes regarding melanoma awareness in black people: (1) lack of understanding of term ‘melanoma’ and features of skin cancer; (2) do not feel at risk of melanoma skin cancer; (3) surprise that melanoma can occur on palms, soles and nails; (4) skin cancer awareness messages do not apply to or include black people; and (5) Importance of relationship with healthcare and habits of utilisation.ConclusionsAnalysis of these in-depth semistructured interviews illuminate the pressing need for health information on melanoma designed specifically for black people. We highlight two key points for focused public health messaging: (1) melanoma skin cancer does occur in black people and (2) high-risk sites for melanoma in black people include the palms, soles and nail beds. Therefore, public health messages for black people and their healthcare providers may involve productively checking these body surface areas.

Background Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. Objective This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. Methods Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. Results Patients’ median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. Conclusions In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. Trial Registration ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796

Objectives Precision behavioral medicine techniques integrating wearable ultraviolet radiation (UVR) sensors may help individuals avoid sun exposure that places them at-risk for skin cancer. As a preliminary step in our patient-centered process of developing a just-in-time adaptive intervention, this study evaluated reactions and preferences to UVR sensors among melanoma survivors. Materials and Methods Early stage adult melanoma survivors were recruited for a focus group (n = 11) or 10-day observational study, which included daily wearing a UVR sensor and sun exposure surveys (n = 39). Both the focus group moderator guide and observational study exit interviews included questions on UVR sensing as a potential intervention strategy. These responses were transcribed and coded using an inductive strategy. Results Most observational study participants (84.6%) said they would find information provided by UVR sensors to be useful to help them learn about how specific conditions (eg, clouds, location) impact sun exposure and provide in-the-moment alerts. Focus group participants expressed enthusiasm for UVR information and identified preferred qualities of a UVR sensor, such as small size and integration with other devices. Participants in both studies indicated concern that UVR feedback may be difficult to interpret and some expressed that a UVR sensor may not be convenient or desirable to wear in daily life. Discussion Melanoma survivors believe that personalized UVR exposure information could improve their sun protection and want this information delivered in a method that is meaningful and actionable. Conclusion UVR sensing is a promising component of a precision behavioral medicine strategy to reduce skin cancer risk.

Background: Early stage melanoma survivors are typically otherwise healthy adults with a median age of 56.5 years for women at the time of diagnosis. Women have a projected lifespan of 20 to 30 additional years during which they should be able to enjoy and benefit from leisure outdoor physical activities while limiting their risk of a second melanoma from unprotected sun exposure. Objective: This study evaluated the physical activity of melanoma survivors before their diagnosis of melanoma as well as 2 to 3 months and 12 months after surgical resection. Methods: Participants in this observational study were early stage melanoma survivors (Stage 0-1A) who were surgically treated for melanoma within the last 6 months. Participants completed three online surveys (Leisure Time Exercise Questionnaire) that estimated their physical activity 2 to 3 months prior to the diagnosis with melanoma as well as 2 to 3 months and 12 months after surgery. Results: All 75 participants were non-Hispanic white, and 38 of 75 participants (50.6%) were women. The median age of this urban/suburban Midwest population was 52 years. Prior to their diagnosis, all melanoma survivors were active, and 55% of women reported vigorous leisure physical activity. Two to three months after surgery, 11 of 38 women (30%) were inactive and 31% were inactive at 12 months. At 12 months after surgery, inactivity was positively correlated with older age (61-80+ years; F1050 = 15.38; p < .001) and being a woman (0.05; F1050 = 11.02; p < .01). Conclusion: Dermatologists are in a position to promote a healthy lifestyle for melanoma survivors, especially older women who can be expected to live many more years and may restrict leisure outdoor physical activity to comply with sun protection recommendations. When considering the overall health of older, female melanoma survivors, dermatologists may recommend they walk with a friend at any time of the day while wearing a hat, protective clothing, and sunscreen on exposed skin. Keywords: melanoma, physical activity, inactivity, healthy lifestyle

BACKGROUND Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. OBJECTIVE This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. METHODS Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. RESULTS Patients’ median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. CONCLUSIONS In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. CLINICALTRIAL ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796

Despite knowledge of subsequent melanoma risk and the benefit of sun protection in risk reduction, melanoma survivors often do not engage in adequate sun protection and continue to sunburn at rates similar to individuals without a history of skin cancer. This novel intensive intervention provided a wearable UV sensor delivering real-time UV exposure with a smartphone and daily text messages. On days 1–10 (period 1), behavioral facilitation and outcome expectancies messages were provided. On day 10, participants reviewed and reflected on their daily UV exposure on the previous 10 days and set goals for improving sun protection. Then on days 11–21 (period 2) self-efficacy and self-regulation messages were provided. Sixty melanoma survivors were randomized (1:1) to receive structured or unstructured goal setting queries on day 10. Controlling for cloudy/rain conditions with less UV due to weather, there was a time effect with a significant decrease in UV exposure from periods 1–2 [period 1–2, F (59) = 22.60, p

Histopathologic assessment of melanocytic neoplasms is the current gold standard of diagnosis. However, there are well recognized limitations including inter-observer diagnostic discordance. This study aimed to determine if integrating dermoscopy with histopathology of melanocytic neoplasms impacts diagnosis and improves inter-observer agreement. We conducted a prospective cohort study in a pigmented lesion clinic. Consecutive melanocytic lesions were identified for biopsy based on atypical gross or dermoscopic features. Standardized immunohistochemistry and levels were ordered on each specimen. The cases were randomized. Three dermatopathologists blinded to the clinical impression assessed each lesion. The cases were then re-randomized and re-assessed with addition of gross clinical and dermoscopic images. Inter-rater reliability (IRR) using Fleiss' kappa statistic revealed an increase from 0.447 without to 0.496 with dermoscopy amongst all dermatopathologists. The kappa increased from 0.495 before to 0.511 with dermoscopy in separating high-grade atypia or melanoma from moderate atypia or less. In 16 of 136 cases, at least 2 of 3 dermatopathologists favored a diagnosis of melanoma only after dermoscopy. In total, the consensus grade of atypia changed in 24.3% (33/ 136) of cases thereby representing changes to excisional margins and patient follow up. This study is limited by the cohort size. Dermoscopy significantly impacts diagnosis and improves identification of early melanomas in high risk populations and improves inter-observer agreement.

In population and clinical-based studies, UV wearable sensors are increasingly being used to estimate UV exposure and time spent in physical activity outdoors, which is critical for understanding people's sun exposure behavior. This is particularly important in young adults at risk of developing melanoma as well as melanoma survivors, who want to continue engaging in outdoor activities which are a normal source of recreational physical activity. While wearable sensors provide objective and timely measures in free-living populations, self-report data are needed to provide important contextual information (e.g. sunscreen applied, clothing to protect from the sun) that improve our understanding of health behaviors. However, lack of proper time alignment between sensor and self-report data hinders analyses incorporating these data streams. We formulate this problem of alignment as a network flow graph and propose a Sensor Self-Report Alignment (SSRA) framework to fuse and align data from a chest-worn UV sensor, a hip-worn physical activity sensor, and a self-report. We performed a study on 40 participants (20 melanoma survivors, 20 young adults, who were first-degree relatives of melanoma survivors) who wore a chest-worn UV sensor and a hip-worn physical activity sensor for 7 consecutive summer days (total of 254 days assessed) and provided end-of-day self-reports of sun protection. The proposed SSRA framework provides a new approach to aligning sensor and self-report data, which results in significant changes in measures of time outdoors, as assessed by UV or physical activity sensors. This paper highlights the importance of using wearable sensors and alignment to self-report to reduce sun exposure assessment error, while laying the groundwork for integrating such a framework into population-based studies.

Recent progress in the treatment of advanced melanoma has led to unprecedented improvements in overall survival and, as these new melanoma treatments have been developed and deployed in the clinic, much has been learned about the natural history of the disease. Now is the time to apply that knowledge toward the design and clinical evaluation of new chemoprevention agents. Melanoma chemoprevention has the potential to reduce dramatically both the morbidity and the high costs associated with treating patients who have metastatic disease. In this work, scientific and clinical melanoma experts from the national Melanoma Prevention Working Group, composed of National Cancer Trials Network investigators, discuss research aimed at discovering and developing (or repurposing) drugs and natural products for the prevention of melanoma and propose an updated pipeline for translating the most promising agents into the clinic. The mechanism of action, preclinical data, epidemiological evidence, and results from available clinical trials are discussed for each class of compounds. Selected keratinocyte carcinoma chemoprevention studies also are considered, and a rationale for their inclusion is presented. These data are summarized in a table that lists the type and level of evidence available for each class of agents. Also included in the discussion is an assessment of additional research necessary and the likelihood that a given compound may be a suitable candidate for a phase 3 clinical trial within the next 5 years.

One in five US adults will be diagnosed with skin cancer. As most skin cancers are attributable to sun exposure, this risk factor is an important target for research and intervention. Most sun exposure measures assess frequency of specific sun-protection behaviors, which does not account for the use of multiple, potentially overlapping sun-protection methods. In contrast, the Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory assesses sun-protection behavior during self-reported activities, providing several useful metrics, including duration of unprotected sun exposure on 17 body sites, combined to yield an overall MUSE score weighted by percent of body exposed. The present study was conducted July–September 2017, in Chicago, IL USA. For 10 days, participants (39 melanoma survivors; Mage = 58.59, 64.5% female) wore an ultraviolet radiation (UVR) sensor and completed the Daily MUSE Inventory each evening. The Sun Habits Survey was completed at the end of the study. Outdoor time reported in the MUSE Inventory significantly predicted outdoor time recorded by UVR sensors, B = 0.53, p

BACKGROUND: Early detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma. OBJECTIVE: To develop and demonstrate the efficacy of online training. DESIGN: Randomized educational trial. PARTICIPANTS: Primary care providers (PCPs). INTERVENTION: Mastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard. MAIN MEASURES: Pre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention. KEY RESULTS: Among the 89 PCPs, 89.8% were internal medicine physicians, and the remainder were physician assistants embedded in internists’ practices. There were no differences between control and intervention groups regarding gender, age, race, or percentage of full-time PCPs. The control group had more PCPs who reported less than 5 years of practice (n = 18) than the intervention group (n = 6) (χ(2) [6, n = 89] = 14.34, p = 0.03). PCPs in the intervention group answered more melanoma detection questions correctly on the post-test (M = 10.05, SE = 1.24) compared to control group PCPs (M = 7.11, SE = 0.24), and had fewer false-positive and no false-negative melanoma diagnoses (intervention, M = 1.09, SE = 0. 20; control, M = 3.1, SE = 0.23; ANCOVA, F[1,378] =27.86, p

Highlights • At-risk women receiving online skin self-examination education initiated mole checks. • Women receiving skin self-examination education sought health care when necessary. • Provided education increased confidence in mole checking and did not affect anxiety. • Women trained to do skin checks had fewer appointments for benign mole than controls. • Detection of early melanomas was facilitated by skin self-examination education., Secondary melanoma prevention remains crucial to reduce morbidity and mortality for the 200,000 people in the United States estimated to develop melanoma in 2021. This 3-month randomized controlled trial of online skin self-examination (SSE) education among 1000 at-risk women who received care at Northwestern Medicine in Illinois sought to determine SSE initiation and monthly performance, SSE anxiety and confidence, and health care practitioner (HCP) visits for concerning moles. Positive responses to a personal history of sunburn, a personal or family history of skin cancer, and/or having 10 or more lifetime indoor tanning sessions identified and informed women of their increased risk of melanoma. At one month, 96.2% of women receiving SSE education (SSE women) initiated SSE compared to 48.1% in the active control arm (control) (p

Background: Invasive melanoma, a lethal form of skin cancer, is the seventh most common cancer in women. Factors such as a history of indoor tanning or sunburn and a personal or family history of skin cancer increase a woman’s risk of developing a melanoma. Objective: Because the majority of melanomas occur in patients age 40 years or older, which is the age that is recommended for women to begin screening mammograms, the mammogram experience could be used to promote early detection of melanoma by introducing skin self-examinations (SSE) to a population of women who are already invested in preventive health. Methods: This was a pilot and feasibility study that was designed to promote the early detection of melanoma among women who undergo a mammogram at the Lynn Sage Breast Center at the Northwestern Medicine/Prentice Women’s Hospital in Chicago, Illinois. The study was conducted in three phases: development of the materials, delivery of the program, and assessment of the program effectiveness. Results: Eighty six percent of women with scheduled mammogram appointments participated in the study (n = 560). Among these women, 68% noticed the SSE information in the changing rooms, 78% thought the information applied to them, and 68% identified with at least one of the risk factors for melanoma. Twenty percent of the patients checked their skin in the changing room, 13% noticed a concerning mole, and 60% of those women who noted a concerning lesion stated their intent to see a dermatologist for further evaluation. Conclusion: A large proportion of the women in our study had risk factors for developing a melanoma and noticed the SSE information in the screening center. Placing an intervention to encourage methods for the early detection of melanoma in an outpatient mammography environment is an effective strategy to increase awareness in a large proportion of at-risk women. Keywords: melanoma, skin self-examination, skin cancer screening, mammogram

Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.

Objective This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. Method We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. Results Findings indicate that no entity in the health care system self-identifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. Conclusions To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sociocultural values toward skin color manifest in daily behaviors, such as sun-seeking behaviors in Euro-American culture and sun-protective behaviors in Chinese culture. However, little research has investigated how attitudes toward skin color affect sun-related behaviors in the face of conflicting cultural values. This study explores how sociocultural contexts shape attitudes toward skin color and sun-related behaviors in three groups of genetically Chinese women, located on a spectrum from predominantly Chinese culture to predominantly Euro-American culture. Using ethnographic and qualitative comparative approaches, interviews were conducted with (a) 15 Chinese women (Mage = 25; SD = 2.73) who grew up in mainland China until at least age 18 years and then moved to the United States, (b) 15 second-generation Chinese Americans (Mage = 20; SD = 1.16) raised in the United States by Chinese parents, and (c) 18 Chinese adoptees (Mage = 21; SD = 1.13) raised in the United States by Euro-American parents. Overall, Chinese women leaned toward Chinese culture, preferred lighter skin, and engaged in more sun-protection practices. Chinese adoptees leaned toward Euro-American culture, preferred tanned skin and sun-seeking behaviors, and experienced more sunburns. Chinese Americans had mixed results, exemplifying a double-bind in adherence to either Euro-American or Chinese cultural values. Findings elucidate the connections between sun-related behaviors and sociocultural backgrounds, especially how embracing Euro-American culture might increase sun exposure and sunburn tendency. Since sun exposure contributes to health outcomes (e.g., skin cancer, vitamin D status, and bone density), these findings have significant implications for public health prevention efforts.

Author(s): Jeter, Joanne M; Bowles, Tawnya L; Curiel-Lewandrowski, Clara; Swetter, Susan M; Filipp, Fabian V; Abdel-Malek, Zalfa A; Geskin, Larisa J; Brewer, Jerry D; Arbiser, Jack L; Gershenwald, Jeffrey E; Chu, Emily Y; Kirkwood, John M; Box, Neil F; Funchain, Pauline; Fisher, David E; Kendra, Kari L; Marghoob, Ashfaq A; Chen, Suephy C; Ming, Michael E; Albertini, Mark R; Vetto, John T; Margolin, Kim A; Pagoto, Sherry L; Hay, Jennifer L; Grossman, Douglas; Ellis, Darrel L; Kashani-Sabet, Mohammed; Mangold, Aaron R; Markovic, Svetomir N; Jr, Meyskens Frank L; Nelson, Kelly C; Powers, Jennifer G; Robinson, June K; Sahni, Debjani; Sekulic, Aleksandar; Sondak, Vernon K; Wei, Maria L; Zager, Jonathan S; Dellavalle, Robert P; Thompson, John A; Weinstock, Martin A; Leachman, Sancy A; Cassidy, Pamela B

Melanoma is one of the most treatable types of cancers if detected early, a task that often depends on non-dermatologist providers. However, only 54%–56% of family practitioners and internists reported skill and comfort in performing total body skin exams and fewer than 50% of referrals to dermatologists include the correct diagnosis.1 2 The asymmetry, border, colour, diameter and evolution (ABCDE) system is traditionally taught for detecting melanoma but uses exclusively rule-based criteria, whereas melanoma and its mimickers belong to ‘fuzzy’ categories in which visual features overlap on a spectrum.3 Perceptual expertise, the ability to identify objects rapidly and accurately at specific levels of categorisation, contributes to discriminating between fuzzy categories.4 Novices may develop perceptual expertise through experience or through targeted visual perception training (VPT). Previous work demonstrated that VPT successfully improved the ability of undergraduates to diagnose melanoma, although follow-up was limited to 1 week.5 This prospective cohort trial of preclinical medical students was performed to evaluate the effectiveness of a novel, technology-based VPT system for melanoma detection with retention assessed at 4 weeks. All participants were preclinical medical students at an urban, private medical school in the USA. All participants (both control and intervention) were presented with a web-based instructional handout describing the ABCDEs of identifying suspicious skin lesions. The ABCDEs remains a mainstay of education for both dermatologists and non-dermatologists in the detection of melanoma.6 We assigned 20 medical students to the VPT training group and 10 to …

BACKGROUND Cancer survivors face an increased risk of cardiovascular events compared with the general population. Adopting a healthy lifestyle may reduce these risks, and guidelines encourage health-promotion counseling for cancer survivors, but the extent of physician adherence is unclear. METHODS This mixed-method study surveyed 91 physicians, including 30 primary care physicians (PCPs), 30 oncologists, and 31 specialists (urologists, dermatologists, and gynecologists). Interviews also were conducted with 12 oncologists. RESULTS Most PCPs (90%) reported recommending health promotion (eg, weight loss, smoking cessation) to at least some cancer survivors, whereas few oncologists (26.7%) and specialists (9.7%) said they ever did so (P

Exposure to electromagnetic radiation can have a profound impact on human health. Ultraviolet (UV) radiation from the sun causes skin cancer. Blue light affects the body’s circadian melatonin rhythm. At the same time, electromagnetic radiation in controlled quantities has beneficial use. UV light treats various inflammatory skin conditions, and blue light phototherapy is the standard of care for neonatal jaundice. Although quantitative measurements of exposure in these contexts are important, current systems have limited applicability outside of laboratories because of an unfavorable set of factors in bulk, weight, cost, and accuracy. We present optical metrology approaches, optoelectronic designs, and wireless modes of operation that serve as the basis for miniature, low-cost, and battery-free devices for precise dosimetry at multiple wavelengths. These platforms use a system on a chip with near-field communication functionality, a radio frequency antenna, photodiodes, supercapacitors, and a transistor to exploit a continuous accumulation mechanism for measurement. Experimental and computational studies of the individual components, the collective systems, and the performance parameters highlight the operating principles and design considerations. Evaluations on human participants monitored solar UV exposure during outdoor activities, captured instantaneous and cumulative exposure during blue light phototherapy in neonatal intensive care units, and tracked light illumination for seasonal affective disorder phototherapy. Versatile applications of this dosimetry platform provide means for consumers and medical providers to modulate light exposure across the electromagnetic spectrum in a way that can both reduce risks in the context of excessive exposure and optimize benefits in the context of phototherapy.

Summary Although a deadly form of skin cancer, melanoma is treatable if detected early. However, current rule-based training practices in melanoma detection are not effective. We assessed an innovative technique to train melanoma detection using the perceptual expertise principles. Participants in the training group were trained to categorize melanoma and benign lesions to 95% accuracy. Participants in the control group received no training. Prior to testing all participants reviewed the ABCDE rules. Training was evaluated by the pre and post tests using the Melanoma Detection Test where participants categorized images of melanoma and benign lesions. As compared to the control group, the training group showed significant improvement in melanoma detection and became less liberal (i.e., bias toward categorizing a lesion as melanoma), and both improvements maintained a week after the training. These findings indicate that perceptual expertise training is a promising approach to train melanoma detection.Copyright © 2016 John Wiley & Sons, Ltd.

Muir-Torre syndrome (MTS) is a rare inherited syndrome, with an increased risk of sebaceous and visceral malignancy. Prior reports suggest screening for mismatch repair (MMR) deficiency may be warranted in patients50 years and when sebaceous neoplasms are located on a non-head and neck location. Previously, appropriate use criteria (AUC) were developed for clinical scenarios in patients60 years concerning the use of MMR protein immunohistochemistry (MMRP-IHC). This analysis explores the appropriateness of testing in patients ≤60 years.Panel raters from the AUC Task Force rated the use of MMRP-IHC testing for MTS for previously rated scenarios with the only difference being age.Results verify the previously developed AUC for the use of MMRP-IHC in neoplasms associated with MTS in patients60 years. Results also show that in patients ≤60 years with a single sebaceous tumor on a non-head and neck site, MMRP-IHC testing should be considered. Testing can also be considered with a 2-antibody panel on periocular sebaceous carcinoma in younger patients.Our findings align with known evidence supporting the need to incorporate clinical parameters in identifying patients at risk for MTS, with age being a factor when considering MMRP-IHC testing.

Many medical professions require practitioners to perform visual categorizations in domains such as radiology, dermatology, and neurology. However, acquiring visual expertise is tedious and time-consuming and the perceptual strategies mediating visual categorization skills are poorly understood. In this paper, the Ease algorithm was developed to predict an item’s categorization difficulty (Ease value) based on the item’s perceptual similarity to all within-category items versus between-category items in the dataset. In this study, Ease values were used to construct an easy-to-hard and hard-to-easy training schedule for teaching melanoma diagnosis. Whereas previous visual training studies suggest that an easy-to-hard schedule benefits learning outcomes, no studies to date have demonstrated the easy-to-hard advantage with complex, real-world images. In our study, 237 melanoma and benign images were collected for training and testing purposes. The diagnostic accuracy of images was verified by an expert dermatologist. Based on their Ease values, the items were grouped into easy, medium, and hard categories, each containing an equal number of melanoma and benign lesions. During training, participants categorized images of skin lesions as either benign or melanoma and were given corrective feedback after each trial. In the easy-to-hard training condition, participants learned to categorize all the easy items first, followed by the medium items, and finally the hard items. Participants in the hard-to-easy training condition learned items in the reverse order. Post-training results showed that training in both conditions transferred to the classification of new melanoma and benign images. Participants in the easy-to-hard condition showed modest advantages both in the acquisition and retention of the melanoma diagnosis skills, but neither scheduling condition exhibited a gross advantage. The Ease values of the items predicted categorization accuracy after, but not before training, suggesting that the Ease algorithm is a promising tool for optimizing medical training in visual categorization. Electronic supplementary material The online version of this article (10.1186/s41235-018-0131-6) contains supplementary material, which is available to authorized users.

BackgroundMelanoma 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.Methods39 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.FindingsFor 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.ConclusionThese 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.

IMPORTANCE: Despite receiving dermatologic care, many patients with or without a history of skin cancer either do not use sun protection or fail to use it in an effective manner. OBJECTIVE: To examine the association of a brief dermatologist-delivered intervention vs usual care with patient satisfaction and sun protection behavior. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal controlled cohort study among adults receiving dermatology care was conducted from April 25 to November 6, 2017, at 2 dermatologic clinic sites within a Northeastern health care system to compare outcomes associated with the intervention with that of usual care on 1- and 3-month patient outcomes. The sample consisted primarily of non-Hispanic white patients aged 21 to 65 years. Participants were assigned to the intervention group (n = 77) or the control group (n = 82) based on the site location of their dermatologists. INTERVENTIONS: The intervention (

BACKGROUND: Guidelines for follow-up of melanoma patients are based on limited evidence. OBJECTIVES: To guide skin surveillance, we developed a risk prediction model for subsequent primary melanoma based on demographic, phenotypic, histopathologic, sun exposure, and genomic risk factors. METHODS: Using Cox regression frailty models, we analysed data for 2,613 melanomas from 1,266 patients recruited to the population-based Genes, Environment and Melanoma (GEM) study in New South Wales, Australia, with a median of 14 years follow-up via the cancer registry. Discrimination and calibration were assessed. RESULTS: The median time to diagnosis of a subsequent primary melanoma decreased with each new primary. The final model included 12 risk factors. Harrell’s C-statistic was 0.73 (95% confidence interval [CI] 0.68–0.77), 0.65 (95% CI 0.62–0.68) and 0.65 (95% CI 0.61–0.69) for predicting second, third and fourth primary melanomas, respectively. The risk of a subsequent melanoma was 4.75 times higher (95% CI 3.87–5.82) for the highest versus lowest quintile of the risk score. The mean absolute risk of subsequent primary melanoma within 5 years was 8.0% (standard deviation [SD] 4.1%) after the first melanoma and 46.8% (SD 15.0%) after the second, but varied substantially by risk score. CONCLUSIONS: The risk of developing a subsequent primary melanoma varies considerably between individuals and is particularly high for those with two or more previous melanomas. This risk prediction model and nomograms enables estimation of absolute risk of subsequent melanoma based on an individual’s risk factors and can be used to tailor surveillance intensity, communicate risk and provide patient education.

Background Although treatments to address cosmetic concerns are common, patients' self-reported motives for considering such procedures have not been systematically explored. Objective To develop a framework of categories to describe patients' self-reported motivations for undergoing minimally invasive cosmetic procedures. Methods Face-to-face, semistructured patient interviews were conducted with adult participants who had undergone or were considering minimally invasive cosmetic dermatologic procedures. A qualitative constant comparative approach was used to analyze interview transcripts, yielding themes and subthemes. Results A total of 30 interviews were completed. Most patient-reported motivations for cosmetic procedures could be subsumed under 8 general categories (themes): (1) mental and emotional health, (2) cosmetic appearance, (3) physical health, (4) work and/or school success, (5) social well-being, (6) cost and/or convenience, (7) procedural perceptions, and (8) timing of treatment. Many individual motivations in these categories were unrelated to desire for physical beauty. In particular, participants wanted to avoid being self-conscious, enhance confidence, reduce the time and expense required to conceal physical imperfections, and be perceived as capable at work. Limitations Only English-speaking patients in the United States were interviewed. Conclusion Patient-reported motivations for cosmetic procedures mostly pertained to physical and psychosocial well-being. Indeed, a desire for improved cosmetic appearance was only 1 of the 8 themes revealed through the patient interviews.

Background: Sun exposure, particularly during childhood, is an important contributing factor in developing melanoma later in life. Objective: To develop a family-centered, self-reinforcing sun protection educational intervention that supports pediatrician’s anticipatory guidance and assess the feasibility of delivering the sun protection intervention in pediatrician offices, and use of sun protection among those receiving the intervention. Methods: Focus groups and structured interviews with stakeholders supported the iterative design process for the read-along book to be read by caregivers with 2-6 year old children. A feasibility study examined distribution of the read-along books and shirts in pediatrician’s offices, whether the books were read and how often, and sun protection used. Results: The read-along books were distributed to 153 children in two ambulatory office locations. Offices that usually distributed books to enhance literacy distributed the read-along book more than those who did not customarily distribute books. (p