Melanoma survivors: health behaviors, surveillance, psychosocial factors, and family concerns.

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.

Recognition of melanoma: a dermatologic clinical competency in medical student education.

BACKGROUND: Non-dermatologist physicians are well positioned for opportunistic melanoma detection; however, education in the skin cancer examination is limited during medical school and traditionally lecture-based. Simulating melanoma cases provides a means to demonstrate whether proficiency in knowledge and recognition of melanoma images translates into improved clinical skill. OBJECTIVE: To evaluate medical student recognition and appropriate response to a prosthetic melanoma placed on a standardized patient (SP) during a simulated clinical encounter. METHODS: In this pilot study, prosthetic mimics of melanoma were placed on the backs of SPs unbeknownst to a convenience sample of 59 second-year medical students. The study took place during clinical skills practice sessions with SPs conducted from February to April 2010 at Mount Sinai School of Medicine (New York, NY). SPs presented with non-dermatologic chief complaints typical for an acute office visit. All students had the opportunity to attend a lecture on the clinical signs of melanoma 2 to 4 months earlier, for which pre-test and post-test data were collected. RESULTS: Recognition and evaluation of a prosthetic melanoma as determined by querying the SPs and reviewing the students' examination notes. During the SP encounter, 37 students (63%) asked about the melanoma moulage; of those, 25 (68%) made recommendations for further evaluation. The moulage was documented in 17 examination notes (43%). Thirty-three students (56%) asked about the skin on review of systems, although this did not predict moulage detection. CONCLUSIONS: Prosthetic mimics of melanoma are useful tools for assessing skin cancer awareness and detection skills among medical students.

Developing an interactive web-based learning program on skin cancer: the learning experiences of clinical educators.

Web-based learning in medical education is rapidly growing. However, there are few firsthand accounts on the rationale for and development of web-based learning programs. We present the experience of clinical educators who developed an interactive online skin cancer detection and management course in a time-efficient and cost-efficient manner without any prior skills in computer programming or technical construction of web-based learning programs. We review the current state of web-based learning including its general advantages and disadvantages as well as its specific utility in dermatology. We then detail our experience in developing an interactive online skin cancer curriculum for primary care clinicians. Finally, we describe the main challenges faced and lessons learned during the process. This report may serve medical educators who possess minimal computer programming and web design skills but want to employ the many strengths of web-based learning without the huge costs associated with hiring a professional development team.

Skin cancer education for primary care physicians: a systematic review of published evaluated interventions.

BACKGROUND: Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting. OBJECTIVE: We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma. DESIGN: Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary. APPROACH: Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes. KEY RESULTS: All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics. CONCLUSIONS: Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.

Knowledge, motivation, and behavior patterns of the general public towards sun protection.

The general public has long been educated about the harms of ultraviolet (UV) exposure and the benefits of photoprotection. Many organizations have worked in close collaboration to deliver the photoprotection message through a variety of programs. Most address the health-related consequences of UV radiation, although appearance-based strategies have also been initiated. As is common with preventative health measures, these intervention efforts have not resulted in meaningful changes in public behavior despite providing seemingly adequate knowledge to do so. Behaviors are often difficult to change on a societal, personal, and biological level. Within these categories, there are unique reasons for the unsatisfactory outcome with photoprotection such as (1) tan is perceived as beautiful, (2) the knowledge conveyed is often superficial, (3) there is a lack of immediate risk/reward, and (4) UV has reinforcing effects on mood. We propose that better results could be achieved by creating interventions focused on demographic subsets of the population. Specific techniques include anti-tanning legislature, age or gender-based screening campaigns, anti-tan beauty campaigns, and UV photography. Future photoprotection messages should shift from purely promoting knowledge to inspiring improvements in behavior with targeted strategies.

Effect of dermoscopy education on the ability of medical students to detect skin cancer.

OBJECTIVES: To determine students' ability to discriminate benign vs malignant lesions and to assess attitudes regarding skin cancer examination (SCE). DESIGN: Second-year medical students at 1 institution participated in an SCE intervention for 2 consecutive years. INTERVENTION: Cohort 1 received intervention A, consisting of SCE teaching without a dermoscopy tutorial. Cohort 2 received intervention B, consisting of SCE teaching with a dermoscopy tutorial, access to online dermoscopy resources, and a dermoscope. MAIN OUTCOME MEASURE: Surveys before and after the lecture included an image-based test of 10 lesions to assess ability to differentiate benign from malignant lesions. RESULTS: There were 130 participants from cohort 1 and 131 participants from cohort 2 at the postintervention survey. At baseline, students in both groups reported similar attitudes regarding the value of SCE (P = .05) and intention to perform SCE on patients (P = .55). Overall, cohort 2 exhibited improvement (P < .001) from preintervention (52.0% correct) to postintervention assessments (63.0% correct), whereas cohort 1 did not (47.0% and 46.0% correct, respectively; P = .50). Although both groups improved (P < .001) in the diagnosis of the superficial spreading melanoma, cohort 2 improved in the diagnosis of the basal cell carcinoma (P < .001) and cohort 1 displayed deterioration in identifying the malignant nature of this lesion (P < .001). For the nodular melanoma, correct diagnosis decreased significantly in cohort 1 (P < .001) and negligibly in cohort 2 (P = .90). CONCLUSIONS: Students receiving the dermoscopy tutorial improve in diagnosis of cutaneous lesions compared with those not receiving the dermoscopy intervention. Teaching SCE with inclusion of dermoscopy may be an effective means of enhancing skin cancer knowledge.

Dermoscopy in skin self-examination: A useful tool for select patients.

BACKGROUND: Education for patients on the technique of skin self-examination is important for improving the rate of early detection of melanoma. Strategies to improve skills in skin self-examination include the use of mnemonics to facilitate the recognition of melanoma features and photography to assist in the detection of change. OBSERVATION: We describe 2 patients who used dermoscopy on their own initiative to help identify suspicious pigmented lesions during skin self-examination. CONCLUSIONS: Dermoscopy has not yet been evaluated for patient use. We were intrigued by this concept and suggest that dermoscopy, with appropriate training, may improve the ability for early detection of melanoma in skin self-examination for select patients.