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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. 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. 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. 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.

Although 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. Inductive thematic analysis of in-depth semistructured interviews. Interviews were conducted with participants via video software or telephone in the USA. Participants 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. We 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. Analysis 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 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 < .05). In both phases, trained survivors performed significantly more SSEs on the scalp than controls at 9 and 18 months (P < .05). Phase 1 survivors performed significantly more SSEs on the abdomen, buttocks, and soles of the feet than controls, but this did not occur in Phase 2. Finally, in both phases, survivors trained with the workbook resulted in greater detection of suspicious lesions and melanomas. Conclusions These findings justify the benefits of remote SSE training for patients as an adjunct to provider‐administered screening. 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.

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.

Compared with other cancers, melanoma has the longest delays measured as the median time from symptom onset to patient presentation (6). Since most melanomas are visible on the surface of the skin at a curable phase in their evolution, people at-risk to develop melanoma can check their moles by performing skin self-examination (SSE). Rural residents, who are older, more socioeconomically disadvantaged and less educated than their urban counterparts, have greater travel distances and transportation difficulties in reaching healthcare providers (HCPs) for both general and specialty care than urban residents (11). [...]self-management for early detection of melanoma among at-risk people and health disparities are effectively addressed, patients will present late in the disease incurring significant mortality, morbidity and healthcare costs. Among those at-risk to develop melanoma, melanoma survivors may be reached by physicians because patients receive routine follow-up care from physicians every 3-12 months (13), While the importance of early detection is usually recognized by melanoma survivors, they may not realize that 7-12% of patients with a history of melanoma develop a second primary melanoma (15). [...]physicians need to inform melanoma survivors of their risk of developing another melanoma. Since a new melanoma may arise in the interval between physician follow-up visits, physician endorsement of SSE is worthwhile.

Identification of barriers to seeking health care for a concerning mole found during skin self-examination (SSE) by women educated during screening mammography. 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. 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 < 0.001) and a history of indoor tanning (Fisher’s two-sided exact test, p = 0.011) were significantly associated with lack of follow-up for a concerning mole. Targeted melanoma self-identification with SSE relies upon participants initiating performance and seeking medical care for a concerning mole. The burden of a positive screening mammogram reported to women at about the same time as they identified the concerning mole was associated with failing to seek care for their concerning mole. Reminders to check moles for change 4 months after identifying a concerning mole may benefit women. Clinicaltrials.gov NCT03512457

In the USA, skin cancer is the most common cancer, more than all other cancers combined. Skin cancer may be prevented by using sun protection. This is particularly important in 18–29-year-olds who, compared to older individuals, experience sunburns more frequently. Moreover, in locations close to the equator, such as Florida, people are at an increased risk of developing melanoma. College marching band members spend a significant amount of time in the sun, as much as 25 h weekly practicing and performing at games, yet little is known about this population. We examined and compared sun exposure and protection practices among Florida college marching band members and alumni. In 2020, anonymous cross-sectional web-based surveys were distributed via email and private Facebook groups. A total of 859 members and alumni of five Florida university marching bands participated. Questionnaires assessed demographic characteristics, sun protection behaviors, as well as history of sunburn and skin cancer. Analyses of variance and multiple linear regression analyses were employed to compare sun protection practices between band members and alumni. During sunny day practices, only 16.1% (63/391) of alumni and 27.1% (127/468) of current band members always wore sunscreen. In the multiple linear regression, after adjusting for gender, race/ethnicity, and family history of skin cancer, alumni, who participated in marching band practices within the past 50 years, were significantly less likely to wear sunscreen or hats compared to current band members. Overall, men were less likely to wear sunscreen but were more likely to wear hats and shirts with sleeves that cover their shoulders compared to women. Compared to the general US population in 2017 (0.38%), alumni of Florida college marching bands in 2020 (2.04%) have a self-reported increase in melanoma prevalence of 1.66%. Of note, melanoma diagnoses were only reported by alumni who self-identified as non-Hispanic white; none of the non-Hispanic black, Hispanic, or other alumni reported a melanoma diagnosis. As skin cancer incidence continues to rise, it is critical that leaders in the marching band community continually address unprotected sun exposure, by promoting protective practices, as well as modifying attitudes and behaviors regarding sun exposure and protection.

BackgroundEarly detection of melanoma represents an opportunity to reduce the burden of disease among people at increased risk for melanoma.ObjectiveTo develop and demonstrate the efficacy of online training.DesignRandomized educational trial.ParticipantsPrimary care providers (PCPs).InterventionMastery learning course with visual and dermoscopic assessment, diagnosis and management, and deliberate practice with feedback to reach a minimum passing standard.Main MeasuresPre-test/post-test diagnostic accuracy. Referral of concerning lesions for 3 months before and after the educational intervention.Key ResultsAmong 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) (χ2 [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 < 0.001; ηp2 = 0.26). PCPs who underwent training referred fewer benign lesions, including nevi, seborrheic keratoses, and dermatofibromas, than control PCPs (F[1,79] = 72.89, p < 0.001; ηp2 = 0.489; F[1,79] = 25.82, p < 0.001; ηp2 = 0.246; F[1,79] = 34.25, p < 0.001; ηp2 = 0.302; respectively). Those receiving training referred significantly more melanomas than controls (F[1,79] = 24.38, p < 0.001; ηp2 = 0.236). Referred melanomas (0.8  ± 0.07 per month for intervention, 0.17 ± 0.06 for control) were mostly located on the head and neck.ConclusionsMastery learning improved PCPs’ ability to detect melanoma on a standardized post-test and may improve referral of patients with suspected melanoma. Further studies are needed to confirm this finding.ClinicalTrials.gov NCT02385253.

Three culturally distinct groups elucidated the connections between sun-related behaviors and sociocultural backgrounds, especially how embracing Euro-American cultural values might increase sun exposure and sunburn tendency.AbstractSociocultural 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.