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Figure.
Spanish Translation of the Skin Self-examination ABCDE Card
Spanish Translation of the Skin Self-examination ABCDE Card

ABCDE indicates assess, border, color, diameter, and evolution.

Table. 
Participant Knowledge Impediments, Perceptions, and Strategies to Enhance SSE Relevance in the Latino Community
Participant Knowledge Impediments, Perceptions, and Strategies to Enhance SSE Relevance in the Latino Community
1.
Robinson  JK, Joshi  KM, Ortiz  S, Kundu  RV.  Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education.  Psychooncology. 2011;20(3):313-320.PubMedGoogle ScholarCrossref
2.
Stapleton  JL, Turrisi  R, Mallett  KA, Robinson  JK.  Correspondence between pigmented lesions identified by melanoma patients trained to perform partner-assisted skin self-examination and dermatological examination.  Cancer Epidemiol Biomarkers Prev. 2015;24(8):1247-1253.PubMedGoogle ScholarCrossref
3.
Wu  XC, Eide  MJ, King  J,  et al.  Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006.  J Am Acad Dermatol. 2011;65(5)(suppl 1):S26-S37.PubMedGoogle ScholarCrossref
4.
Robinson  JK, Wayne  JD, Martini  MC, Hultgren  BA, Mallett  KA, Turrisi  R.  Early detection of new melanomas by patients with melanoma and their partners using a structured skin self-examination skills training intervention: a randomized clinical trial.  JAMA Dermatol. 2016;152(9):979-985.PubMedGoogle ScholarCrossref
5.
Hernandez  C, Mermelstein  RJ.  A conceptual framework for advancing melanoma health disparities research.  Arch Dermatol. 2009;145(12):1442-1446.PubMedGoogle ScholarCrossref
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Research Letter
July 2017

Enhancing the Relevance of Skin Self-examination for Latinos

Author Affiliations
  • 1Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Biobehavioral Health and Prevention Research Center, The Pennsylvania State University, University Park
JAMA Dermatol. 2017;153(7):717-718. doi:10.1001/jamadermatol.2017.0322

Despite having a risk of developing melanoma similar to that of non-Hispanic whites (NHWs) with the same skin tones, Latino/Hispanic (Latino) individuals are not as knowledgeable about ways to reduce risks.1 Compared with their NHW counterparts, Latino patients in the United States more often present with tumors thicker than 1 mm (34.5% vs 24.9%), further advanced disease (Table), greater regional involvement (12.4% vs 8.3%), and more distant disease (6.6% vs 3.6%), all of which result in greater mortality.3 The present study of skin self-examination (SSE) among Latinos extends the reach of this intervention, the effectiveness of which has already been demonstrated in a randomized clinical trial of a more general population,4 and aligns the scoring of features by participants and the dermatologist.2 Psychosocial correlates within the Latino culture are evaluated, including knowledge of melanoma, perceived risk for developing melanoma, perceived benefit of early detection, perceived self-efficacy to perform SSE, perceived peer norms for checking the skin and seeking care from a physician, and perceived barriers to checking the skin. The study also examines culturally sensitive ways of enhancing the relevance of SSE for Latinos.

Methods

Our partners, 4 leaders of Latino community organizations that constitute the Community Advisory Board (CAB), helped to identify gaps in knowledge and attitude in the Latino community about melanoma and SSE. The CAB members identified Latinos whose countries of origin or descent were either Mexico or Puerto Rico. Four small focus groups of 5 to 6 Latino community members met in the evenings with a bicultural and bilingual group leader (M.N. or L.C.) in the organizations’ respective community centers and discussed psychosocial correlates and culturally sensitive ways of enhancing SSE relevance. A key element of standard effective SSE training, the card illustrating the ABCDE rule (assess, border, color, diameter, and evolution),4 was translated into Spanish (Figure) and presented to the groups along with tools they could use to implement SSE: a lighted magnifying lens, a clear millimeter ruler, and a pencil with an eraser. Iterative changes in the presentation of strategies to enhance relevance were made with successive focus groups until acceptance among the participants was achieved.

Results

Most participants (83%; 20 of 24 people) preferred small group discussions in Spanish (Table). The concepts of a changing mole and of skin that burns in the sun were found to lack cultural context. The information most frequently requested by the focus group members was the incidence and mortality among Latinos. And simply stating that the proportion of Latinos who died from melanoma was greater than that of whites was not adequate—they wanted to know the actual numbers (Table). Participants requested images of moles and melanomas on skin of color and a brief description in Spanish to explain the concepts of SSE. The first focus group requested an example of a changing mole on skin of color. Subsequent focus groups did not request further changes in the pictures used to illustrate lesion evolution.

Participants preferred to use the clear plastic ruler rather than the pencil eraser to measure the greatest diameter of the lesion because they could see the border of the lesion through the ruler and obtain a reliable measurement to assess change in the future. The pencil eraser covered the lesion and made it difficult for them to assess change in the diameter. After skills training, participants accurately assessed the features of their moles, which provided support for the translated materials.

Discussion

Melanoma early detection measures have been typically directed toward SSE among NHWs. To correct this health disparity, pictures and Spanish audio discussions to enhance the relevance of the message for Latinos are needed in public education campaigns.5 The Latinos in the present study identified their lack of familiarity with the concepts of changing moles and melanoma. They requested more culturally relevant images of concerning lesions on Latino skin and descriptions in Spanish of the concepts of SSE skills. When these were provided, the participants had no difficulty acquiring SSE skills. Future research is needed to test SSE behavioral outcomes in this underserved population using a rigorous randomized clinical trial.

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Article Information

Corresponding Author: June K. Robinson, MD, Northwestern University Feinberg School of Medicine, 676 N St Clair St, #1267, Chicago, IL 60611 (june-robinson@northwestern.edu).

Accepted for Publication: January 28, 2017.

Published Online: April 26, 2017. doi:10.1001/jamadermatol.2017.0322

Author Contributions: Drs Robinson and Turrisi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Robinson, Nodal, Mallett, Turrisi.

Acquisition, analysis, or interpretation of data: Chavez, Ali, Turrisi.

Drafting of the manuscript: Robinson, Turrisi.

Critical revision of the manuscript for important intellectual content: Nodal, Chavez, Ali, Mallett, Turrisi.

Statistical analysis: Turrisi.

Administrative, technical, or material support: Robinson, Nodal, Chavez, Ali.

Study supervision: Turrisi.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported by National Cancer Institute (NCI) grant R01 CA154908 (Dr Robinson).

Role of the Funder/Sponsor: The NCI had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: Dr Robinson is the Editor of JAMA Dermatology but was not involved in the editorial evaluation or editorial decision to accept this work for publication.

Additional Contributions: We thank the 4 members of CAB, Blanca Martinez, Estela Melgoza, Roxanne Padilla, and Ramon Sanchez, for their help in identifying gaps in knowledge and attitude in the Latino community about melanoma SSE. They received no compensation for their contributions.

References
1.
Robinson  JK, Joshi  KM, Ortiz  S, Kundu  RV.  Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education.  Psychooncology. 2011;20(3):313-320.PubMedGoogle ScholarCrossref
2.
Stapleton  JL, Turrisi  R, Mallett  KA, Robinson  JK.  Correspondence between pigmented lesions identified by melanoma patients trained to perform partner-assisted skin self-examination and dermatological examination.  Cancer Epidemiol Biomarkers Prev. 2015;24(8):1247-1253.PubMedGoogle ScholarCrossref
3.
Wu  XC, Eide  MJ, King  J,  et al.  Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006.  J Am Acad Dermatol. 2011;65(5)(suppl 1):S26-S37.PubMedGoogle ScholarCrossref
4.
Robinson  JK, Wayne  JD, Martini  MC, Hultgren  BA, Mallett  KA, Turrisi  R.  Early detection of new melanomas by patients with melanoma and their partners using a structured skin self-examination skills training intervention: a randomized clinical trial.  JAMA Dermatol. 2016;152(9):979-985.PubMedGoogle ScholarCrossref
5.
Hernandez  C, Mermelstein  RJ.  A conceptual framework for advancing melanoma health disparities research.  Arch Dermatol. 2009;145(12):1442-1446.PubMedGoogle ScholarCrossref
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