Skin Examination Behavior: The Role of Melanoma History, Skin Type, Psychosocial Factors, and Region of Residence in Determining Clinical and Self-conducted Skin Examination | Dermatology | JAMA Dermatology | JAMA Network
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Oct 2012

Skin Examination Behavior: The Role of Melanoma History, Skin Type, Psychosocial Factors, and Region of Residence in Determining Clinical and Self-conducted Skin Examination

Author Affiliations

Author Affiliations: School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia (Dr Kasparian); Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden (Drs Bränström and Brandberg); Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia (Drs Bränström and Kanetsky);Section of Epidemiology and Biostatistics, Leeds Cancer Research UK Centre, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, England (Drs Chang and Newton-Bishop, Mr Affleck, and Ms Chan); Department of Psychology (Dr Aspinwall) and Huntsman Cancer Institute and Department of Dermatology, School of Medicine (Dr Leachman), University of Utah, Salt Lake City; Center for Human and Clinical Genetics (Dr Tibben) and Department of Dermatology (Drs Bergman and Gruis), Leiden University Medical Center, the Netherlands; Dermatology Department, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Dr Azizi); Health Promotion Program, School of Public Health, Haifa University, Haifa, Israel (Dr Baron-Epel); Departments of Health Sciences (Dr Battistuzzi) and Internal Medicine and Medical Specialties (Dr Bruno), University of Genoa, Italy; Department of Dermatology, Hospital Clinic Barcelona, Barcelona, Spain (Drs Cuellar and Puig and Ms Gonzalez); International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland (Drs Debniak and Ertmanski); Latvian Biomedical Research and Study Center, Riga, Latvia (Drs Pjanova and Heisele); Skin Cancer Unit, Deutsches Krebsforschungszentrum Stiftung des Öffentlichen Rechts, Heidelberg, Germany (Drs Figl and Schadendorf); Queensland Institute of Medical Research, Brisbane, Australia (Dr Hayward and Ms Palmer); Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia (Drs Hocevar and Peric).

Group Information: A list of the GenoMEL members appears at

Arch Dermatol. 2012;148(10):1142-1151. doi:10.1001/archdermatol.2012.1817

Objective To examine the frequency and correlates of skin examination behaviors in an international sample of individuals at varying risk of developing melanoma.

Design A cross-sectional, web-based survey.

Setting Data were collected from the general population over a 20-month period on behalf of the Melanoma Genetics Consortium (GenoMEL).

Participants A total of 8178 adults from Northern (32%), Central (33%), and Southern (14%) Europe, Australia (13%), and the United States (8%).

Main Outcome Measures Self-reported frequency of skin self-examination (SSE) and clinical skin examination (CSE).

Results After adjustment for age and sex, frequency of skin examination was higher in both Australia (odds ratio [OR]SSE = 1.80 [99% CI, 1.49-2.18]; ORCSE = 2.68 [99% CI, 2.23-3.23]) and the United States (ORSSE = 2.28 [99% CI, 1.76-2.94]; ORCSE = 3.39 [99% CI, 2.60-4.18]) than in the 3 European regions combined. Within Europe, participants from Southern Europe reported higher rates of SSE than those in Northern Europe (ORSSE = 1.61 [99% CI, 1.31-1.97]), and frequency of CSE was higher in both Central (ORCSE = 1.47 [99% CI, 1.22-1.78]) and Southern Europe (ORCSE = 3.46 [99% CI, 2.78, 4.31]) than in Northern Europe. Skin examination behavior also varied according to melanoma history: participants with no history of melanoma reported the lowest levels of skin examination, while participants with a previous melanoma diagnosis reported the highest levels. After adjustment for region, and taking into account the role of age, sex, skin type, and mole count, engagement in SSE and CSE was associated with a range of psychosocial factors, including perceived risk of developing melanoma; perceived benefits of, and barriers to, skin examination; perceived confidence in one's ability to engage in screening; and social norms. In addition, among those with no history of melanoma, higher cancer-related worry was associated with greater frequency of SSE.

Conclusions Given the strong association between psychosocial factors and skin examination behaviors, particularly among people with no history of melanoma, we recommend that greater attempts be made to integrate psycho-education into the fabric of public health initiatives and clinical care, with clinicians, researchers, and advocacy groups playing a key role in guiding individuals to appropriate tools and resources.