Effect of intervention for melanoma early detection on thorough skin self-examination, availability of wall mirrors, and skin surgeries.

PR-12

Melanoma is a significant public concern and public health problem, with about 8000 deaths annually in the US. It is one of the few cancer sites that are increasing in incidence, a trend that is likely to continue. Early detection of this malignancy holds tremendous promise, since it appears that most ultimately fatal melanomas were visible on the surface of the skin at a curable point in their evolution. The Check-It-Out project sought to exploit aspects of this feature of melanoma by examining the predictors of Thorough Skin Self-Examination (TSSE) for the early detection of melanoma, and by evaluating the effect of an intervention to encourage this practice on TSSE performance and on other potential consequences. In preliminary studies we found that assessment of the performance of TSSE depends on the method of inquiry regarding this practice: general inquiries yield high proportions of the population reporting TSSE, whereas more specific questions regarding specific areas of the body examined yield lower proportions reporting TSSE. We then interviewed 2126 patients presenting for a routine primary care appointment, and noted that several factors were key predictors of TSSE: advice from a physician to do so, availability of a partner to assist, availability of a wall mirror, and measures of attitudes and self-efficacy for this activity. We then randomized 1356 of these individuals to receive an intervention aimed at encouraging TSSE or a corresponding dietary intervention, and interviewed them at 2, 6, and 12 months. The skin examination intervention included cues, aids, a video and information booklet, brief counseling from a health educator, and tailored feedback letters. At 12 months 55% of the intervention group reported performing TSSE, compared to 35% of the diet control group (p<.001). We also found that the proportion without a wall mirror declined from 20% to 12% in the skin examination group, although it was essentially unchanged in the diet control group (18% to 17%) (p=.04 for the difference between groups). Skin surgeries were performed on similar proportions of both groups during the 6 months prior to randomization, but were performed more than twice as frequently in the skin group during the 6 months after randomization (8.0% vs 3.6%, p=.0005), yet this difference was no longer present 6 to 12 months after randomization. We conclude that intervention for TSSE may result in a lasting effect on performance of this activity, and hence potentially on melanoma early detection, while only causing a short-term effect on skin surgeries.