Kasparian Nadine A, Bränström Richard, Chang Yu-mei, Affleck Paul, Aspinwall Lisa G, Tibben Aad, Azizi Esther, Baron-Epel Orna, Battistuzzi Linda, Bruno William, Chan May, Cuellar Francisco, Debniak Tadeusz, Pjanova Dace, Ertmanski Slawomir, Figl Adina, Gonzalez Melinda, Hayward Nicholas K, Hocevar Marko, Kanetsky Peter A, Leachman Sancy, Bergman Wilma, Heisele Olita, Palmer Jane, Peric Barbara, Puig Susana, Schadendorf Dirk, Gruis Nelleke A, Newton-Bishop Julia, Brandberg Yvonne
School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
Arch Dermatol. 2012 Oct;148(10):1142-51. doi: 10.1001/archdermatol.2012.1817.
To examine the frequency and correlates of skin examination behaviors in an international sample of individuals at varying risk of developing melanoma.
A cross-sectional, web-based survey.
Data were collected from the general population over a 20-month period on behalf of the Melanoma Genetics Consortium (GenoMEL).
A total of 8178 adults from Northern (32%), Central (33%), and Southern (14%) Europe, Australia (13%), and the United States (8%).
Self-reported frequency of skin self-examination (SSE) and clinical skin examination (CSE).
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.
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.
在一个患黑色素瘤风险各异的国际样本中，研究皮肤检查行为的频率及其相关因素。
一项基于网络的横断面调查。
在20个月的时间里，代表黑色素瘤遗传学联盟（GenoMEL）从普通人群中收集数据。
共有8178名成年人，分别来自北欧（32%）、中欧（33%）、南欧（14%）、澳大利亚（13%）和美国（8%）。
自我报告的皮肤自我检查（SSE）和临床皮肤检查（CSE）的频率。
在对年龄和性别进行调整后，澳大利亚（皮肤自我检查优势比[OR] = 1.80 [99%可信区间，1.49 - 2.18]；临床皮肤检查OR = 2.68 [99%可信区间，2.23 - 3.23]）和美国（皮肤自我检查OR = 2.28 [99%可信区间，1.76 - 2.94]；临床皮肤检查OR = 3.39 [99%可信区间，2.60 - 4.18]）的皮肤检查频率高于欧洲三个地区的总和。在欧洲内部，南欧的参与者报告的皮肤自我检查率高于北欧（皮肤自我检查OR = 1.61 [99%可信区间，1.31 - 1.97]），中欧（临床皮肤检查OR = 1.47 [99%可信区间，1.22 - 1.78]）和南欧（临床皮肤检查OR = 3.46 [99%可信区间，2.78, 4.31]）的临床皮肤检查频率高于北欧。皮肤检查行为也因黑色素瘤病史而异：无黑色素瘤病史的参与者报告的皮肤检查水平最低，而先前被诊断为黑色素瘤的参与者报告的水平最高。在对地区进行调整后，并考虑到年龄、性别、皮肤类型和痣数量的作用，参与皮肤自我检查和临床皮肤检查与一系列心理社会因素相关，包括感知到的患黑色素瘤风险；对皮肤检查的感知益处和障碍；对自己进行筛查能力的感知信心；以及社会规范。此外，在无黑色素瘤病史的人群中，较高的癌症相关担忧与更频繁的皮肤自我检查相关。
鉴于心理社会因素与皮肤检查行为之间存在密切关联，尤其是在无黑色素瘤病史的人群中，我们建议加大力度将心理教育融入公共卫生举措和临床护理体系，临床医生、研究人员和倡导团体在引导个体获取适当工具和资源方面发挥关键作用。
