Implementing the Self-Assessment Melanoma Risk Scoring in Primary Care

Skin cancer is one of the most prevalent yet treatable cancers. Head-to-toe skin assessments are recommended for high-risk patients. However, there is no universal risk-scoring method. At a suburban primary care clinic, providers revealed concerns about the overall lack of skin exams conducted. At this practice there is no skin assessment protocol in place for any group of patients, and skin exams are seldom performed unless prompted by a patient’s request. This quality improvement project evaluated the success of using the Self Assessment for Melanoma (SAMScore) to determine high-risk patients and the subsequent completion of a head-to-toe skin assessment and provider referral. The primary intervention was the use of the SAMScore survey in appropriate patients, completed over 8 weeks. The SAMScore survey was used to score patients\u27 skin cancer risk and prompt further assessments. Overall 85% of eligible patients were scored as high and low risk for skin cancer. The SAMScore identified 20.6% of patients as high risk. High risk patients were referred to dermatology providers 58% of the time. The SAMScore survey and subsequent skin assessment process increased the number of head-to-toe assessments done in the clinic and facilitated patient dermatology referrals over 50% of the time

Screening for Melanoma for At-Risk Population: A Practice Guide

ABSTRACT Shakya, Sapana. Screening for Melanoma for At-Risk Population: A Practice Guide. Unpublished Doctor of Nursing Practice scholarly project, University of Northern Colorado, 2019. Melanoma is a lethal skin cancer that kills one American every hour (American Academy of Dermatology, 2018b). The incidence and prevalence rate of melanoma is on the rise and continues to affect people, increasing the mortality and morbidity rate and financial burden of the disease. In 2016, the U.S. Preventive Services Task Force concluded that there was insufficient evidence to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults. However, this recommendation was only applicable to the patients who were asymptomatic. The routine skin cancer screening has shown promising results in patients who are at high risk for melanoma (American Cancer Society, 2018b). Primary care providers do not perform routine skin cancer screenings for melanoma or do not even perform screening to identify if the patients are at high risk for melanoma or not. Thus there is a lack of a standardized screening tools/models and workflow processes to include melanoma screening in the clinic settings. To address this need, an evidence-based melanoma screening workflow algorithm was developed specifically to a federally qualified health center in a rural and small mountain community in Northern Colorado. The workflow algorithm included the self-assessment of melanoma risk score (SAMScore) as the risk prediction model to screen patients at high risk for melanoma. The Doctor of Nursing Practice (DNP) scholarly project was implemented to screen patients for melanoma between ages 35 to 75 years old for annual exams, excluding well women visits, who were able to speak, read, and write in English. Depending on the screening result, an appropriate intervention was done by the providers of the clinic by performing a full-body skin exam or biopsy or referral or educating patients on primary prevention of melanoma. The project was evaluated by utilizing the Donabedian framework. After implementation, there was a 300% increase in the number of melanoma screenings completed, increased awareness on melanoma, and melanoma screening protocols among the providers and patients. The clinic has continued to utilize the melanoma screening algorithm and SAMScore to screen patients for melanoma and continues to distribute the handout on primary prevention of melanoma by the American Association of Dermatology. Further studies are needed to assess the validity of the SAMScore in languages other than English and French and evaluate the effectiveness of the SAMScore and the melanoma screening algorithm in a larger clinic with a greater number of staff

SAMScore: A Semantic Structural Similarity Metric for Image Translation Evaluation

Image translation has wide applications, such as style transfer and modality conversion, usually aiming to generate images having both high degrees of realism and faithfulness. These problems remain difficult, especially when it is important to preserve semantic structures. Traditional image-level similarity metrics are of limited use, since the semantics of an image are high-level, and not strongly governed by pixel-wise faithfulness to an original image. Towards filling this gap, we introduce SAMScore, a generic semantic structural similarity metric for evaluating the faithfulness of image translation models. SAMScore is based on the recent high-performance Segment Anything Model (SAM), which can perform semantic similarity comparisons with standout accuracy. We applied SAMScore on 19 image translation tasks, and found that it is able to outperform all other competitive metrics on all of the tasks. We envision that SAMScore will prove to be a valuable tool that will help to drive the vibrant field of image translation, by allowing for more precise evaluations of new and evolving translation models. The code is available at https://github.com/Kent0n-Li/SAMScore

Risk prediction models for melanoma: a systematic review.

Melanoma incidence is increasing rapidly worldwide among white-skinned populations. Earlier diagnosis is the principal factor that can improve prognosis. Defining high-risk populations using risk prediction models may help targeted screening and early detection approaches. In this systematic review, we searched Medline, EMBASE, and the Cochrane Library for primary research studies reporting or validating models to predict risk of developing cutaneous melanoma. A total of 4,141 articles were identified from the literature search and six through citation searching. Twenty-five risk models were included. Between them, the models considered 144 possible risk factors, including 18 measures of number of nevi and 26 of sun/UV exposure. Those most frequently included in final risk models were number of nevi, presence of freckles, history of sunburn, hair color, and skin color. Despite the different factors included and different cutoff values for sensitivity and specificity, almost all models yielded sensitivities and specificities that fit along a summary ROC with area under the ROC (AUROC) of 0.755, suggesting that most models had similar discrimination. Only two models have been validated in separate populations and both also showed good discrimination with AUROC values of 0.79 (0.70-0.86) and 0.70 (0.64-0.77). Further research should focus on validating existing models rather than developing new ones.This report is independent research arising from a Clinician Scientist award supported by the National Institute for Health Research (RG 68235) and J Usher-Smith is funded by a National Institute for Health Research Clinical LectureshipThis is the author accepted manuscript. The advanced access published version can be found on the publisher's website at: http://cebp.aacrjournals.org/content/early/2014/06/03/1055-9965.EPI-14-0295.abstrac

The Effect of a Sun Damage Simulation Photography App on the Skin-Protective Behavior Intentions of Women with Children Age 18 or Younger

Abstract Background: Skin cancer is the most common form of cancer diagnosed in the U.S. annually, despite being a largely preventable disease through the limitation of ultraviolet radiation exposure. Attempts to decrease its incidence have focused on appearance-based interventions. These have been effective at improving sun-protective behaviors among various subpopulations including people of color. Anecdotal observations suggest mothers more frequently utilize sun protection for their children than on themselves. Purpose: The purpose of this project was to gain an understanding of the sun protection practices and beliefs of Caucasian and African American mothers, to assess the response to an appearance-based intervention for motivating sun-protective behaviors, and to educate mothers about skin cancer risks and prevention. Methods: The project was comprised of multiple phases. First, a retrospective chart review was performed to assess the frequency of sun protection counseling at well-child visits for Caucasian and African American children between the ages of four and 18 years. In the intervention phase, mothers completed a survey about their attitudes towards tanning, sun protection, their current practices, and the practices they use for their children. Their actual melanoma risk was calculated using the Self-Assessment Melanoma Risk Score (SAMScore). Next, they used the Sunface App, a facial morphing smartphone application that simulates the effects of sun damage on facial photography. Then, they were provided an educational presentation consisting of the American Academy of Dermatology’s Spot Skin Cancer campaign. Results: The chart review indicated sun protection occurred at 44% of well-child visits (n = 61) with no significant differences between race, gender, or among the age of the patients. Survey results found no significant difference between racial groups with regards to sun protection beliefs, personal practices, and protection for their children (n =14). Older mothers, and those that reported high frequencies of personal sunscreen use were more likely to put sunscreen on their children (rs = .696, p \u3c .05; rs = .533, p = 0.050, respectively). Having a higher actual risk for melanoma was not associated with more perceived risk of skin cancer by mothers (F=.745, p \u3e.05). Sunface app reactions fell under three main themes: surprise or disbelief, negative feelings about their appearance, or motivation to increase sunscreen use. Discussion: While few statistically significant results were found in the study, findings indicate a need for education to mothers about their risk for skin cancer development. Future research is needed to determine factors that may influence the inclusion of sun protection counseling at well-child visits including family histories or competing demands. The Sunface application shows promise as a convenient and effective tool to motivate mothers to improve sun protection practices. Qualitative follow-up survey responses (n = 2) indicated participants were motivated to increase sun protection practices following the intervention. Study results and sample size may have been limited by the Fall/Winter timing of the project as well as the percentage of international and low-income patient population at the project setting. Conclusion: The Sunface application elicited powerful responses by participants and may motivate improved sun protection practices. Primary care providers are in prime, unique positions to counsel their patients on risks for skin cancer and its prevention. With limited visit times and competing demands, alternative methods of providing preventive counseling may need to be considered

Using the SAMScore Questionnaire to Increase Skin Cancer Risk Screenings at Adult Patient Annual Exams

Background: Malignant melanoma has become an increasingly prevalent problem in the United States. The earlier a skin cancer is identified, the better the outcome. There are conflicting recommendations about screening for skin cancer but in general identifying high risk patients is important and it is not being achieved in primary care. Purpose: The purpose of this study is to evaluate use of the SAMScore Questionnaire to determine high risk patients at adult annual visits. Methods: This was a multi-phased study with a quasi-experimental design that took take place at a family and community primary care clinic in central Kentucky. Baseline assessment of skin cancer screening frequency and education during annual exams was obtained with a medical record review. Providers were then educated on the use of the SAMScore and asked to start using with adult patients during annual exams. After a period of 3 weeks, a post-intervention review of medical records was completed to assess provider documentation related to skin cancer screening risk using SAMScore and education. Inclusion criteria involved patients aged 18-64 years old of all genders, races, and ethnicities. Results:The phase one chart audit included 30 patient charts and the phase three chart audit included 48 patient charts. There was a significant increase in screening completion from pre- to post-intervention. None of the participants were screened pre-intervention, and more than half (56%) were screened post (p Conclusion: One hundred percent of the patients identified as high risk at this clinic were educated on skin protection, but only about half of the eligible patients were indeed screened. Further research should be done to address barriers to screening and continued efforts should be made to ensure our primary care providers are identifying those at high risk for skin cancer

Improving Skin Cancer Screening in Primary Care

Skin cancer is one of the most common forms of cancer in the United States, with melanoma having the highest rate of mortality of all forms of skin cancer (CDC, 2019). However, there is hesitancy among primary care providers to perform skin cancer screenings (Oliveria et al., 2011). Prevention and early detection of melanoma is key. Melanoma has been known to be highly curable when found early. This makes early detection even more important in order to prevent metastasis and potential mortality (Bruce et al, 2017). The use of targeted screening tools can potentially save lives when utilized in primary care. This project was carried out in a rural, Midwestern public health clinic. The implementation of the SAMScore questionnaire was completed for adult patients seen during office visits from August 24, 2020 through November 25, 2020. Providers involved in the project reviewed survey answers with patients to determine level of risk. Dermatology referrals were recommended to those found to be high-risk. All patients involved in this project were provided education on skin cancer and preventive measures. Of the 19 patients screened, four were found to be high-risk for melanoma with one patient being diagnosed with melanoma after referral to dermatology. This project provided not only an educational opportunity for patients, but it also brought forth a screening method that is quick, concise, and financially feasible. Although this project consisted of a small sample size, future replications can easily be implemented in a larger and more diverse primary care setting

Риск-ориентированный подход к профилактике и диспансеризации лиц из группы риска по возникновению злокачественных новообразований кожи

Цель работы – разработать научно-обоснованные рекомендации по диспансеризации пациентов из группы риска по возникновению злокачественных новообразований кожи на основании результатов комплексного исследования эпидемиологических, клинических, инструментальных показателей и разработки инновационной автоматизированной диагностической программы

Organ-aware CBCT enhancement via dual path learning for prostate cancer treatment

BACKGROUND: Cone-beam computed tomography (CBCT) plays a crucial role in the intensity modulated radiotherapy (IMRT) of prostate cancer. However, poor image contrast and fuzzy organ boundaries pose challenges to precise targeting for dose delivery and plan reoptimization for adaptive therapy. PURPOSE: In this work, we aim to enhance pelvic CBCT images by translating them to high-quality CT images with a particular focus on the anatomical structures important for radiotherapy. METHODS: We develop a novel dual-path learning framework, covering both global and local information, for organ-aware enhancement of the prostate, bladder and rectum. The global path learns coarse inter-modality translation at the image level. The local path learns organ-aware translation at the regional level. This dual-path learning architecture can serve as a plug-and-play module adaptable to other medical image-to-image translation frameworks. RESULTS: We evaluated the performance of the proposed method both quantitatively and qualitatively. The training dataset consists of unpaired 40 CBCT and 40 CT scans, the validation dataset consists of 5 paired CBCT-CT scans, and the testing dataset consists of 10 paired CBCT-CT scans. The peak signal-to-noise ratio (PSNR) between enhanced CBCT and reference CT images is 27.22 ± 1.79, and the structural similarity (SSIM) between enhanced CBCT and the reference CT images is 0.71 ± 0.03. We also compared our method with state-of-the-art image-to-image translation methods, where our method achieves the best performance. Moreover, the statistical analysis confirms that the improvements achieved by our method are statistically significant. CONCLUSIONS: The proposed method demonstrates its superiority in enhancing pelvic CBCT images, especially at the organ level, compared to relevant methods

Риск-ориентированный подход к профилактике и диспансеризации лиц из группы риска по возникновению злокачественных новообразований кожи

Монография посвящена изучению вопросов заболеваемости, ранней диагностики, профилактики, динамического наблюдения пациентов из группы риска по возникновению злокачественных новообразований кожи, в том числе с применением современных компьютерных технологий. В работе представлены результаты комплексного исследования эпидемиологических, клинических, инструментальных показателей и разработки инновационной автоматизированной диагностической программы с целью разработки научно-обоснованных рекомендаций по диспансеризации пациентов из группы риска по возникновению злокачественных новообразований, а также результаты внедрения инновационной методики. Монография предназначена для врачей-дерматовенерологов, врачей-онкологов, врачей-терапевтов, семейных врачей, студентов и ординаторов медицинских вузов