Skin cancer is the most common cancer in the nation and the cost to treat it is around 8 billion dollars a year. Sun exposure is linked to all three types of skin cancer and incidence of melanoma is highest in Caucasians compared to other races. In Brookfield, CT which is comprised of a predominantly Caucasian population, there is a lack of awareness of skin cancer detection and prevention. One of the best ways to promote skin cancer awareness is through education about the different types of skin cancers and sun safety behaviors. The idea is to start the conversation about skin cancer by capturing people’s attention with a visual poster. A poster is multifaceted in that patients can spend time reading it while in the waiting or exam room, can be used as instructional aide by the physician and can be transformed into a miniature handout made available for patients to take home with them. The goal is to promote skin cancer awareness so skin cancer can be detected and treated in a timely manner and patients are equipped with tips on how to minimize sun exposure.https://scholarworks.uvm.edu/fmclerk/1307/thumbnail.jp

Kolli, Sree Sahithi

English

UVM ScholarWorks

University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2017Promoting Skin Cancer AwarenessSree Sahithi KolliFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationKolli, Sree Sahithi, "Promoting Skin Cancer Awareness" (2017). Family Medicine Clerkship Student Projects. 274.https://scholarworks.uvm.edu/fmclerk/274Promoting Skin Cancer AwarenessS R E E  S A H I T H I  KO L L I ,  M S I I IM AY/ J U N E  2 0 1 7B R O O K F I E L D  FA M I LY  M E D I C I N EM E N T O R :  D R .  R O B E R T  M A S C I A , M DThe Problem & Need for InterventionoSkin cancer is the most common type of cancer o1 in 5 Americans diagnosed with skin cancer in lifetimeo40-50% of people who will live to age 65 will have basal cell carcinoma (BCC) at least onceoMajority of skin cancer deaths from melanomao Every hour 1 person dies from melanomaoIncidence of melanoma highest in Caucasians compared to all raceso Incidence rate of 26 out of 100,000 in Caucasians compare to 5 in Hispanics and 1 in African AmericansoConnecticut (CT) had a higher rate of incidence of melanoma than Hawaii in 2013 according to Centers for Disease Control (CDC)oBrookfield, CT has a population that is approximately 90% Caucasiano After seeing and talking with many patients during their annual health maintenance visits, it became apparent that there is a lack of awareness on sun safety and skin cancer prevention o There is a lack of a good skin cancer poster in the Brookfield Family Medicine exam rooms which patients can learn from and physicians can utilize in order to educate patientso Local dermatologist Dr. Kim Eickhorst mentioned how she gets asked about a poster on melanoma often because of its strong visuals which makes patients more interested in learning how to detect and prevent skin cancer. Public Health CostoMore people have had skin cancer than all other cancers combined.oAnnual cost for treating skin cancer was $8.1 billion.o $4.9 billion for nonmelanoma skin cancer and $3.4 billion for melanoma.o Skin cancer costs from tanning beds were $343 million.o126% increase in costs to treat skin cancer compared to 25% increase for all other cancers combined.oIncidence of skin cancer still rising in CT despite public safety interventions such as banning use of tanning beds by minors under the age of 17.o As the incidence of skin cancer rises, so do the costs to treat it.oProven skin cancer prevention programs could save $250 million by 2030 according to CDC.Community Perspectives Dr. Kim Eickhorst, MD,  Dermatology Associates of Western Connecticut◦ How important is it to promote skin cancer awareness in this community?◦ Super important. There is so little awareness. People don’t realize that sun damage is cumulative and not reversible. People downplay skin care and only take it seriously once they get skin cancer. ◦ What are some common misconceptions patients have about their risks in getting skin cancer?◦ People don’t understand that skin cancer can occur anywhere on the body. It can occur on their feet, genitalia or buttocks which are normally covered. ◦ There is a misconception on what melanoma looks like. It doesn’t present the same way each time.◦ As a clinician what has been the most effective way in preventing skin cancer?◦ Patient education.◦ Skin checks with primary care physicians (PCP) are not enough. PCPs are dealing with so many issues that they may not be able to do thorough skin checks. Sometimes a PCP might see something on a patient's skin and then refer them to a dermatologist. The lesion turns out to be benign but then I spot something that turns out to be more serious and is not the lesion that prompted the visit in the first place. Therefore , I recommend patients to get an annual skin check from a dermatologist.Community PerspectivesInterview with Dr. Eickhorst continued…oWould an educational poster in the waiting/exam room be beneficial for patients in a PCP’s office? Would you use a poster to educate patients?o Without a doubt. I use one poster that demonstrates melanoma and I get asked about it all the time because the visuals jump out at the patient. So patients do pay attention when they see something that catches their eye and I use it to educate them.oWhat items should be included on the poster?o Educating patients on the three common types of skin cancer because people are focused on melanoma but basal cell carcinoma is the most common of the skin cancers.o Educating patients on different presentations of melanoma. I tell patients to go home and google images of melanoma so they can see how it presents.oWhat specific advice do you give patients in preventing skin cancer?o I tell patients to not be sun scared but be sun smart. Limit activities to the poles of the day (morning and night). Use sunscreen in addition to hats and protective clothing.oIn 2013, CT passed a law banning the use of tanning beds by minors under the age of 17. What other public health safety measures could potentially be as influential in decreasing skin cancer rates?o Better education in schools because teaching kids when they are young sets a precedent. Teaching kids about it and making it a primary part of their health curriculum would be great.  In Australia and New Zealand they can’t go to the playground without a hat and sunscreen is encouraged but the schools here won’t allow you to put sunscreen without going to the nurse first and requesting it. Community Perspectives Continued…..CARMELA LUZI, PA-C, DERMATOLOGY ASSOCIATES OF WESTERN CONNECTICUT oHow important is it to promote skin cancer awareness in this community?o Necessary. A lot of people brush off skin cancer and underestimate its impact.oWhat are some common misconceptions people have about their risks of getting skin cancer? o People aren’t accurate in assessing how much sun exposure they have been getting. o People should protect themselves 365 days of the year not just when they go to the beach. o People with darker skin don’t think they are at risk but they are still at risk. oWould an educational poster be beneficial? Would you use it?o Yes, there is a lack of education of skin cancer.  I would use it.oWhat would you put on the poster?o ABCDEs of melanoma. Advise people to use sunscreen and sun protective clothing including hatsoIn 2013, CT passed a law banning the use of tanning beds by minors under the age of 17. What other public health safety measures could potentially be as influential in decreasing skin cancer rates?o Adding UV index to weather reports in the morning. o Making sun safety a mandatory part of the health curriculum in schools.DR. ROBERT MASCIA, MD, BROOKFIELD FAMILY MEDICINEoHow important is it to promote skin cancer awareness in this community?o Very important.oWhat are some common misconceptions people have about their risks of getting skin cancer? o People don’t realize they can’t just apply sunscreen once in the morning and be protected for the rest of the day.oWould an educational poster be beneficial? Would you use it?o Yes, it would help.oWhat would you put on the Poster?o Effects of sun exposure. Wearing sunscreen, proper clothing and being in the in shade. If people are engaging in water activities, then they should reapply sunscreen frequently.oIn 2013, CT passed a law banning the use of tanning beds by minors under the age of 17. What other public health safety measures could potentially be as influential in decreasing skin cancer rates?o Education about sun safety in the schools would be beneficial.Intervention and MethodologyoIntervention:o There is a growing need to increase awareness of skin cancer through education on how to detect it and ways patients can prevent it in this community based on interactions with patients and talking to community experts.o Posters in the waiting/exam room can capture the patient’s attention with strong visuals and pertinent information so patients start paying attention to their skin. It can also serve as an instructional aid for physicians to use. There are a lot of issues patients deals with at a PCP’s office so a poster can be a much needed reminder for patients to continue to self-monitor their skin when there isn’t enough time for a thorough skin exam. Patients would also have the option of taking home a handout which is the exact copy of the poster if they want to. o Created a poster that highlights important points that were gathered from community interviews and additional information drawn from online resources on skin cancer:o All three types of skin cancer will be demonstrated with information and visuals for people to learn how to detect it.o Melanoma also presents differently so educating patients on the different types with visuals is important. o Patients are encouraged to use tools like the ABCDEs to keep track of their moles and poster serves as reminder with each visit.o Patient should also have useful tips on how to protect themselves from the sun because sun exposure is linked to all three types of cancer.  oMethodology:o Patients were randomly selected in the waiting room at Brookfield Family Medicine and given a handout which is the exact replica of the poster that would hang on the exam room wall and patients were surveyed on the effectiveness of the poster by:o Assessing their current sun safety behaviorso Assessing the usefulness of the poster in learning how to detect and prevent skin cancero Assessing if the poster has influenced them to incorporate more sun safety behaviors in their livesIntervention: Detection and Prevention of Skin Cancer3rd leading cause of skin cancerLeading cause of skin cancer deathsUncontrolled growth of melanocytes, pigment producing cellsRisk factors:  Intense, intermittent sun exposure Family history of melanoma Over >100 Moles on body5 Types of Melanoma 2nd leading cause of skin cancer Uncontrolled growth of squamous cells, most abundant cells of skin most commonly caused by cumulative sun exposure Persistent scaly, red patch with irregular borders and crusting Commonly found on face, ears, lower lip, neck, hands, arms, legsBasal Cell Carcinoma (BCC) Melanoma Seek shade especially from 10-4pm when sun’s rays are strongest Wear protective clothing including wide-brimmed hats and UV-blocking sunglasses Use sunscreen with SPF of 15 or higher every day. Apply 30 minutes before sun exposure and reapply every 2 hours Avoid tanning beds Schedule annual skin examination from a dermatologist Examine your own skin from  head-to-toe every month and keep track of suspicious moles with the ABCDEs of MelanomaActinic Keratosis (AK) 40-60% of SCC develops from these precancerous lesions Rough, scaly lesions Commonly on face and back of handsMonitor Moles with the ABCDEsAmelanotic MelanomaSquamous Cell Carcinoma (SCC) #1 leading cause of skin cancer Uncontrolled growth of basal stem cells of skin most commonly caused by cumulative sun exposure Persistent shiny, pink pearly ulcerated lesion with rolled borders and blood vessels: it’s the pimple that won’t go away! Commonly found on face, scalp, upper lip, neck, ears, shoulders and backDon’t Be Sun Scared, Be Sun Smart!Reference: http://www.skincancer.org/Asymmetry of moleBorder is irregularColor is variedDiameter is >6mmEvolution of moleSuperficial Spreading NodularLentigo Maligna Acral LentiginousBenign MalignantResults of Intervention0%20%40%60%80%100%Not at all Somewhat AbsolutelyAre you more interested in learning about sun safety and skin cancer?0%20%40%60%80%100%Never Rarely Sometimes Often AlwaysHow often do wear sunscreen and/or sun protective clothing?0%20%40%60%80%100%Not helpful Somewhat helpful Very helpfulHow helpful was this poster in learning how to detect and prevent skin cncer?0%20%40%60%80%100%Not at all Maybe AbsolutelyAre you more likely to now incorporate sun safety behaviors such as wearing sunscreen and using sun protective clothing on a regular basis?Effectiveness of the Intervention and LimitationsoEffectiveness:o The goal was to promote skin cancer awareness through education using a poster which was accomplished.o The poster was well received by Dr. Mascia at Brookfield Family Medicine.o The response from the poster was positive and effective based on the quantitative and qualitative feedback from patients’ surveys and verbal feedback:o 64% of patients rated the poster as “very helpful” in learning about how to detect and prevent skin cancer. o 75% of patients were “somewhat” and “absolutely” more interested in learning more about sun safety and skin cancer after reading the poster.o 54% of patients would “absolutely” incorporate sunscreen and other sun safety behaviors on a regular basis after reading the poster.o Many patients shared how much they appreciated learning more about skin cancer through the information and visuals on the poster.oLimitations: o There was no feedback on poster from the local community dermatologist, Dr. Eickhorst, due to time constraintso Small sample size of 17 patients surveyed didn’t allow for a more robust responseo Was not able to survey younger children and adolescents due to lack of availabilityo Was not able test poster’s effectiveness as an instructional aide during visits o In addition, it has yet to be seen how much of an impact this poster will have on skin cancer detection and rates without more extensive surveying and tracking incidence of skin cancer in the local area.Recommendations for Future InterventionsoAssess the effectiveness of using the poster as an instructional aide in increasing skin cancer awarenessoAssess how effective it is in increasing awareness when the poster is given as a smaller handout for patients to take home with them oEducate children and teens in schools on sun safety and skin cancer as part of their health curriculumoCreate a smart phone application that has a mole tracker so patients can have an easier time in monitoring themoCreate a kid friendly poster for exam/waiting room in the PCP’s officeReferenceso“Skin Cancer.” American Academy of Dermatology.  https://www.aad.org/media/stats/conditions/skin-cancer. Accessed 16 May 2017. o“Skin Cancer Rates by State.” Centers for Disease Control and Prevention, https://www.cdc.gov/cancer/skin/statistics/state.htm. Accessed 16 May 2017.o“Skin Cancer Rates by Race and Ethnicity.” Centers for Disease Control and Prevention, https://www.cdc.gov/cancer/skin/statistics/race.htm. Accessed 16 May 2017.o“Brookfield.” City Data, www.city-data.com/city/Brookfield-Connecticut.html. Accessed 16 May 2017.o“Annual Cancer facts and stats 2017.” American Cancer Society, https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf. Accessed 16 May 2017.o“ Melanoma.” Skin Dermatologists, www.skindermatologists.com/melanoma.html. Accessed 16 May 2017.o"Melanoma." Harvard Health Publications, www.health.harvard.edu/cancer/melanoma-overview. Accessed 16 May 2017. o“ State Cancer Profiles.” National Cancer Institute, https://statecancerprofiles.cancer.gov/quick-profiles/index.php?statename=connecticut. Accessed 16 May 2017.References Continued….o ”Actinic Keratosis.” lane.stanford.edu/search.html?q=actinic+keratosis&source=pmc-images-all. Accessed 16 May 2017.o“Basal Cell Carcinoma.” lane.stanford.edu/search.html?q=Carcinoma%2C+Basal+Cell&source=images-all. Accessed 16 May 2017.o"US skin cancer costs rise from 2002 through 2011." Centers for Disease Control and Prevention, https://www.cdc.gov/media/releases/2014/p1110-skin-cancer.html. Accessed 16 May 2017. oThielking, Megan. "Skin Cancer from Tanning Beds Costs $343 Million per Year." , https://www.scientificamerican.com/article/skin-cancer-from-tanning-beds-costs-343-million-per-year/. Accessed 16 May 2017.oRosner, Cara. "Don’t soak up the UV rays Connecticut; skin cancer rates on the rise.“ www.nhregister.com/article/NH/20150723/NEWS/150729790. Accessed 16 May 2017.o“Skin cancer facts and statistics.” Skin Cancer Foundation, www.skincancer.org/. Accessed 16 May 2017.o “Sunscreen and Sunglasses.” https://www.flickr.com/photos/maryellenmaguireeisen/8166781361/in/photolist-6bgf9W-7yFPXe-769Diq-iW5pY-Ka75oT-w1PRiC-drETzc-7yFPV6. Accessed 16 May 2017.o“Melanoma.” lane.stanford.edu/search.html?q=Melanoma,%20Amelanotic&source=pmc-images-all&page=1#ncbi.nlm.nih.gov%2FPMC3731173%2Famjcaserep-14-280-g001. Accessed 16 May 2017.o“Skin Cancer.” lane.stanford.edu/search.html?q=skin+cancer&source=images-all#visualsonline.cancer.gov%2F9234. Accessed 16 May 2017.Interview ConsentThank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X___ / No _____Name: Dr. Kim Eickhorst, MD, Dermatology Associates of Western ConnecticutThank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X___ / No _____Name: Dr. Robert Mascia, MD, Brookfield Family MedicineThank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes __X___ / No _____Name: Carmela Luzi, PA-C, Dermatology Associates of Western Connecticut

Promoting Skin Cancer Awareness

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Promoting Skin Cancer Awareness

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