J AM ACAD DERMATOL

VOLUME 65, NUMBER 2Letters 427

Check your skin: Insights regarding skincancer education

To the Editor: Skin cancer is themost common cancerworldwide.1 In 2007 there were an estimated 59,940new cases of malignant melanoma with 8110deaths.2 Sunlight is a contributing factor. TheAmerican Academy of Dermatology (AAD) hasbeen dedicated to public education focusing on thedetection and prevention of skin cancers.3

The AAD recommended medical trainees andprimary carephysicians learn how to counsel patientson prevention and early detection of malignant mel-anoma.3 The Check Your Skin project had medicalstudents counsel the Richmond, VA, community onthese issues. The program included a lecture sessionwith a pretest and posttest (available online at http://www.eblue.org). Analysis of the answers revealedinformation about our broader educational efforts.

The project was approved by the VirginiaCommonwealth University Institutional ReviewBoard and was awarded grants from the AmericanCancer Society, the Virginia CommonwealthUniversity Alumni Association, and the AmericanAcademy of Medical Colleges.

The objective of the program was to educate thecommunity on the early detection of skin cancerand to encourage the use of skin examinations.Medical students visited various institutions andcommunity centers. The audiences were given a

Fig 1. Number of persons answering correctly onZ-scores are given at top of each pair of bars. Gresults of questions focusing on dangers of sun expon malignant melanoma features and early detect

21-question quiz before receiving education aboutskin cancer. Eleven of the questions specificallytested the participants’ knowledge in the areasof sun dangers and early signs, risk factors, andfeatures of malignant melanoma. The audienceswere educated in these areas and given the samequiz again.

There were 1617 participants in the pretest and1530 participants in the posttest. Z-score and t scoreanalyses were used to compare prior knowledgewith the amount of knowledge gained througheducation. For analysis, the questions were dividedinto two broad categories: (1) sun dangers, and (2)features of melanoma.

Z-scores tested each question for the difference inthe number of persons answering correctly on theposttest versus the pretest. Fig 1 shows the propor-tion of persons correctly answering pretest questionspertaining to sun dangers was higher than theproportion of persons correctly answering questionspertaining to melanoma. The larger z-scores for thequestions about melanoma indicate there is a higherstandardized posteducation improvement for thiscategory.

The t test applied to the pretest scores of the twocategories revealed the average number of correctresponders was higher for the questions about sundangers on the pretest. We conclude participantsbegan the session with less knowledge of melanomathan of the dangers of sun exposure.

pretest (blue bars) and posttest (red bars).raph is divided into two portions showingosure (left) and results of questions focusingion (right).

Table I. Baseline demographics of patients com-pleting study

Characteristics

Patients with vitiligo

(Total = 16)

Age, years (range) 35.5 (15-60)Sex M:F = 7:9Disease duration, years (range) 4.1 (0.5-11)Family history of vitiligo,No. of patients

2 (12.5%)

Autoimmune disease,No. of patients

0 (0%)

Clinical types of vitiligoFocal 4 (25%)Acrofacial 2 (12.5%)Vulgaris 10 (62.5%)

Treated siteHead and neck 6 (37.5%)Trunk 9 (56.3%)Extremity 1 (6.3%)

M:F, Male:female ratio.

Fig 1. Repigmentation scores as assessed by two derma-tologists blinded as to treatment using a quartile gradingscale among the E, C, and T groups.

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The results suggest our educational efforts havenot been uniformly successful. The tested popula-tion came to the sessions with a good fund ofknowledge relating to the dangers of excess sunexposure. Yet, the lower pretest knowledge of mel-anoma is striking, as was the improvement notedafter a short educational session. This combination ofresults indicates additional emphasis should beplaced on melanoma awareness.

William Gillen,a Seth B. Forman, MD,c Julia R.Nunley, MD,a Sonya Bhole,a Kyle Eliason,a PaigeFox,a and Calvin O. McCall, MDa,b

Department of Dermatology, Virginia Common-wealth University Medical Center, Richmonda;Hunter Holmes McGuire Department of VeteransAffairs Medical Center, Richmondb; and Univer-sity of Central Florida College of Medicine,Orlandoc

Supported by the American Cancer Society, Vir-ginia Commonwealth University Alumni Associ-ation, and American Academy of MedicalColleges.

Conflicts of interest: None declared.

Correspondence to: Calvin O. McCall, MD, Depart-ment of Dermatology, Virginia CommonwealthUniversity Medical Center, PO Box 980164,Richmond, VA 23298

E-mail: comccall@vcu.edu

REFERENCES

1. Leiter U, Garbe C. Epidemiology of melanoma and nonmela-

noma skin cancerethe role of sunlight. Adv Exp Med Biol

2008;624:89-103.

2. American Cancer Society. Cancer facts and figures 2007.

Available from: www.cancer.org/downloads/STT/CAFF2007PWSec

ured.pdf. Accessed November 1, 2010.

3. Harris J. Plan to promote the prevention and early detection of

melanoma. Dermatol Nurs 2000;12:329-33.

doi:10.1016/j.jaad.2010.11.041

Combination treatment of non-segmentalvitiligo with a 308-nm xenon chloride excimerlaser and topical high-concentration tacalcitol:A prospective, single-blinded, paired,comparative study

To the Editor: Vitamin D analogues have been usedas monotherapy or in combination with photother-apy for the treatment of vitiligo. However, the trueeffects of vitamin D analogues on vitiligo remaincontroversial. Some studies have reported a goodresponse or an augmented response over conven-tional treatment,1,2 whereas other studies have

reported no response or a limited effect.3,4 Highconcentration tacalcitol (HT) ointment, which hasbeen reported to be safe for the treatment of psoriasisvulgaris5 has not yet been used for the treatment ofvitiligo.

This study was a 16-week, open-label, prospec-tive, randomized, single-blinded, paired compara-tive study. The study protocol was approved by theInstitution Review Board of Severance Hospital. Ineach patient with non-segmental vitiligo (NSV), atleast two lesions similar in size, localization, andprogression, but sufficiently distant from one an-other were selected and assigned to one of 3 groups;HT alone (T group), 308-nm xenon chloride excimerlaser alone (E group), and combination treatment

APPENDIX[Questions are listed in the order in which the data bars for each question appear in Figure 1.]

Sun dangers:

1) When outside on a summer day, which level of Sun Protection Factor (SPF) should your sunscreen have to be considered ACCEPTABLE for sun protection? [correct answer B]A. less than SPF 10B. SPF 15-29C. SPF 30+

2) True or false? You do not need to worry about skin cancer if you only go out in the sun for shortperiods of time (10 to 20 minutes at a time). [correct answer False]

3) True or false? Sunburn may be painful, but not really harmful in the long run. [correct answerFalse]

4) True or false? Wading, swimming or playing in water provides natural sun protection. [correctanswer False]

Early signs, risk factors and features of malignant melanoma:

1) True or false? Melanoma is found mostly on the face and arms. [correct answer False]

2) True or false? Melanoma can spread throughout the body. [correct answer True]

3) True or false? Melanoma always looks like a round brown spot on the skin. [correct answerFalse]

4a-4d) Experts describe worrying features of melanoma in moles as the ‘‘ABCDs of skin cancer.’’Which of the following describes the ABCDs ofmelanoma? (Circle one in each column) [each columnwas considered a separate question] [correct answers are in brackets]

4a 4b 4c 4d

A B C D

Anemic Bulging Circumference Dry[Asymmetrical] Brittle Coarseness [Diameter]Actinic [Border] Crusty DepthAligned Brown [Color] Density

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