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Original Investigation |

Clinical Skin Examination Outcomes After a Video-Based Behavioral Intervention:  Analysis From a Randomized Clinical Trial

Monika Janda, PhD1; Philippa Youl, PhD2; Rachel Neale, PhD3; Joanne Aitken, PhD1,2; David Whiteman, PhD3; Louisa Gordon, PhD4; Peter Baade, PhD1,2,4
[+] Author Affiliations
1School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
2Queensland Cancer Council, Brisbane, Queensland, Australia
3Queensland Institute of Medical Research, Brisbane, Queensland, Australia
4Griffith University, Brisbane, Queensland, Australia
JAMA Dermatol. 2014;150(4):372-379. doi:10.1001/jamadermatol.2013.9313.
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Importance  Older men are at risk of dying of melanoma.

Objective  To assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention.

Design, Setting, and Participants  This was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (n = 469) or brochures only (n = 461; overall response rate, 37.1%) and were again interviewed 7 months later (n = 870; 93.5% retention).

Interventions  Video on skin self-examination and skin awareness and written informational materials. The control group received written materials only.

Main Outcomes and Measures  Participants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy.

Results  Overall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%]; control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group; P = .01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls; P = .03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis.

Conclusions and Relevance  A video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men.

Trial Registration  anzctr.org.au Identifier: ACTRN12608000384358

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Figure.
Flow of Participants Through Study and Clinical Skin Examination (CSE) Outcomes

Participants were randomized into intervention and control groups.

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