The ECR provided data on melanoma and demographic characteristics of the patients. The questionnaire included a generic and cancer-specific HRQoL instrument (36-Item Short-Form Health Survey [SF-36] and Impact of Cancer [IOC], respectively) and additional questions regarding demographic variables, disease progression, and current comorbidity (adapted from the Charlson comorbidity index).13- 15 For the SF-36, standard scoring procedures of the 8 scales) (ie, Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional subscale, Mental Health) were followed where higher scores indicate better functioning (range, 0-100).13 Two higher-order component scores for physical (PCS) and mental health (MCS) were also calculated. The IOC was developed by Zebrack et al15 in 2006 to measure the well-being of long-term cancer survivors and their adjustment to changes. It consists of 41 questions (5-point response scale), 6 domains (ie, physical, psychological, social, existential, meaning of cancer, health worry) with 10 dimensional subscales.14,15 These 10 subscales are Physical: Health Awareness (4 items); Physical: Body Changes (5 items); Psychological: Positive Self-Evaluation (8 items); Psychological: Negative Self-Evaluation (4 items); Existential: Positive Outlook (3 items); Existential: Negative Outlook (4 items); Social: Life Interferences (3 items); Social: Value of Relationships (2 items); Meaning of Cancer (5 items); and Health Worry (3 items). These subscales were combined to form a higher-order positive or higher-order negative scale (range, 0-5) with higher scores indicating a more positive or negative impact of cancer, respectively (Table 1). In addition to these preexisting validated instruments, several melanoma-specific items that assess issues related to treatment, impact on daily life, and follow-up were included (based on expert opinion) because these issues were not covered by the SF-36 or IOC questionnaires (see the subsections titled “Melanoma-Specific Items” and Practical Issues Related to Melanoma” in the “Results” section). Responses were categorized as “less,” “the same,” “a little bit more,” “more,” or “a lot more.” In the analyses, “more” and “a lot more” were combined. To evaluate the physical symptoms experienced due to melanoma or its treatment, questions regarding pain, itch, swelling, and numbness with a 3-point scale were included.9 Several items pertained to the extent to which the diagnosis of melanoma affected patients' sun (exposure) behavior (ie, activity in the sun, worry about the effects of the sun on the skin, and sun-protective measures) were included. Furthermore, patients were asked whether applications for health, life, and disability insurance or home mortgage had been hampered because of their melanoma.