There are currently more than 325,000 Americans who are long-term survivors of childhood and adolescent cancer. While these individuals have greatly benefited from recent medical advances, primarily increasing overall survival rates, treatment advances have come at a cost. It is now clear that childhood radiation therapy has caused survivors to be at extremely high risk for non-melanoma skin cancer (NMSC) and increased risk of melanoma. The rate of new skin cancers among childhood cancer survivors more than tripled between 2001 and 2011;these survivors are diagnosed at an average age of 33, some 30 years earlier than in the non-radiation exposed population. Despite their elevated risk, only 30% of survivors report being examined for skin cancer. Early detection is crucial to reduce the morbidity caused by NMSCs and the morbidity and mortality incurred due to melanoma. The extraordinarily high rates of skin cancer in this young population point to the strong need to increase rates of skin self-examination and physician skin cancer examinations. Both patient and provider action are needed to detect and treat early skin cancers and to find new solutions to ensure expedited follow-up care and treatment, especially among those who live where they have little access to dermatologists. To reduce skin cancers among this young and dispersed patient population, several key issues need to be addressed: (1) how to provide them with the skills needed to conduct effective skin self- examinations;2) how to prompt action from their physicians when worrisome moles and lesions are found;and 3) how to ensure rapid access to dermatologic exams, which in some parts of the US can take weeks or months to schedule. The widespread availability of cell phone technology and teledermatology (remote expert assessment of a photographed lesion or mole) make it possible to test different ways to use these innovative technologies to improve skin cancer early detection and treatment. The proposed comparative effectiveness study will compare the impact of patient activation and education: a) alone;b) in combination with physician education;and c) in combination with physician education and rapid access to dermatologic screening through teledermatology. Patient surveys, chart reviews, and pathology reports will be used to measure key outcomes of interest. Results from this intervention will have important implications for childhood cancer survivors and other high- risk populations, including organ transplant recipients (>225,000 recipients) and first- degree relatives of melanoma patients (>2 million Americans), all of whom share strong deficits in skin self-examinations and receipt of physician examinations for skin cancer.
In 2012, the National Cancer Institute released a PDQ(R) (evidence-based data summary) strongly encouraging the use of the annual dermatological exam to screen for early- onset skin cancer in childhood cancer survivors. This study will teach lifelong early detection activation skills to survivors as they continue to develop new skin cancers, and has great relevance to the emerging network of advocacy groups and organizations serving the hundreds of thousands of childhood cancer survivors, transplant recipients, and first-degree relatives of melanoma patients, all at sharply higher risk of skin cancer.