Melanoma is a major public health problem with significant morbidity and mortality, and is increasing in frequency, unlike most cancer sites. The vast majority of the ultimately fatal melanomas were perfectly visible on the skin surface before they metastasized, yet they were not detected in time, hence not excised until it was too late for cure. Primary care clinicians are well-positioned to have a substantial impact on melanoma mortality by detecting these lesions on the skin surface prior to metastasis, yet we have found that they generally do not inspect the areas of the skin on which melanomas most commonly arise. This proposal seeks to change the skin examination practices of primary care physicians by developing the Basic Skin Cancer Triage curriculum into a web-based course and evaluating its efficacy in a geographically diverse sample of community-based primary care physicians. Specifically, we will develop the above course and compare it, in a randomized trial, to a web-based course in weight, diet, and physical activity assessment and counseling. Our primary outcomes will be performance of skin examination and counseling during routine primary care visits, as assessed by patient exit interviews. We will also assess self-reported ? practices and other measures. If this course is found to be efficacious, it will be made freely available on the web, and we will plan efforts to encourage its broad dissemination. ? ?
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