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. 2023 May 3:13:1174542.
doi: 10.3389/fonc.2023.1174542. eCollection 2023.

Educational level-dependent melanoma awareness in a high-risk population in Switzerland

Alina Miriam Mueller  1   2 , Elisabeth Victoria Goessinger  1   2 , Sara Elisa Cerminara  1   2 , Lisa Kostner  1   2 , Margarida Amaral  1 , Stephanie Marie Huber  1 , Lea Pauline Passweg  2 , Laura Garcia Moreno  2 , Daniel Bodenmann  2 , Michael Kunz  1 , Mitchell Paul Levesque  3   4 , Julia-Tatjana Maul  3   4 , Phil Fang Cheng  3 , Alexander Andreas Navarini  1   2 , Lara Valeska Maul  1   2
Affiliations

Educational level-dependent melanoma awareness in a high-risk population in Switzerland

Alina Miriam Mueller et al. Front Oncol. .

Abstract

Introduction: The worldwide incidence of melanoma has been increasing rapidly in recent decades with Switzerland having one of the highest rates in Europe. Ultraviolet (UV) radiation is one of the main risk factors for skin cancer. Our objective was to investigate UV protective behavior and melanoma awareness in a high-risk cohort for melanoma.

Methods: In this prospective monocentric study, we assessed general melanoma awareness and UV protection habits in at-risk patients (≥100 nevi, ≥5 dysplastic nevi, known CDKN2A mutation, and/or positive family history) and melanoma patients using questionnaires.

Results: Between 01/2021 and 03/ 2022, a total of 269 patients (53.5% at-risk patients, 46.5% melanoma patients) were included. We observed a significant trend toward using a higher sun protection factor (SPF) in melanoma patients compared with at-risk patients (SPF 50+: 48% [n=60] vs. 26% [n=37]; p=0.0016). Those with a college or university degree used a high SPF significantly more often than patients with lower education levels (p=0.0007). However, higher educational levels correlated with increased annual sun exposure (p=0.041). Neither a positive family history for melanoma, nor gender or Fitzpatrick skin type influenced sun protection behavior. An age of ≥ 50 years presented as a significant risk factor for melanoma development with an odd's ratio of 2.32. Study participation resulted in improved sun protection behavior with 51% reporting more frequent sunscreen use after study inclusion.

Discussion: UV protection remains a critical factor in melanoma prevention. We suggest that melanoma awareness should continue to be raised through public skin cancer prevention campaigns with a particular focus on individuals with low levels of education.

Keywords: awareness; education; melanoma; prevention; sunscreen.

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Conflict of interest statement

AM has received support for conference attendance from ALK, Bencard and Galderma. LK has received speaking fees in a presentation sponsored by Boehringer Ingelheim. ML has project-specific research funding from Roche, Novartis, Molecular Partners, and Oncobit AG and has received speaking fees from Danaher. J-TM is and has served as advisor and/or received speaking fees and/ or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, BMS, Celgene, Eli Lilly, LEO Pharma, Janssen-Cilag, MSD, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi, UCB. AN declares being a consultant and advisor and/or receiving speaking fees and/or grants and/or served as an investigator in clinical trials for AbbVie, Almirall, Amgen, Biomed, Bristol Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Galderma, GlaxoSmithKline, LEO Pharma, Janssen-Cilag, MSD, Novartis, Pfizer, Pierre Fabre Pharma, Regeneron, Sandoz, Sanofi, and UCB. LM has served as advisor and/or received speaking fees and/or participated in clinical trials sponsored by Almirall, Amgen, BMS, Celgene, Eli Lilly, MSD, Novartis, Pierre Fabre, Roche and Sanofi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
SPF use of at-risk patients vs. melanoma patients. Significant trend for melanoma patients to use higher SPF than at-risk patients (SPF 50+: 48% [n = 60] vs. 26% [n = 37], χ2 = 15.33, df = 3, p = 0.0016). SPF is color-coded.
Figure 2
Figure 2
(A) Correlation of education level and choice of SPF. OR 4.54; 95% CI 1.92-10.83; p = 0.0007; (B) Correlation of education level and sun exposure per year. OR 2.23, 95% CI 1.07-4.89; p = 0.041. (C) Correlation of education level and choice of SPF with comparison of the at-risk cohort and melanoma patients. At-risk patients: p = 0.007; melanoma patients: p = 0.011. (D) Correlation of education level and sun exposure per year with comparison of the at-risk cohort and melanoma patients. at-risk patients: p = 0.2; melanoma patients: p = 0.059. Low SPF = 6-10 or 15-25, High SPF = 30-50 or 50+. Light blue = secondary school or apprenticeship, dark blue = college or university.
Figure 3
Figure 3
Correlation of age and sun exposure per year. Significantly more participants ≥ 40 years had a sun exposure of ≥ 5 weeks per year (OR 4.17, 95% CI 1.34-13.24; p = 0.0136). Light blue = sun exposure of not more than 5 weeks per year, dark blue = sun exposure of more than 5 weeks per year. OR 4.17, 95% CI 1.34-13.24; p = 0.0136.
Figure 4
Figure 4
Correlations between demographics and hobbies and melanoma (data derived from melanoma patients, n = 125). An odds ratio close to 1.0 indicates that the odds are the same between the two compared groups.
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