Wireless, battery-free, flexible dosimeters measure personalized exposure to electromagnetic radiation outdoors and in clinical environments.

For those at risk of developing skin cancer, taking preventive actions to reduce UV light (UVL) exposure is an effective strategy to decrease mortality from melanoma and to lessen the physical and emotional burden of the disease. From 1992 through 2002, the average annual increase in melanoma incidence was 2.4% per year, with increases observed among children younger than 20 years,¹ women of all ages, and men 40 years or older.² In the United States, northern states at higher latitudes with lower UVL had a more rapid increase in melanoma incidence than states with higher UVL.³ This finding is thought to be due to persons living in northern states acquiring more sunburn by using fewer precautions during the first sunny days after winter, more commonly seeking indoor UVL exposure in winter, or traveling to other locations in winter where they acquire sunburn.⁴

More than 1 million patients with melanoma in the United States are at risk to develop a second primary melanoma.¹ The risk of a second melanoma is elevated for up to 20 years and is 10 times greater than the risk of a first melanoma in the general population.^2-4 In populations with genetic mutations, 12.7% developed a second primary melanoma within 2 years of the initial diagnosis and 19.1% by 5 years after diagnosis.^5,6 Under current practice guidelines, in the third year after treatment, skin examinations of patients with early melanoma usually decrease to annual examination by a dermatologist and continue for 5 years.⁷ After 5 years, skin examination may be performed annually as clinically indicated for the remainder of the life of the patient.

Early detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined. The electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention. The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention. The demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist's examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes). This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention's role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations. ClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK).