***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Although some evidence indicates that early detection protects against the development of lethal melanoma , no r and omized clinical trials have been conducted to measure the efficacy of early detection ( or screening ) in preventing death from this disease . Since melanoma incidence in the United States is relatively rare , a r and omized clinical trial to test the efficacy of screening would be extremely expensive . PURPOSE As an alternative to a r and omized clinical trial , we conducted a population -based , case-control study to investigate whether early detection through skin self-examination ( SSE ) is associated with a decreased risk of lethal melanoma ( includes the presence of advanced disease with distant metastases in addition to death from melanoma ) . METHODS SSE ( conducting a careful , deliberate , and purpose ful examination of the skin ) was assessed in all subjects by use of a structured question naire and personal interviews . The major exposure variable , SSE , was defined following focus-group interviews with melanoma patients and healthy control subjects . The final study population consisted of 1199 Caucasian residents of the state of Connecticut enrolled from January 15 , 1987 , through May 15 , 1989 ; 650 individuals were newly diagnosed with cutaneous melanoma , and the remaining 549 individuals were age- and sex-frequency matched control subjects from the general population . During the study interviews , nevi on the arms and backs of subjects were counted . In 5 years of follow-up ( through March 1994 ) , 110 lethal cases of melanoma were identified . The study design allowed separate estimation of the impact of SSE on reduced melanoma incidence ( primary prevention ) and survival among incident cases ( secondary prevention ) . Odds ratios ( ORs ) were used to measure the associations between SSE and melanoma and between SSE and lethal melanoma . RESULTS SSE , practice d by only 15 % of all subjects , was associated with a reduced risk of melanoma incidence ( adjusted OR = 0.66 ; 95 % confidence interval [ CI ] = 0.44 - 0.99 ; comparing case patients with control subjects ) . The data indicated further that SSE may reduce the risk of advanced disease among melanoma patients ( unadjusted risk ratio = 0.58 ; 95 % CI = 0.31 - 1.11 ) ; however , longer follow-up is required to confirm this latter estimate . If both estimates are correct , they suggest , in combination , that SSE may reduce mortality from melanoma by 63 % ( adjusted OR = 0.37 ; 95 % CI = 0.16 - 0.84 ; comparing lethal cases with general population controls ) . CONCLUSIONS AND IMPLICATION S SSE may provide a useful and inexpensive screening method to reduce the incidence of melanoma .  SSE may also reduce the development of advanced disease . The results of this study need to be replicated before strategies to increase the practice of SSE  are further developed and promoted BACKGROUND In epidemiologic studies , sunscreen use is associated with increased risk of cutaneous melanoma , basal cell skin cancer , and higher numbers of nevi . It has been proposed that sunscreens may encourage prolonged sun exposure because they delay sunburn occurrence . We examined whether , under habitual conditions of sunscreen use , the sun-protection factor ( SPF ) had an influence on sun-exposure duration . METHODS Before the 1997 summer holidays , we r and omly assigned 87 French and Swiss participants who were 18 - 24 years of age to receive an SPF 10 or an SPF 30 sunscreen . Neither medical personnel nor study participants were aware of their sunscreen assignment . Participants were asked to complete daily records of their sun exposure . To avoid influencing the recreational sun-exposure habits of the study participants , no recommendation was made about sun exposure or sun protection . Furthermore , participants were told that the trial end point was the number of pigmented skin lesions before and after the holidays . One subject was lost to follow-up . All statistical tests were two-sided . RESULTS The SPF 10 ( n = 44 ) and SPF 30 ( n = 42 ) groups had equivalent mean holiday duration s ( 19.4 days versus 20.2 days ) and mean quantities of sunscreen used ( 72.3 g versus 71.6 g ) . The mean cumulative sun exposures for the two groups were 58.2 hours and 72.6 hours , respectively ( P = .011 ) . The mean daily duration s of sunbathing were 2.6 and 3.1 hours , respectively ( P = .0013 ) , and , for outdoor activities , they were 3.6 and 3.8 hours , respectively ( P = .62 ) . There was no difference in sunburn experience between the two groups . CONCLUSIONS Use of higher SPF sunscreen seems to increase the duration of recreational sun exposure of young white Europeans Prospect theory suggests that people respond differentially to factually equivalent messages depending on how these messages are framed ( A. Tversky & D. Kahneman , 1981 ) . A. J. Rothman and P. Salovey ( 1997 ) relied on prospect theory to predict that messages highlighting potential " gains " should promote prevention behaviors such as sunscreen use best . This experiment compared the effectiveness of 4 differently framed messages ( 2 highlighting gains , 2 highlighting losses ) to persuade 217 beach-goers to obtain and use sunscreen . Attitudes and intentions were measured before and immediately following the delivery of the framed information , and after completing the question naire participants were given a coupon redeemable for a small bottle of sunscreen later that same day . People who read either of the 2 gain-framed brochures , compared with those who read either of the 2 loss-framed brochures , were significantly more likely to ( a ) request sunscreen , ( b ) intend to repeatedly apply sunscreen while at the beach , and ( c ) intend to use sunscreen with a sun protection factor of 15 or higher OBJECTIVE To examine the role of  partner assistance in learning and implementation of an intervention design ed to promote skin self-examination ( SSE ) behaviors in persons at risk of developing melanoma . DESIGN R and omized controlled trial with immediate and 4-month follow-up visits . SETTING Clinical offices in the ambulatory care area of a hospital . Patients The study included 130 participants and their cohabiting partners drawn from a melanoma registry . Intervention The subjects were r and omly assigned to receive the intervention either as solo learning or as dyadic learning . The intervention consisted of a 10-minute demonstration of the ABCDE ( asymmetry of shape , border irregularity , color variegation , diameter > or = 6 mm , and evolution of the lesion ) rule and skills training . MAIN OUTCOME MEASURES Behavioral measures included self-reported performance of SSE and use of a body map design ed to record areas of concern found during SSE . Intentions , along with attitudinal measures such as perceived importance of SSE and self-efficacy in performing SSE , were also assessed at the 4-month follow-up visit . RESULTS The participants in the dyadic learning group were significantly more likely to report engaging in SSE behaviors ( P<.05 ) . The dyadic learning group also exhibited greater intentions to perform future SSE ( P<.01 ) , higher perceived importance of SSE ( P<.01 ) , and higher perceived self-efficacy ( P<.01 ) . CONCLUSION Dyadic learning may be more effective than solo learning in regard to interventions design ed to teach and promote health behaviors , such as SSE Background Skin cancer is the most prevalent yet most preventable cancer in the US . While protecting oneself from ultraviolet radiation ( UVR ) can largely reduce risk , rates of unprotected sun exposure remain high . Because the desire to be tan often outweighs health concerns among sunbathers , very few interventions have been successful at reducing sunbathing behavior . Sunless tanning ( self-tanners and spray tans ) , a method of achieving the suntanned look without UVR exposure , might be an effective supplement to prevention interventions . Methods and Design This cluster r and omized trial will examine whether a beach-based intervention that promotes sunless tanning as a substitute for sunbathing and includes sun damage imaging and sun safety recommendations is superior to a question naire only control group in reducing sunbathing frequency . Female beach visitors ( N = 250 ) will be recruited from 2 public beaches in eastern Massachusetts . Beach site will be the unit of r and omization . Follow-up assessment will occur at the end of the summer ( 1-month following intervention ) and 1 year later . The primary outcome is average sunbathing time per week . The study was design ed to provide 90 % power for detecting a difference of .70 hours between conditions ( st and ard deviation of 2.0 ) at 1-year with an intra-cluster correlation coefficient of 0.01 and assuming a 25 % rate of loss to follow-up . Secondary outcomes include frequency of sunburns , use of sunless tanning products , and sun protection behavior . Discussion Interventions might be improved by promoting behavioral substitutes for sun exposure , such as sunless tanners , that create a tanned look without exposure to UVR.Trial registration Abstract Objective : Whole-body skin self-examination ( SSE )  with presentation of suspicious lesions to a physician may improve early detection of melanoma . The aim of this study was to establish the prevalence and determinants of SSE in a high-risk population in preparation for a community-based r and omised controlled trial of screening for melanoma . Methods : A telephone survey reached 3110 residents older than 30 years ( overall response rate of 66.9 % ) r and omly selected from 18 regional communities in Queensl and , Australia . Results : Overall , 804 ( 25.9 % ) participants reported whole-body SSE within the past 12 months and 1055 ( 33.9 % ) within the past three years . Whole-body SSE was associated in multivariate logistic regression analysis with younger age ( < 50 years ) ; higher education ; having received either a whole-body skin examination , recommendation or instruction on SSE by a primary care physician ; giving skin checks a high priority ; concern about skin cancer and a personal history of skin cancer . Conclusion : Overall , the prevalence of SSE in the present study is among the highest yet observed in Australia , with about one-third of the adult population reporting whole-body SSE in the past threeyears . People over 50 years , who are at relatively higher risk for skin cancer , currently perform  SSE  less frequently than younger people BACKGROUND Melanoma is a major public health problem for which early detection may reduce mortality . Since melanoma is generally asymptomatic , this requires skin examination . We sought to evaluate the extent to which the general public has their skin examined by themselves , their partners , or health care providers and the frequency of these examinations . METHODS R and om-digit-dial survey of adult Rhode Isl and ers . RESULTS Only 9 % performed a thorough skin examination ( TSE ) at least once every few months , although over half of the sample reported conducting skin self-examination " deliberately and systematic ally . " Participants were more likely to perform TSE if they were women and if their health care provider had asked them to examine their skin . Most participants reported that their health care provider never or rarely looked at the areas of their skin in which melanoma is most likely to arise . CONCLUSIONS The reported frequency of  skin self-examination  depends critically on the manner of inquiry . TSE by self or a partner is uncommon , and health care providers do not routinely examine the areas of the skin on which melanomas commonly arise BACKGROUND Thorough skin self-examination ( TSSE ) has substantial potential to reduce melanoma mortality by early detection . METHODS We interviewed 2,126 patients before a scheduled routine visit with a primary care physician , at which participation in a r and omized trial was offered as part of the Check-It-Out Project . We asked about skin examination behavior and related issues . RESULTS By our a priori definition of TSSE , 18 % of participants performed this activity , but other definitions led to widely varying estimates of 12 % to 38 % . Using a partner to assist in the examination was strongly associated with TSSE . That partner was generally the spouse , and wives were more likely to assist their husb and s in these examinations than the reverse . The availability of a wall mirror was a particularly important predictor of TSSE performance . Visual impairment also affected performance . CONCLUSIONS Estimates of TSSE performance vary substantially with the questions used to elicit this information . Partners , particularly spouses , appear to play a critical role in the conduct of TSSE , and wives appear more often and more effectively engaged in this process . Appropriate circumstances , such as availability of a wall mirror , are also important factors . These findings can be used to design interventions to increase TSSE performance with the ultimate aim of reducing melanoma mortality 
    Output:
    
Evidence demonstrated that individuals with MM still engaged in sunbathing , indoor tanning , and reported sunburns .
Moreover , survivors reported inadequate levels of both sun protection and skin self-examinations .