***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 
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    Input: OBJECTIVE To improve the proportion of men 50 years or older who conduct a thorough whole-body skin self-examination ( SSE ) , because these men are at increased risk of being diagnosed as having thick melanomas and dying of melanoma . DESIGN R and omized trial of a video-based intervention to increase whole-body SSE compared with brochures-only control . SETTING Men from an Australian population register . PARTICIPANTS The study included 930 men 50 years or older . INTERVENTION The men were r and omly assigned to receive either written material s only ( control ) or written material s along with a DVD or video and 2 postcard reminders ( intervention ) . Telephone interviews were conducted at baseline and at 7 and 13 months . MAIN OUTCOME MEASURE The proportion of men who conducted a whole-body SSE with the help of 2 mirrors and /or a person to assist with difficult-to-see areas . RESULTS Compared with baseline ( 10 % ) , by 13 months both groups had increased their whole-body SSE behaviors similarly ( 36 % intervention and 31 % control ) ( P = .85 ) . At 7 months , the intervention group was significantly more likely to examine at least 1 part of their back ( P < .001 ) and to examine a greater number of body sites ( P < .001 ) . At 7 months , the proportion of men conducting any SSE increased by 28 % in the intervention group compared with 13 % in the control group ( P < .001 ) , but at 13 months , the prevalence of any self-examination ( 83 % vs 80 % ) was again similar . CONCLUSION While men 50 years or older are responsive to appropriately targeted intervention material s to increase their SSE behaviors , the addition of a video or DVD to written material s had only a transient advantage for optimal SSE practice s. TRIAL REGISTRATION anzctr.org.au Identifier : 12608000384358 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 The " ABCD " mnemonic to assist non-experts ' diagnosis of melanoma is widely promoted ; however , there are good reasons to be sceptical about public education strategies based on analytical , rule-based approaches -- such as ABCD ( i.e. Asymmetry , Border Irregularity , Colour Uniformity and Diameter ) . Evidence suggests that accurate diagnosis of skin lesions is achieved predominately through non-analytical pattern recognition ( via training examples ) and not by rule-based algorithms . If the ABCD are to function as a useful public education tool they must be used reliably by untrained novices , with low inter-observer and intra-diagnosis variation , but with maximal inter-diagnosis differences . The three subjective properties ( the ABCs of the ABCD ) were investigated experimentally : 33 laypersons scored 40 r and omly selected lesions ( 10 lesions × 4 diagnoses : benign naevi , dysplastic naevi , melanomas , seborrhoeic keratoses ) for the three properties on visual analogue scales . The results ( n = 3,960 ) suggest that novices can not use the ABCs reliably to discern benign from malignant lesions Most education campaigns for melanoma ( MM ) detection in the general population have used the " ABCD " algorithm , although recognition of objects in the real life is based on a holistic image recognition rather than on analytic criteria . The objective was to compare analytic ( ABCD ) and cognitive ( photographs ) strategies for teaching self-recognition of MM . A prospect i ve 4-arm stratified r and omized trial in 255 individuals compared 3 realistic educative interventions by leaflets : 1 ) ABCD algorithm ( " ABCD " ) , 2 ) a set of photographs chosen to stimulate recognition of MM among benign pigmented lesions ( " Cog " ) , 3 ) photographs + explanations ( " Cog-Ex " arm ) and 4 ) no intervention ( " NI " ) . A 40-slides test was performed before intervention ( T0 ) , 1 week after ( T1 ) and after induction of anxiety ( T2 ) . In the " ABCD " arm , sensitivity slightly improved ( 80 to 83.8 % , p = 0.04 ) , but specificity dropped from 65.1 to 56.3 % ( p < 0.001 ) , with no benefit in accuracy as compared to " NI " . In " Cog " arm , there was no change in sensitivity , but a strong increase in specificity ( 65.9 to 81.1 % , p < 0.001 ) and accuracy ( 42.1 to 53.1 % , p < 0.001 ) . " Cog-ex " result ed in similar although lower benefit . Under stress ( T2 ) , there was a dramatic loss of specificity and accuracy in " ABCD " arm ( 65.1 to 44.1 % , p < 0.001 and 40.8 % to 35.8 % , p < or = 0.001 ) without higher gain in sensitivity , while sensitivity and accuracy increased ( p < 0.005 ) after " Cog " leaflet , without decreasing specificity . Finally , the " ABCD " message alone does not seem efficacious and is even worse in the context of anxiety , whereas a quick look at a few photographs is sufficient to improve the ability of the laymen to recognize a MM just by optimizing their spontaneous image recognition capacities . Education by photographs is a realistic strategy which should replace or complete " ABCD " message in the campaigns for self-detection of MM PURPOSE / OBJECTIVES To compare the effect of providing high-risk patients with st and ard brochures versus personalized photo books as part of a comprehensive nursing intervention on knowledge , awareness , and confidence with skin self-examination ( SSE ) performance , as well as compliance in performing SSE . DESIGN R and omized intervention design . SETTING The Lawrence E. Rockefeller Ambulatory Outpatient Cancer Center at Memorial Sloan-Kettering Cancer Center in New York , NY . SAMPLE 100 patients at high risk for melanoma . METHODS Patients completed a baseline question naire before their initial photographs were taken and at the end of a nurse-teaching intervention at the clinic . MAIN RESEARCH VARIABLES Skin cancer knowledge , awareness , and self-confidence in SSE . FINDINGS A two-way analysis of variance with repeated measures was performed to examine differences within and among groups in relation to knowledge , awareness , and confidence . The group-time interaction was not significant . In group A ( nursing intervention with photo book ) , 10 % of the patients at baseline reported performing  SSE  three or more times during the prior four months . Mean knowledge scores , awareness , and confidence scores all increased . In group B ( nurse-teaching intervention using brochures only , without a photo book ) , 20 % reported practicing  SSE  three or more times during the prior four months . Mean knowledge , awareness , and confidence scores increased . CONCLUSIONS The main difficulty that patients experience with self-detection of melanoma is their limited recall of skin appearance ; therefore , photographic records may be the most effective aid for detecting changes at longer intervals . The use of a photo book may help to diminish that difficulty . IMPLICATION S FOR NURSING This study supports the fact that education can increase knowledge , awareness , and confidence regarding SSE , which is consistent with the findings of other investigators . Therefore , nurses should incorporate teaching patients how to perform SSE into their practice and recognize that personal involvement in health care has become a dominant theme in the cancer education literature in recent years . With this new emphasis , important self-care activities , such as testicular self-examination , breast self-examination , and now SSE , are being stressed because early detection has shown favorable effects in improving the prognosis of cancer This prospect i ve study examines psychosocial mediators of an efficacious skin self-examination ( SSE ) intervention  that includes provision of a whole-body digital photography book depicting the entire skin surface . Individuals ( n = 100 ) with established risk factors for melanoma were recruited from the Memorial Sloan-Kettering Cancer Center Pigmented Lesion Clinic during their initial dermatologist visit and were r and omized to receive a photobook immediately ( n = 49 ) or 4 months after intervention delivery ( n = 51 ) . Potential mediators included self-efficacy and response efficacy drawn from Social Cognitive Theory , melanoma worry , and SSE anxiety drawn from Self-Regulation Theory , and skin cancer knowledge , and skin awareness . Only self-efficacy was a significant mediator , accounting for 8 % of the total effect of photobook enhancement on SSE adherence at 4 months . ( Cancer Epidemiol Biomarkers Prev 2006;15(6):1212–6 BACKGROUND Multicomponent Check-It-Out project interventions were found to be effective at increasing thorough skin self-examinations ( TSSE ) . Application of this research will benefit from determining the most important interventions for promoting TSSE . OBJECTIVE Identification of the most important Check-It-Out intervention components for promoting TSSE . METHODS This study analyzed the responses of the 567 participants who were r and omized into the skin examination intervention group and who did not report performing TSSE at their baseline interview . RESULTS Watching the video , using the h and mirror , shower card , American Cancer Society brochure , sample photographs , and finding the health educator helpful were associated with performing TSSE at 2 months , 12 months , or both . LIMITATIONS Use of the material s within the skin group was not r and omly assigned . All data were based on participant self-report . CONCLUSIONS As future interventions to increase TSSE are developed , the identified useful components will be important to include Two studies are reported on the effects of photographic and written information on performance in an experimental  melanoma detection task . Subjects were shown slides  of four types of skin lesions , including melanoma , and were asked what they would do if the lesion was on their skin . Four response options were provided from seeing a doctor immediately to doing nothing . In Experiment 1 , no clear differences in performance were found as a function of prior instruction using four , eight or 16 photographs of each of the four lesion types . In Experiment 2 , the effects of written and photographic instructional material were compared . The written material contained descriptions of each lesion type and details of the ABCD criteria for melanoma detection . Eight photographs were provided for each lesion type . Photographic information result ed in superior performance ( P < 0.001 ) for seborrhoeic keratoses and a combination of both types of information was superior ( P < 0.05 ) for melanoma . The two kinds of instructional material produced different effects , suggesting that a brochure offering a combination of photographs and written information is likely to be most useful in helping members of the public identify early melanoma as suspicious BACKGROUND Results from a single case-control study suggest that  skin self-examination ( SSE ) has the potential to reduce mortality from melanoma by 63 % . Despite these encouraging results , SSE rates are low . Few prospect i ve studies of interventions to 
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RESULTS Images positively affected knowledge and self-efficacy related to SSE .
Images motivated the performance of SSE and increased the accuracy of SSE and melanoma detection .
The use of visual images to promote accurate and frequent SSE is encouraged