***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 Rates of malignant melanoma are rising , with those people with sun-sensitive skin most at risk . Health education interventions are needed to help people protect themselves by detecting early signs of melanoma and by protecting their skin from sunburn . This study aim ed to evaluate the impact of an interactive multimedia intervention " Skinsafe " on patients ' knowledge about melanoma and on their skin protective behaviors . METHODS In this cluster-r and omized , controlled trial conducted in Nottinghamshire , UK , doctors and nurses in 5 family practice s prescribed Skinsafe to patients with higher risk skin characteristics .  Measures of melanoma knowledge , perceived risk of melanoma and reported skin protective behaviors were obtained at baseline and at 6-month follow-up from 259 patients receiving the intervention and 330 patients with higher risk skin characteristics in 5 matched control practice s. RESULTS AND DISCUSSION Participants had low levels of melanoma knowledge at baseline . At follow-up , the intervention group had higher knowledge scores than control ( 3.71 vs. 3.03 , P < or = 0.001 ) , reported more protective skin behaviors ( 5.36 vs. 5.06 , P = 0.007 ) and were more likely to report mole checking ( odds ratio 1.67 , 95 % CI 1.04 to 2.70 , P = 0.035 ) . The Skinsafe intervention was evaluated positively by patients and could be used to support melanoma health education within clinical setting 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 AND DESIGN Basal cell carcinoma ( BCC ) of the skin is the most common neoplasm in white population s , and solar radiation is generally accepted to be the dominant environmental risk factor for this disease . However , little information is available on the nature of the relationship between BCC and sunlight . The purpose of this study was to evaluate the nature of the relationship between sunlight exposure , pigmentary factors , and BCC of the skin . A population -based case-control study of 226 male patients with BCC diagnosed from January 1 , 1983 , through December 31 , 1984 , and 406 r and omly selected male control subjects was conducted in Alberta , Canada . The study was conducted using a st and ardized question naire , administered in person by trained interviewers . Data were analyzed using conditional logistic regression methods . RESULTS After controlling for other host and pigmentary factors , the risk of BCC was increased in subjects with light skin color and those who freckled in childhood . A history of severe sunburn in childhood also increased risk . Subjects of southern European ethnic origin were at significantly lower risk of BCC . Surprisingly , no association was seen between mean annual cumulative summer sunlight exposure and risk of BCC . A significantly increased risk of BCC was seen in subjects with increased recreational sunlight exposure  in adolescence and childhood ( age , 0 to 19 years ) , although an inverse relationship was seen with lifetime recreation exposure . The relationship with childhood sun exposure was most pronounced among sun-sensitive subjects whose skin tended to burn rather than tan in the sun . CONCLUSIONS The lack of association between cumulative sun exposure and BCC contradicts conventional wisdom about the cause of this tumor , and the increased risk with sun exposure at age 0 to 19 years suggests that childhood and adolescence may be critical periods for establishing adult risk for BCC BACKGROUND Although sun exposure is an established cause of cutaneous malignant melanoma , possible interactions with host factors remain incompletely understood . Here we report the first results from a large prospect i ve cohort study of pigmentation factors and sun exposure in relation to melanoma risk . METHODS The Women 's Lifestyle and Health Cohort Study included 106 379 women from Norway and Sweden who were aged 30 - 50 years in 1991 or 1992 when they completed an extensive question naire on personal characteristics and exposures . Linkages to national registries ensured complete follow-up through December 31 , 1999 . Poisson regression models were used to estimate relative risks ( RRs ) . All statistical tests were two-sided . RESULTS During an average follow-up of 8.1 years , 187 cases of melanoma were diagnosed . Risk of melanoma was statistically significantly associated with increasing body surface area ( RR for > or = 1.79 m2 versus < or = 1.61 m2 = 1.60 , 95 % confidence interval [ CI ] = 1.03 to 2.48 ; P(trend ) = .02 ) , number of large asymmetric nevi on the legs ( RR for > or = 7 nevi versus 0 nevi = 5.29 , 95 % CI = 2.33 to 12.01 ; P(trend)<.001 ) , hair color ( RR for red versus dark brown or black = 4.05 , 95 % CI = 2.11 to 7.76 ; P(trend)<.001 ) , sunburns per year at ages 10 - 19 , 20 - 29 , and 30 - 39 years ( P(trend)<.001 , P(trend ) = .03 , and P(trend ) = .05 , respectively ) , and use of a device that emits artificial light ( solarium ) one or more times per month ( P = .04 ) . CONCLUSIONS Our results confirm previous findings that hair color , number of nevi on the legs , and history of sunburn are risk factors for melanoma and suggest that use of a solarium is also associated with melanoma risk . Adolescence and early adulthood appear to be among the most sensitive age periods for the effects of sunburn and solarium use on melanoma risk . However , it may be too early to see the full effect of adult exposures in this cohort This population -based case-control study systematic ally examined reported malignant melanoma risk factors by anatomic site . Study subjects consisted of 548 invasive melanoma cases diagnosed in Connecticut during 1987 - 1989 and 494 r and omly selected controls .  Multivariate polychotomous logistic regression was used to determine whether risk factors differed across anatomic sites . Risk factors examined included demographic and pigmentary characteristics , sun exposure-related factors , anatomic site-specific sunburn , recreational water activity clothing habits and number of nevi . A pattern of site-specificity was observed for sunburn . A history of sunburn at an anatomic site was specifically related to the development of malignant melanoma at that site more so than at other sites . This site-specificity was consistent with a direct role for intense , intermittent sun exposure in the development of melanoma . Age and gender were the only risk factors that differed significantly in effect across anatomic sites . The age difference was explained by differences in histologic subtype across sites . The gender difference could not be explained by sex differences in anatomic site-specific sunburns or in recreational water activity clothing habits . Alternative explanations include sex differences in behavioral patterns of sun exposure that we did not measure and as yet uneluci date d differences in susceptibility to melanoma according to sex and anatomic site Skin cancer represents a significant health threat with over 1.3 million diagnoses , 8000 melanoma deaths , and more than $ 1 billion spent annually for skin cancer healthcare in the US . Despite findings from laboratory , case‐control , and prospect i ve studies that indicate a link between  youthful indoor tanning ( IT ) and skin cancer , IT is increasing among US youth .  Appearance‐focused interventions represent a promising method to counteract these trends The Nambour Skin Cancer and Actinic Eye Disease Prevention Trial ( the Nambour Trial ) is a field trial conducted in an unselected adult population in Australia . Using a r and omized 2 x 2 factorial design , the principal aim is to evaluate whether regular use of high-protection sunscreen and /or dietary supplementation with beta-carotene ( 30 mg daily ) can alter the incidence rates of basal cell carcinomas and squamous cell carcinomas of the skin over a minimum follow-up time of 4.5 years . Changes in the incidence of solar keratoses and actinic eye disease and the rate of photoaging after intervention will also be investigated . In 1992 , 1626 participants between the ages of 25 and 75 years were enrolled , all of whom had been r and omly selected from residents of the southeastern Queensl and township of Nambour for an earlier skin cancer prevalence survey . This paper describes the background to the trial and its design , with respect to evaluation of effects on actinic skin disease , and documents the baseline characteristics of participants recruited into the Nambour Trial OBJECTIVES We investigated whether the Kidskin sun protection intervention increased children 's body mass index by reducing the time spent outdoors at midday . METHODS The Kidskin sun protection intervention involved 1614 Australian school children assigned to 1 of 3 groups : a control group , a moderate-intervention group , or a high-intervention group . Schools in the control group received the st and ard health curriculum and schools in the intervention groups received a multicomponent intervention . Outcomes included time spent outdoors and nevus development ( a marker of melanoma risk ) . Height and weight were measured at 3 time points . Body mass index was transformed into age- and gender-specific z scores ; z scores at each age were modeled simultaneously . Time spent outdoors at ages 10 and 12 years was analyzed using a linear mixed effects modeling . RESULTS The proportion of children who were overweight or obese increased with age . The moderate-intervention and control groups had a minimal increase in z score over time , and the z score for the high-intervention group decreased over time . There were no differences among groups with respect to total time outdoors at any age . CONCLUSIONS It is possible to reduce the time children spend outdoors when ultraviolet radiation is high without producing an unfavorable effect on the children 's body mass index The histories of exposure to sun through occupational , recreational and vacation activities of 595 patients with newly incident cutaneous melanoma excluding lentigo maligna and acral lentiginous melanoma , were compared to those of comparison subjects drawn r and omly from the same population and matched for age , sex and province of residence in Western Canada . Significant increases in risk were seen with increasing amount of sun exposure through outdoor activities associated with recreation and vacations ; activities likely to involve more intense sun exposure were associated with greater increases in risk . While a moderate amount of occupational exposure was associated with increased risk , greater occupational exposure result ed in no further increase ; in men a decrease in risk was seen . These findings were independent of the effects of hair and skin colour , freckles , ethnic origin and socio-economic status . The results suggest that short-term exposure to unusually intense sunlight increases the risk of melanoma , while long-term constant exposure has no effect or may decrease risk . No simple relationship was seen between melanoma risk and total sunlight exposure . This study introduces new methods of assessing different types of sun exposure from retrospective data A previous r and omized trial found that sunscreen use could extend intentional sun exposure , thereby possibly increasing the risk of cutaneous 
    Output:
    
In young women , appearance-focused behavioral interventions decrease indoor tanning and ultraviolet exposure .
In young adolescents , computer support can decrease midday sun exposure and increase sunscreen use .
Increasing intermittent sun exposure in childhood is associated with an increased risk for squamous cell carcinoma , basal cell carcinoma , and melanoma .
Evidence suggests that regular or early use of indoor tanning may increase melanoma risk .
On the basis of 1 fair- quality trial , regular sunscreen use can prevent squamous cell carcinoma , but it is yet unclear if it can prevent basal cell carcinoma or melanoma .
R and omized , controlled trials suggest that primary care-relevant counseling can increase sun-protective behaviors and decrease indoor tanning