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Survey of Knowledge of and Awareness About Melanoma -- United States, 1995

Skin cancer is the most commonly diagnosed cancer in the United States (1). Although the incidence of melanoma is lower than those of squamous cell and basal cell carcinomas, melanoma is associated with the highest case-fatality rate of all skin cancers. In 1996, an estimated 38,300 cases of melanoma will be diagnosed, and approximately 7300 melanoma-associated deaths will occur (2). Primary and secondary prevention strategies can assist in reducing the occurrence of melanoma and deaths associated with this cancer, and information about public awareness of melanoma, including risk factors, can assist in developing intervention strategies. To assess public knowledge and awareness about melanoma, the American Academy of Dermatology (AAD) conducted a nationwide telephone survey in 1995. This report summarizes the survey findings, which indicate that a high proportion (42%) of respondents had no knowledge about melanoma, and the level of awareness about melanoma was lowest among persons aged 18-24 years.

The AAD survey was a population-based, random-digit-dialed telephone survey of the U.S. civilian, noninstitutionalized population aged greater than or equal to 18 years. A total of 1001 persons participated in the survey (response rate=78%). Respondents were asked about their general knowledge and awareness of risk factors for melanoma. Data were weighted to calculate national estimates. Statistical analyses included calculation of odds ratios and 95% confidence intervals (CIs) (3). Because rates of melanoma previously have varied by race, the findings in this report are stratified, in part, by race; however, data are presented only for whites and blacks because numbers for other racial groups were too small for meaningful analysis.

Respondents were asked, "Can you tell me what melanoma is?"; 55% knew melanoma is a type of cancer, 34% knew it is a type of skin cancer, and 42% did not know about melanoma. After being informed that melanoma is a specific type of skin cancer, 95% identified at least one risk factor for melanoma, including history of sun exposure (82% {95% CI=79.9%-84.7%}), family history of melanoma (67% {95% CI=64.5%-70.3%}), and severe childhood sunburn as a risk factor for developing melanoma later in life (58% {95% CI=55.4%-61.4%}). Other risk factors identified by respondents were fair skin (63% {95% CI=60.3%-66.3%}), moles (41% {95% CI=38.3%-44.3%}), red hair and blue eyes (28% {95% CI=25.0%-30.6%}), and freckles (22% {95% CI=19.1%-24.3%}).

Awareness of melanoma (defined as knowledge that melanoma is a type of cancer or specifically a type of skin cancer) varied substantially by demographic factors (Table_1). Awareness generally was higher among respondents who were women, white, aged greater than or equal to 25 years, and of higher income levels. Approximately 50% of men and 35% of women reported they did not know the term melanoma. Awareness varied substantially by age group: 38% of respondents aged 25-64 years were aware that melanoma is a type of skin cancer, compared with 16% of those aged 18-24 years.

Awareness also was directly related to levels of education and income. Approximately 50% of respondents who were college graduates were aware that melanoma is a type of skin cancer, compared with 16% of those with less than a high school education. Of the respondents with annual incomes less than $20,000, 60% reported they did not recognize the term melanoma; in comparison, of respondents in the highest annual income group (greater than or equal to $75,000), 31% reported they did not recognize the term.

Reported by: DR Miller, ScD, AC Geller, MPH, HK Koh, MD, Dept of Dermatology, Dept of Medicine, and Dept of Cancer Prevention and Control, Boston Univ, Massachusetts. American Academy of Dermatology, Evanston, Illinois. Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: During 1973-1992, the death rate for melanoma increased 48% among men, representing the highest sex-specific increase of all cancers (4). However, the AAD survey documented that a high proportion of U.S. adults (42%) lacked knowledge and awareness about melanoma. The finding that levels of awareness were lowest among the youngest respondents (persons aged 18-24 years) is especially important because of the strong association between severe sunburn at a young age and risk for melanoma later in life. Previous studies indicate that approximately 80% of lifetime sun exposure occurs before age 18 years (5), emphasizing the importance of educating young persons, their parents, and others about behaviors necessary to reduce or minimize exposure to the sun and ultraviolet (UV) radiation. The findings in this report also indicate limitations in the ability to distinguish between risk factors for melanoma and those for other skin cancers (see box).

Risk Factors and Prevention Measures for Melanoma and Other Skin Cancers Risk Factors for Melanoma (6)

  • Light skin color

  • Family history of melanoma

  • Personal history of melanoma

  • Presence of moles and freckles

  • History of severe sunburn occurring early in life

Risk Factors for Squamous Cell and Basal Cell Carcinomas (6)

  • Chronic exposure to the sun

  • Family history of skin cancer

  • Personal history of skin cancer

  • Light skin color

Measures to Prevent Skin Cancer

  • Reduce direct exposure to the sun, especially from 10 a.m. to 4 p.m.

  • Wear a broad-brimmed hat and clothes that protect sun-exposed areas of the body

  • Use sunscreen with a sun protection factor (SPF) greater than or equal to 15 as protection against ultraviolet A and ultraviolet B radiation

  • Refer to the daily ultraviolet index (available in 58 cities) when planning outdoor activities.

    A national health objective for the year 2000 is to increase

to at least 60% the proportion of persons of all ages who limit sun exposure, use sunscreens and protective clothing when exposed to sunlight, and avoid artificial sources of UV light (e.g., tanning beds) (7). Based on the 1992 National Health Interview Survey, substantial progress must be made to meet these objectives. Survey results indicate that only 31% of U.S. adults limited their exposure to the sun, 28% routinely used sunscreen, and 28% wore protective clothing (7).

The findings from this survey are assisting CDC and the AAD in the National Skin Cancer Prevention Education Program, a collaborative effort to increase public awareness about skin cancer and to help achieve the year 2000 objectives for skin cancer prevention. Goals of this program are to develop and disseminate educational messages for children, their parents, and other caregivers; develop guidelines for school curricula; evaluate the utility and value of the UV index; and develop educational messages for health-care providers. Recommendations to prevent the development of melanoma and other skin cancers should emphasize behaviors necessary to reduce or minimize exposure to the sun and UV radiation (see box).

References

  1. Weinstock MA, Boggars HA, Ashley M, et al. Nonmelanoma skin cancer mortality: a population-based study. Arch Dermatol 1991;127:1194-7.

  2. Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics, 1996. Atlanta, Georgia: American Cancer Society, 1996.

  3. SAS Insitute, Inc. Statistical Analysis System (SAS), version 6. 3rd ed. Cary, North Carolina: SAS Institute, Inc, 1990.

  4. CDC. Deaths from melanoma -- United States, 1973-1992. MMWR 1995;44:337,343-7.

  5. Stern RS, Weinstein MC, Baker SG. Risk reduction for nonmelanoma skin cancer with childhood sunscreen use. Arch Dermatol 1986; 122:537-645.

  6. DiGiovanna JJ. Prevention of skin cancer due to sun exposure. In: DeVita VT Jr, Hellman S, Rosenberg SA. Cancer prevention. Philadelphia, Pennsylvania: JB Lippincott Publishers, August 1991:1-9.

  7. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- midcourse review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service, 1995.



Table_1
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Percentage distribution of awareness of melanoma *, by selected demographic
characteristics -- United States, Melanoma Awareness and Self-Examination Survey, 1995 +
===========================================================================================
                                 Awareness
                  -----------------------------------------
                  Melanoma       Melanoma
                  is a type      is a type                     Odds
Characteristic    of cancer    of skin cancer    Don't know    ratio & (95% CI @)
-------------------------------------------------------------------------------------------
Sex
 Female              23%            39%              35%        1.0
 Male                18%            29%              49%        2.3    (1.7-3.2)

Race **
 White               23%            38%              35%        1.0
 Black                6%            11%              75%        3.2    (2.1-5.1)

Age (yrs)
 18-24               11%            16%              72%        1.0
 25-44               16%            37%              42%        0.4    (0.3-0.8)
 45-64               29%            39%              30%        0.5    (0.3-0.9)
  >=65               29%            36%              31%        0.5    (0.3-1.0)

Education
 <12 years           16%            16%              63%        1.0
 High school
  graduate           16%             3%              58%        0.7    (0.4-1.3)
 Some college        24%            36%              36%        0.4    (0.2-0.7)
 College
  graduate           24%            52%              20%        0.2    (0.1-0.4)

Income
        <$20,000     16%            18%              60%        1.0
 $20,000-$39,999     23%            30%              58%        0.6    (0.4-1.0)
 $40,000-$74,999     18%            49%              31%        0.3    (0.2-0.5)
       >=$75,000     27%            41%              31%        0.4    (0.2-0.8)

Region ++
 Northeast           19%            32%              45%        1.0
 Midwest             23%            32%              43%        1.2    (0.8-1.9)
 South               20%            31%              43%        0.9    (0.6-1.4)
 West                20%            42%              36%        0.7    (0.5-1.2)

Total                21%            34%              42%
-------------------------------------------------------------------------------------------
*  Defined as knowledge that melanoma is a type of cancer or specifically a type of skin
   cancer.
+  n=1001 adults aged >=18 years in 47 states. (Alaska, Arizona, Hawaii, and Missouri were
   excluded). Percentages may not total 100% because some respondents gave answers that
   are not included in this analysis.
&  Odds of knowing that melanoma is a type of skin cancer versus any other response in
   the specific category as compared with the reference category.
@  Confidence interval.
** Numbers for other racial groups were too small for meaningful analysis.
++ Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York,
   Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas,
   Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and
   Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia,
   Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina,
   Tennessee, Texas, Virginia, and West Virginia; and West=Alaska, Arizona, California,
   Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington,
   and Wyoming.
===========================================================================================

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