CONTENTS | JULY 2023 | ISSUE 5

[ 1 ] Spotlight with Dawn Siegel, MD: Melanoma awareness and prevention among adolescents

[ 2 ] Data Profile: Racial and Ethnic Differences in Melanoma Diagnosis and Survival, 2004 – 2018

[ 3 ] Resources and networking for melanoma prevention and early detection

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Melanoma awareness and prevention among adolescents

Dr. Dawn Siegel, Professor in Dermatology at Stanford University, is a pediatric dermatologist. She is affiliated with Lucile Packard Children's Hospital at Stanford Medicine Children's Health. Her research interests are in improving health equity for children with skin disease through innovative skin health and science education programs, hemangiomas, and the related multiple congenital anomaly syndrome - PHACE (Posterior fossa anomalies, Hemangiomas, Arterial anomalies, Cardiac defects, and Eye anomalies). 

For this issue, I spoke with Dr. Siegel about her team’s research on their innovative, immersive interactive workshop that uses technologies to educate about melanoma awareness and prevention in teens.

What are the top three intriguing lessons you’ve learned from your melanoma related work in pediatric dermatology, which covers children and adolescents?

My work has mainly been focused on implementing augmented reality applications to teach lessons in melanoma prevention and awareness. The top three lessons we’ve learned are:

• The teens are really excited about learning with technology. 

• The teens love understanding the science behind ultraviolet (UV) radiation damage. They’re really interested in learning about the layers of the skin, and how UV light affects skin integrity and skin cells. I was surprised that this is one of their favorite things about the app.

• In terms of melanoma prevention and sun safety practices, it turns out that the parents are less likely to use sun protection for themselves, but they're excited about knowing their kids need to be protected. As a result, they’re thinking about modeling sun safety behavior by doing their own sun protection. This helps to engage the parents, so it is more of a family effort, which is great for changing adolescents' behavior around this. 

What do you want our readers to know about iTS-CORE, starting with what the acronym stands for? Who helps you implement this program?

iTS-CORE is an acronym we’ve developed that stands for Interactive Technology, for Skin - Community Outreach Research and Education. It is an innovative, immersive interactive workshop that uses technologies to educate about melanoma awareness and prevention. We’re developing these programs through community outreach. The research part is using a co-design process with teens so that the information is relevant to them. The teens give us feedback that we can use to improve the education about melanoma awareness.

We have an exciting model in terms of the Stanford teams with whom we work. This collaborative process allows us to improve the app from a multitude of perspectives. The Stanford teams include School of Medicine dermatologists and medical students; the Graduate School of Education Center to Support Excellence in Teaching, which is especially critical in science standards and educating across different socio-economic groups and cultures; the Department of Communication Virtual Human Interaction Lab; and the Chariot Program, which is part of the Lucille Packard Children’s Hospital.

Outside of Stanford, we’ve been working with community groups and several local area schools in the San Francisco Bay Area, including the San Mateo County Office of Education, and groups in Oakland and Santa Clara. Study participants come from diverse backgrounds and cultures.

Once we have our final product in place, we hope to disseminate it across the state, including through Wipe Out Melanoma – California, as well as nationwide. In terms of extending our program further into California, we’re interested in having more of a collaboration in the Central Valley and Central Coast regions. As part of our first steps in this area, we’ve interviewed primary care providers in the Central Valley about the needs of their population around sun safety/protection and melanoma awareness.

Could you explain the educational games you and your team have developed to improve adolescent skin health and melanoma prevention? 

We’re developing an augmented reality sun safety application. Our first version is on the specialized computer called zSpace, which uses three-dimensional technology to give students an immersive learning experience. They learn about UV radiation and other forms of electromagnetic radiation.

The machine has three cameras that track the students’ eye movements. The beauty of it is that the teens don't need goggles, so they can interact with their peers and the people around them but still be in this immersive experience. Then, they can spray on sunscreen and put on hats and sunglasses. There's a 3D model of the skin that they can dissect and learn about the layers of the skin and the sun damage that may occur. And it lets them take apart the layers of the skin.  

In the future, we’re hoping to develop an app that has augmented reality filters so that it could be used on a phone-based system.

How do you see technologies such as Augmented Reality and Virtual Reality advancing the prevention or early detection of melanoma in adolescents, especially in low-income and racial-ethnic minority populations? 

I think the key thing about using augmented reality (AR) and virtual reality (VR) is that it's just so engaging for the kids. They love it. They think it's so much fun. We've tested it with over 30 kids now from very diverse racial and ethnic backgrounds. Over 90 percent think that using augmented reality could help them learn about skin health, and that they're going to think more about protecting their skin from the sun after using the app. We believe It is so much more engaging and exciting than reading a sun safety and protection workshop handout or instruction sheet.

Right now we’re developing the app and doing the testing in person. Once we have a final product, it will be available through a link in a patient after-visit summary or instructions, and also available in curriculum through schools. The augmented reality lessons won’t require special headsets that are typically seen with AR or VR, so it will be easy for most kids to use.

The goal of this app is similar to a public health message, which we can make widely available, whether or not people have this type of technology.

What final items would you like readers to take away from this interview?

The big message is to stay safe in the sun. And, we are really excited about this new technology. We think it's going to be a game changer for kids. We hope it will move the bar on behavior change, since one of the big challenges with education is translating it into a way of life. We hope this immersive experience will do just that.

ELLEN DINUCCI is a contributing writer of WOM-California Gazette and staff member of the Office of Cancer Health Equity at Stanford Cancer Institute.

RACIAL AND ETHNIC DIFFERENCES IN MELANOMA DIAGNOSIS AND SURVIVAL, 2004 - 2018

Two research letters to the editor published in the Journal of the American Academy of Dermatology (Fernandez et al., 2023) reveal racial and ethnic differences in U.S. populations diagnosed with “invasive primary cutaneous melanoma.” The analyses were conducted using 2004 to 2018 case data obtained from the National Cancer Database (NCDB). Below are research findings reported in the studies: 

Male Cases (n=205,125)1:

• Racial and ethnic representation of males diagnosed with melanoma: White - 97.6%, Hispanic - 1.5%, Black - 0.5%, Asian - 0.3%, American Indian/Alaska Native - 0.1%.

• 48.6% of Black males represented nearly half of advanced melanoma diagnosis cases (Stage III or IV), followed by Hispanic - 39.6%, Asian - 37.6%, American Indian/Alaska Native - 29.1%, and White males - 21.1%. These are combined percentages of Stage III and IV diagnosis cases.

•  5-year melanoma survival rates were lowest for Black males at 51.7%, whereas White males had a much higher 5-year survival rate at 75.1%. The 5-year survival rates of other racial and ethnic groups were as follows: American Indians/Alaska Native - 68.5%, Asian - 67.6%, Hispanic - 66.2%.

Female  Cases (n=163,316)2:

• Racial and ethnic representation of females diagnosed with melanoma: White – 96.9%, Hispanic - 1.7%, Black - 0.9%, Asian - 0.4%, American Indian/Alaska Native - 0.1%.

• Black females  had the lowest rate, 35.4%, of being diagnosed with early-stage melanoma (Stage I), followed by Asian - 49.6%, Hispanic - 50.7%, American Indian/Alaska Native – 58.7%, and White females – 69.0%.

• Black women had the lowest 5-year melanoma survival rate at 65.0%, whereas White females had a much higher survival rate at 84.7%. The survival rates of other racial and ethnic groups were as follows: American Indians/Alaska Native – 81.1%, Hispanic – 78.8%, Asian – 75.2%.

Why is it important to understand population differences in cancer data? 

Some groups of people experience higher burdens of cancer, which is often related to detection of later-stage disease and results in more extensive and costly treatment, worse quality of life, and poorer survival outcomes.  Various solutions to identify disparities and diminish the burdens of cancer are being studied. The differences in health are also known as “health disparities.”

The Journal of the American Academy of Dermatology provides open access to select articles. You can view the research letters to the editor by downloading the full journal publications - Volume 89, Issue 4 and Volume 88, Issue 3.

Research data sources: 

1. Fernandez, J.M., Mata, E.M., Bubic, B.N., Kwan, K.R., Whitley, M.J. and Wysong, A., 2023. Racial and ethnic differences in males with melanoma: A retrospective cohort study of 205,125 cases from the National Cancer Database. Journal of the American Academy of Dermatology, 89(4), pp.828-832, DOI: 10.1016/j.jaad.2023.05.080. 

2. Fernandez, J.M., Bubic, B.N., Dahak, S., Mata, E.M., Kwan, K.R., Sutton, A., Whitley, M.J. and Wysong, A., 2023. Racial and ethnic differences in tumor characteristics and overall survival of women with melanoma: A national cancer database retrospective cohort study. Journal of the American Academy of Dermatology, 88(3), pp.694-696, DOI: 10.1016/j.jaad.2022.07.036.

RACHEL MESIA is a contributing writer of WOM-California Gazette and staff member of the Office of Cancer Health Equity at Stanford Cancer Institute.

Free resources help you track your skin checks

Tracking your skin spots and skin checks can help you be aware of your body and the changes on your skin, as well as to communicate to your doctor about your concerns and changes.

• War on Melanoma MoleMapper™: download from Apple Store. Learn about this app made available through Oregon Health & Science University

• UMSkin Check: download from Google Play or Apple Store. Learn about this app made available through University of Michigan Health

• On paper, you can document spots and skin checks. See an example from American Academy of Dermatology Association’s Skin Examination Body Mole Map (PDF)

Find Free Skin Cancer Screening Near You

• Find dates and places for the Skin Cancer Foundation’s Destination Healthy Skin Program free screening and education. The 2024 schedule will be posted on the website or you can subscribe to email updates.

• The American Academy of Dermatology Association can help you search for free skin cancer screening within the United States. You can sign up to be notified via email when a free skin cancer screening is available within 50 miles of your zip code.

Financial related resources for cancer patients

Cancer.Net, an American Society of Clinical Oncology patient information website, provides a Financial Resources web page approved by the Cancer.Net Editorial Board.

AIM at Melanoma Events

• Living with Melanoma Symposiums are in-person and/or virtual educational events to inform patients and their caregivers about the latest research, treatments, and survivorship tips from healthcare professionals and survivors. Visit the website for the schedule or view the recorded sessions.

• Check for updates on AIM at Melanoma’s Walks.

• Visit AIM Webinars on Demand about support and information for people living with melanoma, caregivers, family, and friends.

• Explore the AIM Video Library, which provides a collection focusing on numerous topics. Examples include the role of reconstructive surgery in melanoma; the process clinical trial enrollment; the latest research on herbal supplements and cancer; and the importance of palliative care in melanoma. For additional educational videos, visit the AIM YouTube channel.

Information about melanoma risk and prevention

Read the American Society of Clinical Oncology article on melanoma risk factors and prevention.  

Resource Referral | Do you know a great resource and/or community networking for melanoma prevention and early detection? Let us know by emailing Ellen at edinucci@stanford.edu. Thank you!

Visit the WOM-California Website to learn about how partnerships, researchers, and community members are working together towards the prevention, early detection, and treatment of melanoma. For comments or questions about our newsletter content, please email Ellen at edinucci@stanford.edu.

WOM-California Gazette Editorial Team: RACHEL J. MESIA | ELLEN M. DINUCCI

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