A prospective randomized trial of topical pimecrolimus for cetuximab-associated acnelike eruption.

BACKGROUND: Clinical trials addressing the acneiform rash associated with epidermal growth factor receptor inhibitors are lacking. OBJECTIVE: We evaluated the ability of topical pimecrolimus to reduce the severity of cetuximab-related facial rash. METHODS: In all, 24 patients with metastatic colorectal cancer with cetuximab facial rash received twice daily pimecrolimus application for 5 weeks to half of the face. At baseline, week 2, and week 5, a dermatologist performed facial lesion counts, patients reported perceived severity of rash-related symptoms, and standardized facial photographs were obtained for blinded evaluation of global rash severity. RESULTS: Treatment sides had greater decrease in lesion counts than observation sides of face at weeks 2 (P < .001) and 5 (P = .02). However, there were no significant differences in patients' assessment of symptoms and in review of facial photographs for rash severity between treatment and observation sides. LIMITATIONS: This study was not placebo controlled. CONCLUSIONS: Pimecrolimus application did not translate into clinically meaningful benefit for patients with cetuximab-related facial rash.

A survey of skin cancer screening practices among dermatology nurses.

OBJECTIVES: The objective of this study was to survey the current level of participation dermatology nurses have in screening and skin cancer detection. SAMPLE: Nursing professionals including registered nurses (RNs) and licensed practical nurses and their Ontario, Canadian equivalents (registered practical nurses), advanced practice nurses, such as nurse practitioners and dermatology nurse practitioners, were included in the sample. RN education ranged from associate's to master's degree preparation. DATA ANALYSIS: Demographic, clinical setting, and practice information were reported using descriptive statistics and cross tabulations. RESULTS: Eighty-three percent (n = 89) of nurses surveyed are performing a total-body skin examination (TBSE); 15% (n = 16) are confident and 52% (n = 56) are very confident with their skills. CONCLUSIONS: The vast majority of nurses surveyed reported that they practiced skin cancer screening. They also reported using dermatologic tools, such as dermatoscope and digital camera. Nurses trained to perform TBSEs, as well as those who use dermatoscopes and digital cameras when performing TSBEs, provide an important component in improving cancer screening and detection.

Psychosocial mediators of a nurse intervention to increase skin self-examination in patients at high risk for melanoma.

This prospective 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 randomized 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.

Patient experiences with photo books in monthly skin self-examinations.

Patients with multiple nevi are at greater risk for developing melanoma but may be unable to assess their skin accurately without an effective tool. At Memorial Sloan-Kettering Cancer Center, the standard of practice has been to use a patient educational brochure teaching high-risk patients mole mapping, a procedure of recording moles by drawing them. The photo print book offers patients an improved way of peforming skin self-examination (SSE) in comparison to drawing. The purpose of this study was to determine patient experiences through patient interview and to learn ways to increase patient compliance and understanding of monthly SSE performance using a photo book.

Patient adherence to skin self-examination. effect of nurse intervention with photographs.

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 prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION: Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS: In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS: The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.

Skin self-examination in patients at high risk for melanoma: a pilot study.

PURPOSE/OBJECTIVES: To compare the effect of providing high-risk patients with standard 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: Randomized 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 questionnaire 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. IMPLICATIONS 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.