Liz Wilson

Background In the UK, the time taken to recognise a melanoma symptom and seek medical attention is the third longest of all cancers. There is no validated measure to assess public awareness of melanoma. We aimed to develop and validate a reliable Melanoma Cancer Awareness Measure (M-CAM). Methods Items for symptoms and risk factors were sourced from national cancer guidelines and patient information websites and reviewed by an expert panel. Three validation studies were undertaken. To assess internal and test-retest reliability, the general public (n = 32) completed the M-CAM on two occasions (~14 days apart). Construct validity was assessed by comparing expert (n = 35) and the general public (n = 100) responses. Sensitivity to change was established by comparing responses of participants randomly allocated to a control leaflet (n = 32) or a melanoma leaflet (n = 29). Results Internal reliability was high (Cronbach’s alpha>0.8) for all scales. Public responses were consistent over time, demonstrating test-retest reliability. Experts achieved higher scores than the general public on prompted [11.26(2.70) vs 9.10(3.25),p < 0.001] and unprompted symptom awareness items [3.06(1.81) vs 1.67(1.68),p < 0.001], and unprompted risk factor items [1.26(1.22) vs 0.81(0.95),p = 0.053]. However, prompted risk factor items scores were not different between the groups [10.69(6.07) vs 10.74(4.62),p = 0.422]. The melanoma leaflet group performed better than the control group in the prompted symptom [12.59(1.84) vs 9.75(3.57), p < 0.001], unprompted symptom [4.55(2.08) vs 1.84(1.44),p < 0.001], prompted risk factor [15.59(3.49) vs 12.06(4.40),p < 0.001] and unprompted risk factor items [2.14(1.73) vs 0.87(1.04),p = 0.007] demonstrating the measure is sensitive to change. A risk factor item related to age did not demonstrate construct validity or sensitivity to change. Conclusions The M-CAM is a reliable and valid tool to assess melanoma symptom awareness. Further validation may be needed to assess construct validity of the risk factor subscale. Assessing awareness of melanoma in national surveys could identify gaps in knowledge and support early detection and awareness efforts.

Background: Given Australia's high UV exposure and sun‐seeking habits, public awareness is critical for early melanoma diagnosis. This study aims to assess melanoma awareness in Australian adults. Methods: An adapted Melanoma Cancer Awareness Measure (M‐CAM) survey with both prompted and unprompted questions was used to assess knowledge of melanoma signs and symptoms, targeting adults over 18 years, excluding healthcare professionals. Results: Among 390 participants, the mean number of correctly identified melanoma signs and symptoms was 3.5 out of 17 (unprompted) and 11 out of 14 (prompted). For melanoma risk factors, participants recalled an average of 3.1 items out of 21 (unprompted), and 14 out of 20 items when prompted. The most commonly identified symptoms (unprompted) were changes in the colour (72%), size (41%) and shape (34%) of an existing mole. Sun exposure was the most recognised melanoma risk factor (89%) in unprompted recall, followed by family history of melanoma (64%) and fair skin colour (47%). Conclusion: In this Australian sample, unprompted awareness was low, even among those with a melanoma history. Targeted efforts to identify sub‐groups with low awareness, alongside education highlighting less common signs, may enhance early detection and improve melanoma outcomes.