Melanoma Assessment Questions

We’ll start this assessment with some basic questions about you, such as your age.

Have you ever been diagnosed with cancer, except for non-melanoma skin cancer?

More information: Having non-melanoma skin cancer (basal cell or squamous cell carcinoma) may be associated with a higher risk of developing melanoma. If you have had either form of non-melanoma skin cancer, this questionnaire may underestimate your risk of melanoma.

X A common type of cancer that affects the top layer of the skin. Examples include basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).

X Why is this important? This tool was designed for people who have never had cancer. If you’ve had cancer, this tool can still tell you about other risk factors but keep in mind that the results at the end are more accurate for people without a history of cancer.

Why is this important

Yes

No

This tool was designed for people who have never had cancer. Because you’ve had cancer before, your risk of getting another cancer in the future is higher than someone who hasn’t been previously diagnosed.

We hope you’ll continue with the remaining questions to learn how other factors may affect your risk of developing melanoma. But keep in mind that the results at the end are more accurate for people without a history of cancer.

Are you male or female?

More information: Please answer based on your sex at birth.

X Why is this important? This tool estimates your risk of developing melanoma compared to other people who are the same sex. For this reason, it’s important to know if you’re male or female.

Why is this important

Male

Female

How old are you?

X Why is this important? This tool estimates your risk of developing melanoma compared to people who are the same age. For this reason, it’s important to know how old you are.

Why is this important

Has your biological mother, father, brother, sister or child ever had melanoma?

More information: Include only biological family members (those related by blood) in your response, and only those in your immediate family (e.g., not your aunt, uncle, grandparents). Do not include those you are related to by adoption or marriage.

X Melanoma is a form of skin cancer that starts in the cells that give the skin its colour, sometimes from an existing or new mole. Answer “no” if your relative had a form of non-melanoma skin cancer (squamous or basal cell carcinoma) or a solar (actinic) keratosis (a scaly, crusty growth caused by sun damage).

X Why is this important? Your family history may affect your risk of developing melanoma.

Why is this important

Yes

No

Don't know

Some questions about your physical characteristics.

Is your natural hair colour blond or red?

More information: Answer based on your natural colour in your late teens or early 20s.

X Why is this important? People with lighter hair may have skin that is more susceptible to damage by the sun.

Why is this important

Yes

No

Is your natural eye colour blue, green, hazel or another light colour?

X Why is this important? People with lighter-coloured eyes may have skin that is more susceptible to damage by the sun.

Why is this important

Yes

No

What would happen to your skin if it was repeatedly exposed to bright sunlight in the summer without any protection? Would you (pick the one that best describes you):

More information: For the purposes of this question assume you are somewhere in Ontario. Protection from the sun includes shade, wearing protective clothing or using sunscreen.

X Why is this important? The more easily your skin burns, the more susceptible it is to damage from the sun.

Why is this important

Not relevant - my skin is very dark

Get a dark tan

Get moderately tanned

Get burned, then a light tan

Get burned with no tan

Don't tan/only get freckled

Looking at both of your arms from the shoulder to your wrists, how many moles do you have that are 3 millimetres (mm) in diameter or larger?

More information: Be sure to count only moles and not freckles. Freckles are flat, irregular in shape and usually occur together in patches on the face, shoulders, upper back and arms. Moles are raised up above the skin and tend to be darker and more regularly-shaped than freckles.

X Moles are collections of the skin’s “colour” cells lying just below the surface of the skin. They vary from pale brown to almost black and have a well-defined border. Moles vary in size. They may be completely flat but are usually smooth, dome shaped bumps on the skin that can feel soft or firm. They usually appear during childhood or teenage years.

X Examples of objects that are 3 mm:

Height of 2 quarters on top of each other or thickness of 2 nickels
Diameter of most headphone jacks
Thickness of 3 plastic cards, such as credit or health cards stacked on top of each other

X Why is this important? New or existing moles can sometimes become cancerous.

Why is this important

None

1 - 5

6 - 10

11 or more

Some questions on your medical history.

In any 10-year period of your life (e.g., in your childhood, teens, 20s, 30s, 40s), did you have 5 or more bad sunburns?

More information: This means any sunburn that blisters or is accompanied by pain for 2 or more days.

X Why is this important? Having sunburns can increase the risk of developing melanoma.

Why is this important

Yes

No

Have you ever taken immunosuppressive drugs for organ transplants or chronic auto-immune diseases such as rheumatoid arthritis or inflammatory bowel disease?

More information: Immunosuppressive drugs weaken the body’s immune system. They are used to keep the immune system from attacking transplanted organs or the body’s own tissue (for example, from attacking the joints in rheumatoid arthritis).

X Why is this important? By weakening the body’s immune response, immunosuppressive drugs may make it easier for cancer cells to reproduce and spread.

Why is this important

Yes

No

Here we’ll look at aspects of your life that may affect your melanoma risk.

Which statement best describes your recent use of tanning equipment?

More information: Tanning equipment includes devices such as tanning beds or sun lamps.

X Why is this important? Tanning beds or sun lamps contain the same damaging ultraviolet radiation (UVR) found in sunlight. Exposure to UVR can increase the risk of melanoma.

Why is this important

At least once in the past 12 months

Used in the past but stopped at least a year ago

Have never used tanning equipment

Which statement best describes your recent outdoor sun tanning habits?

More information: Sun tanning refers to deliberate attempts to get a tan. This could be going to the beach or park and lying in the sun or being outside for long periods of time without protection.

X Why is this important? Any change in the colour of the skin, such as a tan, is an indication the skin has been damaged.

Why is this important

Sun tanned in the last 12 months

Sun tanned over a year ago

Have never tried to get a suntan

Between April and September, are you ever outdoors between 11 a.m. and 3 p.m. for 30 minutes or more?

More information: In Ontario from April to September, the UV (ultraviolet) Index between 11 a.m. and 3 p.m. may be 3 or more, which means there is a risk of skin damage.

X Why is this important? Exposure to the sun’s ultraviolet radiation (UVR) without protection can damage the skin and increase the risk of melanoma.

Why is this important

Yes

No

MELANOMA ASSESSMENT

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