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Skin Pigmentation Habits and Their Effects and Relationship to Skin Cancers
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* Indicates required question
Gender
*
Male
Female
Age:
*
Your answer
Where are you from? Please write down the name of your country.
*
Your answer
What is your education level?
*
Elementary School
Middle School
High School
Higher Education (University Degree)
Vocational School
None applicable / Did not receive any form of formal education.
What do you work as?
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Office job.
Outside job
Mix of both.
I am unemployed.
What is your skin type?
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Very fair
Fair
Olive
Dark
Very dark
Are you concerned about UV exposure?
Yes
No
Somewhat.
Clear selection
Have you changed any of your skin pigmentation habits in the past 5 years?
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Yes
No
How did you change your skin pigmentation habits?
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I started implementing skin pigmentation (e.g. tanning) procedures.
I started implementing skin depigmentation (e.g. skin lightening creams) procedures.
I started using sunscreen.
What was the reason for changing your skin pigmentation habits?
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Personal health concerns
Medical advice
Media influence
Other:
Required
Are you concerned about your skin color?
*
Yes
No
Somewhat
Why are you concerned about your skin color?
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Racial reasons
Cultural reasons
Aesthetic reasons
Medical reasons
Other
Required
Which of the following are risks associated with exposure to UV rays on the skin? Select all that apply.
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Growth of foreign structures such as horns on the skin.
Skin cancers
Skin darkening
Skin lightening
Sunburn
Premature aging
Eye damage
No risks associated with UV exposure
Required
How often do you expose yourself to direct sunlight?
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Rarely
Monthly
Weekly
Almost everyday
How do you protect your skin from the sun?
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Sunscreen
Clothing
Sunglasses
Umbrella
None
Required
Do you do any of these self tanning procedures?
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Tanning spray / cream
Tanning booth / bed
Get a tan in the sun.
Required
Have you ever used tanning beds or booths?
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Yes
No
How often do you use tanning beds or booths?
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Every four months
Monthly
Weekly
Almost everyday
How concerned are you about the risk of skin cancer from sun exposure or tanning beds?
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Not concerned at all
Somewhat concerned
Very concerned
Extremely concerned
What area of your skin would you like to be darker / lighter?
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My face.
My upper body.
My lower body.
My genitalia.
Required
Do you use any skin lightening products?
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Yes
No
What methods of skin depigmentation do you use?
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Topical creams and lotions.
Skin lightening soaps and washes.
Skin lightening pills and injections (e.g. melatonan)
Skin lightening procedures such as laser treatment, chemical peels, or microdermabrasion.
Other, please specify in writing.
Required
Have you ever had a skin cancer screening?
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Yes
No
Have you ever had a suspicious mole removed by a doctor?
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Yes
No
Have you ever been diagnosed with skin cancer?
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Yes
No
Do you have a family history of skin cancer?
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Yes
No
How often do you check your skin for changes or unusual moles?
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Rarely (Once every 2 months or more)
Occasionally (Once every month)
Frequently (Once every week)
Almost every day
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