Dermatology: Practical and Conceptual Original Article | Dermatol Pract Concept. 2025;15(2):5350 1 Enhancing Skin Cancer Prevention and Awareness in the Italian Population: Insights from the “Save Your Skin” Screening Campaign Paola Savoia¹, Laura Cristina Gironi², Chiara Airoldi³, Francesca Zottarelli2, Mauro Alaibac4, Marco Ardigò5, Giuseppe Argenziano6, Stefano Astorino7, Francesco Bellinato8, Luca Bianchi9, Maurizio Congedo10, Claudia Costa11, Alessandro Di Stefani12, Maria Concetta Fargnoli13, Caterina Foti14, Pasquale Frascione15, Giampiero Girolomoni8, Vieri Grandi16, Fabrizio Guarneri17, Katharina Hansel18, Francesco Lacarruba19, Serena Lembo20, Angelo Valerio Marzano21, Giuseppe Micali¹9, Steven Paul Nisticò22, Annamaria Offidani23, Ketty Peris12, Bianca Maria Piraccini24, Pietro Quaglino25, Marco Romanelli26, Franco Rongioletti27, Pietro Rubegni28, Camilla Salvini16, Massimiliano Scalvenzi11, Paolo Sena29, Marco Spadafora30, Carlo Francesco Tomasini31, Marina Venturini32, Elisa Zavattaro¹ 1 Department of Health Sciences, University of Eastern Piedmont, Novara, Italy 2 SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy 3 Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy 4 University of Padova, Padova, Italy 5 San Gallicano Dermatological Institute IRCCS, Rome, Italy 6 University L. Vanvitelli, Naples, Italy 7 Studio Medico Piazza Bologna, Rome, Italy 8 AOUI Ospedale Borgo Trento, Verona, Italy 9 Policlinico Tor Vergata, Rome, Italy 10 Ospedale Vito Fazzi, Lecce, Italy 11 AOU Federico II, Naples, Italy 12 Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy 13 Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy 14 AOU Consorziale Policlinico, Bari, Italy 15 IRCCS IFO Istituti Fisioterapici Ospedalieri, Rome, Italy 16 SC Dermatologia, Dip. Scienze della Salute Università degli Studi di Firenze & Azienda USL Toscana Centro, Florence, Italy 17 AOU Policlinico G. Martino, Messina, Italy 18 Dermatology Section, Department of Medicine and Surgery - University of Perugia, Perugia, Italy 19 AOU Policlinico Vittorio Emanuele – PO G. Rodolico, Catania, Italy 20 AOU San Giovanni di Dio e Ruggi D’Aragona dell’Università di Salerno, Salerno, Italy 21 Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy, & Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy 22 AOU Mater Domini, Catanzaro, Italy 23 Ospedali Riuniti Torrette, Ancona, Italy 24 Policlinico S. Orsola, Bologna, Italy 25 Ospedale Dermatologico San Lazzaro, Turin, Italy 26 AOU Ospedale Santa Chiara, Pisa, Italy 27 IRCCS Ospedale San Raffaele, Milan, Italy 28 Ospedale Le Scotte, Siena, Italy 2 Original Article | Dermatol Pract Concept. 2025;15(2):5350 29 ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy 30 Skin Cancer Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy 31 Fondazione IRCCS San Matteo, Pavia, Italy 32 ASST degli spedali Civili, Brescia, Italy Key words: Skin cancer prevention strategies, Awareness campaign, Public health initiative, Cancer screening, Dermatological health Citation: Savoia P, Gironi LC, Airoldi C, et al. Enhancing Skin Cancer Prevention and Awareness in the Italian Population: Insights from the “Save Your Skin” Screening Campaign. Dermatol Pract Concept. 2025;15(2):5350. DOI: https://DOI.org/10.5826/dpc.1502a5350 Accepted: December 15, 2024; Published: April 2025 Copyright: ©2025 Savoia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Elisa Zavattaro, Dept of Health Sciences, University of Eastern Piedmont, via Solaroli 17, Novara, Italy. ORCID: 0000-0003-4537-3014. Email: elisa.zavattaro@med.uniupo.it Introduction: Skin cancer prevention campaigns aim to reduce modifiable risk factors, yet high-risk groups often maintain inadequate protection practices. Objectives: This study analyzed data from Italy’s 2023 “Save Your Skin” campaign, which provided free skin checks nationwide. Methods: Data from 1,773 participants across 29 centers in 13 regions were collected to assess sun exposure, photoprotection habits, and skin cancer awareness, identifying gaps in prevention efforts. Results: Most participants were female (70.16%), with a median age of 36, and 96.61% were born in Italy. While 71.24% joined for prevention reasons, others participated due to changes in a nevus (12.35%) or personal (2.31%) or family (7.33%) history of skin cancer. Self-assessments of nevi often did not align with dermatologists’ evaluations, but family and personal history reporting was more accurate. Participants showed confusion about nevi and melanoma: only 52.7% correctly identified nevi as benign, while 67.2% recognized melanoma as malignant. On average, participants answered 1.57 out of three knowledge questions correctly, with those having a family or personal history of skin cancer performing better. High-risk sun exposure behaviors were identified in 37.78% of participants. Older adults used sunscreen less frequently but relied more on hats and shade, while younger individu- als reported less sun exposure at work. Notably, participants with actinic damage demonstrated lower awareness and provided fewer correct answers on photoprotection. Conclusions: These findings underscore the need for targeted public health strategies to improve education on skin cancer prevention, particularly among high-risk and older populations. ABSTRACT Introduction The clinical and social burden of skin tumors is immense, with a current global incidence of over 320,000 cases for melanoma and 1,200,000 cases for nonmelanoma skin cancer [1]. The frequent appearance of these tumors in vis- ible areas, coupled with the relative ease of addressing key external risk factors, make skin cancer an ideal target for prevention campaigns. These initiatives have been systemati- cally implemented worldwide [2-9]. Typically, the number of new cancers diagnosed during the “open days” dedicated to skin cancer is low, unless patients are selected based on risk factors [2.10.13]. Nonetheless, the educational impact of this campaign is considerable. In Australia, the “Sun Smart” prevention campaign, which has been in place systematically since the summer of 1988-1989, has resulted in a reduction in melanoma incidence [14]. A recent study [15] examining the 30-year impact of this campaign has demonstrated a sig- nificant improvement in the photoprotection habits of the population involved. However, many population groups still use inadequate protective measures during outdoor activities [15.16], even those at high risk [17]. Original Article | Dermatol Pract Concept. 2025;15(2):5350 3 Objectives In this paper, we present data obtained from the question- naires administered to the participants in the Italian preven- tion campaign “Save your skin”, conducted in May 2023 throughout Italy. We analyzed the characteristics of the partic- ipants, focusing on their sun exposure habits, photoprotection practices, and awareness of skin cancer. Our aim was to iden- tify unmet needs in primary prevention among different popu- lation groups, with the goal of developing future public health initiatives that have a greater and more targeted impact. Methods Patient Enrollment and Data Collection The “Save Your Skin” campaign, organized by the Italian Society of Dermatology and Sexually Transmitted Diseases (SIDeMaST), was held across Italy in May 2023. The cam- paign had two primary objectives: i) to raise public awareness about melanoma prevention and ii) to identify any suspicious skin lesions that could be referred for removal. Free dermato- logical consultations were offered at leading dermatological centers nationwide, with no specific criteria for participation. Individuals were simply required to book their appointments by phone. An extensive communication campaign preceded the event, reaching the public through radio, television, and social media to ensure maximum participation. Before their screening visit, participants completed a questionnaire that gathered detailed information, including: i) demographic data (such as gender, age, country of origin, and region of birth for Italian patients, as well as education level); ii) phenotype characteristics (height, weight, hair, and eye color); iii) sun exposure habits (amount of time spent in the sun for work or recreational activities, use of sunscreen and other sun protection measures, and use of sunbeds); iv) phototype and history of sunburns; and v) reasons for their visit and awareness of nevi and melanoma. During the consultation, dermatologists recorded partic- ipants’ personal and family histories of skin cancer, the num- ber of nevi, the presence and type of suspicious lesions, and any relevant information regarding concurrent pathologies and therapies, with special attention to immunosuppression. All participants provided informed consent for data col- lection and processing, which were handled in anonymized form. Data management was conducted using REDCap (Research Electronic Data Capture) tools, hosted by Univer- sità del Piemonte Orientale, Vercelli, Italy. Statistical Analysis A descriptive analysis was conducted considering subjects overall. Absolute and relative frequencies are reported for categorical variables, while mean and standard deviation (SD) or median and interquartile range (IQR) for numerical ones, as appropriate. To evaluate the concordance between self-reported answers and those reported by dermatologists during the visit, the agree- ment index between number of nevi, personal, and familiar his- tory of skin cancer was calculated. Particularly, Cohen’s Kappa were calculated, and 95% confidence intervals were reported [95% CI]. Then, the comparison between the median number of nevi identified by a dermatologist and the self-reported response to high/low number of nevi was done, and non-parametric test was performed. Moreover, the relation between the mean num- ber of correct responses in terms of skin cancer knowledge and personal/familiar history of skin cancer was assessed using t-test. Sun risk behaviors and number of correct responses were then stratified by age categories (<45, 45-65, 65+), and significant associations were identified using chi-square or fisher tests. Particularly, we considered sun risk behaviors: exposure on vacation over than 30 days/year, exposure for work over than 6 hours/day, recreational exposure over than 3 hours/day, sometimes or never use of sunscreen, poor photoprotection in terms of less than two among hat/ sunglasses/t-shirt/shade, severe sunburns, sunbeds, insuffi- cient knowledge about sunscreen use. All the analyses were performed using the software used was SAS 9.4, and significant p-value threshold was consid- ered at 0.05 (2-tailed). Results Demographic Characteristics Data from 1,773 participants across 29 centers in 13 of Italy’s 20 regions were analyzed, with centers evenly distributed across the north (11 centers in four regions), center (10 centers in five regions), and south (eight centers in four regions). The demographic details of the participants are summarized in Table 1. Of those who took part, 70.16% (N=1,244) were female, with a median age of 36 years [IQR 28; 53]. The vast majority (96.61%, N=1,708), were born in Italy, with a rel- atively even distribution across the north (28.02%), center (24.25%), and south and islands (47.73%). Most participants reported a high education level, with 90.48% having completed high school or higher (43.37% with a high school diploma and 47.11% holding a bachelor’s or master’s degree). Skin Characteristics As detailed in Table 1, most participants had brown (N=1,395, 79.35%) or black (N=149, 8.48%) hair. Only a small proportion had blonde hair (N=199, 11.32%) or red hair (N=15, 0.85%). Regarding eye color, brown was the most common, with 28.98% (N=511) having light brown eyes and 41.58% 4 Original Article | Dermatol Pract Concept. 2025;15(2):5350 noticing a change in a nevus, 130 (7.33%) because of a fam- ily history of skin cancer, 41 (2.31%) due to a personal his- tory, and 96 (5.41%) to seek a second opinion. A notable proportion of patients (N=736, 41.51%) reported having a high number of nevi. This self-reported information was compared with dermatologists’ assess- ments during the visit, with a threshold of more than 30 nevi considered a high count. The comparison between self- assessment and clinical diagnosis (Table 2) showed limited concordance, with a Cohen’s Kappa value of 29.09 [95% CI: 24.51-33.67]. However, the median number of nevi identified by dermatologists in patients who reported having “a lot of moles” was 40, compared to 20 among those who cited other reasons for participating. This difference was statistically significant (P<0.001). In contrast, there was strong agreement between self- reports and clinical evaluations for family and personal his- tory of skin cancer, with Cohen’s Kappa values of 79.08 [95% CI: 70.08-87.96] and 60.04 [95% CI: 53.66-66.41], respectively. When interviewed about the benign or malignant nature of nevi and melanoma, participants displayed some confu- sion. Among 1,628 respondents, only 858 (52.7%) correctly identified a nevus as a benign lesion, while 726 (44.59%) were uncertain, and 44 (2.7%) incorrectly considered it malignant. Additionally, 206 participants (12.03%) be- lieved that removing a nevus could cause death, while 729 (42.56%) were uncertain (total responses: 1,713). Responses were more accurate regarding melanoma, with 1,143 participants (67.2%) identifying it as malig- nant. However, 450 (26.46%) were uncertain, and 108 (6.35%) mistakenly thought melanoma was benign (total responses: 1,701). Across these three questions, the mean number of cor- rect answers was 1.57 (SD 1.06), with only 416 respon- dents (23.46%) answering all questions correctly, while 358 (20.19%) got all questions wrong or missed answers. Strat- ifying by family cancer history revealed a higher average of correct answers among those with a family history of cancer (1.78±0.95 vs 1.54±1.07, P=0.0007). Similarly, participants (N=733) having dark brown eyes. Instead, 29.44% (N=519) of participants had green or blue eyes. Skin Cancer Awareness Prevention was the primary motivation for the majority of participants (N=1,263, 71.24%) who joined the campaign. Additionally, 219 patients (12.35%) participated due to Table 1. Demographic Characteristics of the Campaign Participants. N (%) Gender Male 529 (29.84) Female 1244 (70.16) Age, years Mean (DS) 40.15 (15.09) Median [Q1; Q3] 36 [28; 53] Min-max 6-91 Weight, kg Median (DS) 67.71 (14.00) Height, cm Median (DS) 167.74 (8.70) BMI, kg/m^2 Median (DS) 23.96 (4.08) Birthplace (N=1768) Italy 1708 (96.61) Europe 46 (2.60) Asia 3 (0.17) America 10 (0.57) Oceania 1 (0.06) Italian regions (N=1699) Northwest 307 (18.07) Northeast 169 (9.95) Center 412 (24.25) South 591 (34.79) Islands 220 (12.95) Eye color (N=1763) Green/blue 519 (29.44) Light brown 511 (28.98) Dark brown 733 (41.58) Hair color (N=1758) Red 15 (0.85) Blond 199 (11.32) Brown 1395 (79.35) Black 149 (8.48) Education level (E=1766) Lower secondary school 168 (9.51) High school 766 (43.37) Bachelor’s or master’s degree 832 (47.11) Table 2. Comparison Between the Self- Perception and Real Number of Nevi, Absolute Frequencies, and Column Percentages. Actual Number of Melanocytic Nevi Self-Perception of Numerous Nevi No (N=912) Yes (N=736) <10 246 (26.97) 75 (10.19) 11-30 467 (51.21) 291 (39.54) 31-50 158 (17.32) 222 (30.16) 51-100 36 (3.95) 109 (14.81) >100 5 (0.55) 39 (5.30) Original Article | Dermatol Pract Concept. 2025;15(2):5350 5 with a personal history of cancer (N=58) answered cor- rectly more often compared to those without (1.71±1.09 vs 1.56±1.06, P=0.0003). UV Exposure Habits Table 3 summarizes the time that participants reported spending in the sun during vacations, work, or recreational activities, as well as their use of tanning beds. “High-risk” sun exposure habits were identified in 21.25% of partici- pants for vacations, 2.06% for work, and 14.22% for recre- ational activities. Sun Protection Behavior Campaign participants were interviewed about their sun protection habits and knowledge of proper photoprotec- tion, as summarized in Table 4. Notably, there was a clear discrepancy between the reported frequency of sunscreen use and the amount purchased annually (mean: 1.66 tubes/ year, median content: 150 ml). Among those who never used Table 3. Time in the Sun Declared by Campaign Participants. Time in the Sun Days (per year) in the sun on vacation (n=1760) N° of Participants (%) < 15 days/year 588 (33.41) 15/30 days/year 798 (45.34) 30-60 days/year 274 (15.57) 60-90 days/year 71 (4.03) >90 days/year 29 (1.65) Time in the sun for work (N=1747) Never 1286 (73.61) < 4 hours/day 425 (24.33) > 6 hours/day 36 (2.06) Time in the sun hobby (N=1737) Never 465 (26.77) < 3 hours/day 1025 (59.01) 3-6 hours/day 216 (12.44) > 6 hours/day 31 (1.78) Use of sunbeds (N=1736) No 1162 (66.94) Yes 574 (33.06) Mean age at the first sunbed session (total response= 325) Mean (SD) 22.29 (7.08) Tanning bed sessions (N=571) < 10 319 (55.87) 10-100 245 (42.91) >100 7 (1.23) SD = standard deviation. Table 4. Sun Protection Measures Declared by the Campaign Participants. Sun Protection Measure Use of sunscreen (N=1758) N° of Participants (%) No 71 (4.04) Yes 1098 (62.46) Sometimes 589 (33.50) Frequency of application (N=1052) Every two hours 342 (32.51) Twice a day 511 (48.57) Only in the morning 199 (18.92) SPF (N=1394) Low 24 (1.72) Medium 282 (20.23) High 953 (68.36) Medium/low 135 (9.68) Size of sunscreens (N=1581) Small (< 100 ml) 232 (14.67) Medium (100-200 ml 1095 (69.26) Large (400-500 ml) 254 (16.07) Number of tubes purchased/year (N=1566) Median (DS) 1.66 (1.13) Reason for not using sunscreen (n=660) “I want the fullest tan” 71 (10.76) “I want a full vitamin D boost” 71 (10.76) “I don’t like greasy skin” 209 (31.67) “I don’t burn” 77 (11.67) Other Photoprotection Habits Wearing a hat (N=1601) No 642 (40.10) Sometimes 474 (29.61) Yes 485 (31.29) Sunglasses (N=1698) No 206 (12.13) Sometimes 277 (16.31) Yes 1215 (71.55) Wear a t-shirt (N=1540) No 814 (52.86) Sometimes 472 (30.65) Yes 254 (16.49) Stay in the shade (N=1674) No 130 (7.77) Sometimes 518 (30.94) Yes 1026 (61.29) When can sunscreen be spared? Swimming in the sea 143 (8.07) Walking/running 190 (10.72) Table 4 continues 6 Original Article | Dermatol Pract Concept. 2025;15(2):5350 Conclusions The incidence and social burden of skin tumors are contin- uously rising [18-20], making prevention campaigns aimed at the general population increasingly valuable. However, past experiences indicate that the number of newly diag- nosed cancers during such campaigns, if not targeted to- ward specific at-risk populations, tends to be remarkably low [2,10-12,21,23]. As a result, the primary benefit of these campaigns often lies in health education rather than in can- cer detection [4-10]. In this context, we analyzed data related to sun exposure habits, photoprotection, and skin cancer awareness collected during a national prevention campaign (“Save Your Skin”). The aim was to identify critical issues within specific popula- tion groups. By pinpointing specific needs in terms of primary prevention among these groups, it is possible to enhance the overall effectiveness and impact of such campaigns. Twenty-eight centers participated in the campaign, rep- resenting 13 different regions that were evenly distributed across Italy’s three main geographic and climatic areas. An analysis of the participants’ demographic characteristics re- vealed a predominance of female attendees, consistent with findings from other studies showing a higher engagement in preventive health measures among women [8,24]. The me- dian age of participants was 36 years, which is below the age range where skin cancer is most common, further underscor- ing the campaign’s principle value in the realm of primary prevention. Notably, only 7.33% of participants reported a family history of skin cancer, and just 2.31% had a personal history of the disease. While it is possible that individuals at higher risk, such as those with a family history of skin cancer or previous diagnoses, are already engaged in more targeted prevention programs, our data suggest that the campaign may have struggled to reach the higher-risk population (i.e., older males, carriers of gene mutations) and those with poorer prognoses such as immigrants; nearly all campaign participants were Italian. Research has shown that financial constraints, poor social integration, and language barriers can limit healthcare access for migrant populations [25]. These same factors likely hindered their participation in the campaign. It is well established that socioeconomic, environ- mental, and geographic factors significantly affect cancer outcomes, influencing every aspect of cancer management, including prevention [26]. Another notable characteristic of the participants is their high level of education, with 90.48% having completed high school or holding a bachelor’s or master’s degree. This aligns with the tendency of more educated individuals to ac- cess diverse sources of health information. Previous studies have demonstrated a strong correlation between melanoma sunscreen (N=209, 31.67%), the primary reason cited was the discomfort caused by greasy skin. Sunglasses (N=1,215, 71.55%) and seeking shade (N=1,026, 61.29%) were the most commonly adopted protection measures. Furthermore, many respondents stated that sunscreen can be spared in case of cloudy weather (461 answers; 26%) and while stay- ing under the beach umbrella (337 answers; 19%). As summarized in Table 5, sun exposure and protection behaviors were analyzed by patient age, along with the num- ber of correct responses to the questionnaires. Interestingly, younger individuals were significantly less likely to be exposed to the sun for work (1.20% for those under 45, compared to 3.62% and 3.31% for those aged 45–65 and 65+, respectively; P=0.0047). Additionally, older adults (65+) used sunscreen less frequently but were more diligent in using other photoprotective measures, such as hats, clothing, sunglasses, and shade, and they experienced fewer severe sunburns. Nearly 45% of participants in the 45–65 age group reported using tanning beds. Knowledge of correct sunscreen use and the number of correct answers in the questionnaire both declined with age. However, participants with a family or personal his- tory of skin tumors gave significantly more correct answers (1.78±0.95 vs. 1.54±1.07, P=0.0007 for family history; 1.71±1.09 vs. 1.56±1.06, P=0.3003 for personal history). Actinic Damage Dermatologic examination revealed signs of actinic damage in 645 out of 1,773 participants (36.37%). Table 6 outlines the characteristics (age, phototype) and sun-related behav- iors of those with and without actinic damage. The two groups were also compared based on the number of correct answers to questions about proper sun exposure. As expected, age was significantly associated with the pres- ence of actinic damage (P<0.0001), as were factors such as experiencing severe sunburns and using sunbeds (P<0.0001). Notably, participants with actinic damage provided significantly fewer correct answers to questions on photoprotection and skin tumors, indicating a lower level of awareness on these topics. Sun Protection Measure Use of sunscreen (N=1758) N° of Participants (%) Gardening 121 (6.82) In short vacations 48 (2.71) Cloudy weather 461 (26.00) Staying under the beach umbrella 337 (19.01) In adults 11 (0.62) In the elderly 18 (1.02) Table 4. Sun Protection Measures Declared by the Campaign Participants (continued) Original Article | Dermatol Pract Concept. 2025;15(2):5350 7 Table 5. Risk Behaviors Assessed Based on the Patient’s Age, Number, and Percentage of Subjects Who Had Risk Behaviors. <45 (N=268) 45-65 (N=267) 65+ (N=80) P-Value Risk Behavior N (%) Exposure on vacation (N=1688) 238 (21.74) 93 (19.75) 29 (23.77) 0.5365 Exposure for work (N=1676) 13 (1.20) 17 (3.62) 4 (3.31) 0.0047 Recreational exposure (N=1665) 166 (15.41) 55 (11.83) 18 (14.63) 0.1823 Incorrect use of sunscreen (N=1686) 415 (38.14) 152 (32.14) 57 (45.60) 0.0092 Poor photoprotection* (N=1672) 104 (9.62) 62 (13.22) 4 (3.28) 0.0032 Severe sunburns (N=1659) 489 (45.24) 215 (46.64) 37 (31.62) 0.0116 Sunbeds (N=1665) 323 (29.96) 210 (44.87) 17 (14.29) <.0001 Smoker (N=1643) 217 (20.22) 74 (16.37) 12 (10.17) 0.0116 No sunscreen (N=1701) 543 (49.41) 247 (52.11) 82 (64.06) 0.0066 Number of corrected answers (N=1701) 0 193 (17.56) 100 (21.10) 45 (35.16) <.0001 1 264 (24.02) 146 (30.80) 38 (29.69) 2 342 (31.12) 138 (29.11) 31 (24.22) 3 300 (27.30) 90 (18.99) 14 (10.94) Mean (SD) 1.68 (1.06) 1.46 (1.03) 1.11 (1.01) *Hats, clothing, glasses, shade. incidence and higher socioeconomic status; many exogenous risk factors, such as intermittent sun exposure during va- cations and the use of tanning beds, are closely tied to the lifestyle choices of individuals with higher education back- grounds [27,28]. Conversely, limited education has been shown to nega- tively impact secondary prevention, reducing the likelihood of early melanoma diagnosis and consequently leading to higher mortality rates [29,30]. These findings underscore the importance of designing prevention campaigns that also effectively target disadvantaged population groups, where educational barriers may limit awareness and early detection of skin cancers. In this study, we also examined participants’ awareness of skin cancer risks. We observed that while the number of nevi is widely recognized as a risk factor, it tends to be over- estimated, and there is often a lack of concordance between self-assessments and dermatologists’ evaluations. This dis- crepancy can be attributed to the challenges individuals face in distinguishing melanocytic lesions from other pigmented skin lesions, a finding consistent with previous studies [10], even in populations with some level of experience [31,32]. A recent study by Gefeller et al. [31] found that self-assessed nevi counts were consistently higher than those estimated by trained examiners in a large sample of 4,548 subjects, primar- ily clinical medicine students, reinforcing the conclusion that self-assessment is unreliable, even among educated groups. Similarly, a previous study by Flint [33] reported low ac- curacy in self-reported family histories of skin cancer, as the general population often struggles to differentiate between clinically suspicious, precancerous, and neoplastic lesions. In contrast, our experience showed better agreement on family history accuracy, although a high percentage of participants remained confused about the benign nature of nevi and the potential risks associated with their removal (47.29% and 54.56%, respectively). Awareness of melanoma was higher, though 6.35% of respondents mistakenly believed it to be benign. Overall, knowledge of these issues was significantly greater among individuals with a personal or family history of skin cancer. Overall, the participants in the campaign spent a consid- erable amount of time in the sun. Specifically, 21.25% re- ported spending their vacations in sunny locations for more than two months per year, 26.39% were exposed to the sun for work-related reasons, and 14.22% reported spending more than three hours daily in the sun for recreational activ- ities. Additionally, 33.06% of participants admitted to using tanning beds, with the median age at first exposure to artifi- cial UV sources being 22.08 years. Despite this high level of sun exposure, responses to questions about sunscreen usage revealed significant knowl- edge gaps regarding the proper choice of SPF, the frequency of reapplication, and the amount of sunscreen to use. This lack of awareness is consistent with findings from two other Italian studies, which also documented inadequate sunscreen use among sailors and outdoor workers [15,34]. Modenese et al.’s study [34] further highlighted the poor adoption of 8 Original Article | Dermatol Pract Concept. 2025;15(2):5350 Table 6. Characteristics Based on the Presence/Absence of Actinic Damage. No Actinic Damage (N=1128) Actinic Damage (N=645) P-Value Sun Behavior Exposure on vacation (N=1760) 239 (21.34) 135 (21.09) 0.9036 Exposure for work (N=1747) 21 (1.89) 15 (2.37) 0.4979 Recreational exposure (N=1737) 158 (14.21) 89 (14.24) 0.9857 Incorrect use of sunscreen (N=1758) 436 (38.96) 224 (35.05) 0.1036 Poor photoprotection* (N=1744) 120 (10.80) 55 (8.69) 0.1580 Severe sunburns (N=1729) 452 (40.87) 323 (51.85) <.0001 Sunbeds (N=1736) 323 (29.10) 251 (40.10) <.0001 No sunscreen use 563 (49.91) 349 (54.11) 0.0889 Age (N=1701) <45 831 (76.52) 268 (43.58) <.0001 45-65 207 (19.06) 267 (43.41) 65+ 48 (4.42) 80 (13.01) Phototype (N=1721) 1-2 383 (34.85) 229 (36.82) 0.6612 3-4 597 (54.32) 324 (52.09) 5-6 119 (10.83) 69 (11.09) Number of correct answers 0 202 (17.91) 156 (24.19) 0.0012 1 287 (25.44) 180 (27.91) 2 351 (31.12) 181 (28.06) 3 288 (25.52) 128 (19.84) Mean (SD) 1.64 (1.05) 1.44 (1.06) 0.5655 Median [IQR] 2 [1;3] 1 [1; 2] *Hats, clothing, glasses, shade. additional UV protective measures, such as wearing protec- tive clothing, hats, and sunglasses. These findings emphasize the need for enhanced education on effective sun protection practices As expected, incorrect photoprotection behaviors, re- flected by a lower number of correct responses to specific questions, were associated with increased actinic damage. This was significantly correlated with the use of tanning beds and the age of the participants. Notably, the number of correct answers—indicating better knowledge about photoprotection—decreased with increasing age. Older par- ticipants not only demonstrated lower awareness of proper photoprotection but also reported less frequent use of sun- screens, despite being more likely to wear hats and protective clothing. This finding partially aligns with those of Navarro et al. [35], who observed a higher use of head coverings among patients with basal or squamous cell carcinomas. These results underscore the need for targeted educa- tional efforts to improve sun protection behaviors, particu- larly among older populations who may be at higher risk of actinic damage but who exhibit less knowledge and lower sunscreen use. Our experience with the national skin cancer prevention campaign “Save Your Skin” has revealed several significant unmet needs that must be addressed to improve its impact. First, the campaign’s reach was primarily limited to individ- uals who already have easy access to healthcare, ensuring a better prognosis in the event of skin cancer. This underscores the urgent need to develop new communication strategies aimed at engaging populations with lower socioeconomic status who may be at higher risk yet have less access to pre- ventive care. Second, public knowledge about skin cancer remains inconsistent and often inaccurate. While individuals with a personal or family history of skin cancer displayed greater awareness, the general population showed consider- able confusion. This highlights the critical role dermatolo- gists must play in educating patients and the broader public about skin cancer risks, early detection, and prevention. Fi- nally, photoprotection behaviors remain inadequate across the general population. Key challenges include misunderstandings about the cor- rect use of sunscreens, particularly regarding the appropriate quantity and frequency of application, as well as dissatis- faction with the greasiness of available products. Addressing Original Article | Dermatol Pract Concept. 2025;15(2):5350 9 these issues by providing clearer guidance and improving sunscreen formulations could greatly enhance compliance and reduce skin cancer risk. Efforts to improve education and accessibility in these areas are essential to better meet the prevention needs of the population. 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