Skin cancer, characterized by the uncontrolled proliferation of abnormal skin cells, is a global health concern of significant magnitude. While it impacts individuals across all demographics, its prevalence is profoundly influenced by sun exposure. In India, a nation blessed with abundant sunshine, cultivating awareness and fostering preventive measures against skin cancer assumes paramount importance.^1-4

Nestled amidst the breathtaking landscapes and azure skies of Himachal Pradesh's District Mandi lies a concealed health concern that warrants our unwavering attention—skin cancer. In the pursuit of sun safety and the preservation of skin health, this study embarks on a journey to illuminate the levels of awareness and knowledge regarding skin cancer within the diverse population of District Mandi. Through a comprehensive exploration of their understanding of this condition, encompassing its risk factors, early warning signs, preventive strategies and protective measures, we aspire to empower individuals to take proactive steps to safeguard the health of their skin.^5-7

Skin cancer, irrespective of age, gender or ethnicity, underscores the significance of awareness and prevention in our daily lives. The sun, while a life-giving force, can also pose a formidable threat to our skin when we fail to take adequate precautions. Hence, this study endeavors to shed light on the current state of skin cancer awareness in District Mandi, a region where the radiant sun is an integral part of daily life. Our mission is to explore the community's comprehension of this disease, enabling them to recognize the risk factors, identify early signs and advocate for preventive measures, ultimately empowering them to protect their skin from harm.^8-10

The solar kiss of the sun, which graces the residents of District Mandi daily, comes with the responsibility of sun safety and skin health. The consequences of inadequate knowledge and preventative action can be dire, as skin cancer can lead to not only physical discomfort but also significant medical and economic burdens. In our pursuit of enlightening the population of District Mandi, we aim to equip them with the knowledge necessary to make informed decisions about sun exposure, adopt protective measures and embrace the importance of skin health as a fundamental aspect of their well-being.

Objective of the Study

The primary objective of this research is to cast a spotlight on the existing levels of skin cancer awareness among the population of District Mandi, Himachal Pradesh. Through an exploration of the community's comprehension of skin cancer, its risk factors, early signs, prevention and protective measures, we endeavor to arm individuals with the knowledge needed to safeguard their skin from the potential harms posed by this condition.

Research Approach

This study employs a descriptive research approach to comprehensively evaluate knowledge levels related to skin cancer among the general population of District Mandi, Himachal Pradesh.

Research Design

The research design employed for this study is a cross-sectional survey, enabling the collection of data at a specific point in time, thereby allowing for an accurate assessment of skin cancer knowledge among the participants.

Study Area

The study was conducted exclusively within District Mandi, Himachal Pradesh, to ensure that the findings are representative of this specific geographical region.

Study Duration

Data collection for this study took place over a period extending from May 2023 to July 2023.

Study Population

The study population comprises all adults aged 18 and above, who have been residents of District Mandi, Himachal Pradesh, for a minimum of 12 months.

Sample Size Determination

The sample size was calculated to be 400 adults, with an assumption that 50% of participants possess adequate knowledge about skin cancer. The estimation considered a 5% absolute error, a 95% confidence level and a 5% non-response rate.

Study Tool

A meticulously structured questionnaire in the form of a Google Form was developed to gather data, encompassing socio-demographic characteristics and knowledge regarding skin cancer. Pre-testing was conducted among a small group of individuals to ensure the questionnaire's clarity and comprehensibility.

Description of Tool

The questionnaire was divided into two distinct sections:

• Demographic Data Survey Instrument

• Questionnaire

Demographic Data Survey Instrument

This section captured background information, including age, gender, marital status, religion, employment and education.

Questionnaire

This section consisted of 20 structured questions aimed at assessing knowledge levels regarding skin cancer. Correct answers were assigned one mark, while incorrect responses received zero marks. Knowledge levels were categorized as follows:

• 80%               (16-20)  -               very good

• 60-79%         (12-15) -               good

• 41-59%         (8-11)    -               fair

• <40%             (<8)        -               poor

Validity of Tool

To ensure accuracy and appropriateness, experts in the field validated the questionnaire.

Data Collection

Data collection was supervised by designated supervisors. The Google Form questionnaire was disseminated through various online channels, including email and popular social media platforms such as WhatsApp groups, Facebook, Instagram and LinkedIn. Data collection was conducted in both rural and urban areas of District Mandi, Himachal Pradesh and continued until 400 valid responses were obtained.

Data Analysis

The collected data were meticulously entered into a Microsoft Excel spreadsheet and subjected to thorough error checks. Data analysis was conducted using Epi Info V7 software, utilizing appropriate statistical tests such as frequencies and percentages.

Ethical Considerations

The study strictly adhered to ethical guidelines, ensuring the confidentiality and anonymity of participants to safeguard their privacy and protect their personal information throughout the research process.

The goal of the current study was to assess general public knowledge regarding skin Cancer through a non-experimental descriptive survey. A total of 400 respondents took part in the study, with 123 (30.75%) coming from urban areas and 277 (69.25%) from rural areas.

In the current study, the findings revealed varying levels of knowledge among the participants regarding skin cancer. Notably, a significant proportion, comprising 24.75% (equivalent to 99 individuals), exhibited an exceptionally high level of knowledge, scoring within the range of 16 to 20 marks, signifying very good understanding of skin cancer. Furthermore, a substantial segment, accounting for 34.75% (143 individuals), demonstrated a commendable level of knowledge, falling within the 12 to 15 marks range, indicating good familiarity with the subject matter. Additionally, 24.75% of the participants (91 individuals) were found to possess a moderate level of knowledge, scoring between 8 and 11 marks, while 16.75% (67 individuals) displayed a comparatively lower level of knowledge, with scores below 8 marks, indicating poor awareness regarding skin cancer. These findings underscore the diverse range of awareness and comprehension within the study population concerning skin cancer.

Table 1: Knowledge regarding skin Cancer among study participants

Table 2: Knowledge scores towards skin Cancer among study participants

The current study aimed to assess the level of knowledge and awareness regarding skin cancer among the population of District Mandi, Himachal Pradesh. The findings revealed varying levels of understanding, which provide valuable insights into the state of skin cancer awareness within this specific region. This discussion will delve into the implications of these findings and compare them with other relevant studies.

When examining the knowledge levels of the participants, it becomes evident that a significant portion of the population in District Mandi possesses a commendable understanding of skin cancer. Notably, 24.75% of respondents exhibited very good knowledge (scoring 16-20 marks), while an additional 34.75% displayed good knowledge (scoring 12-15 marks). This suggests that a substantial segment of the population is well-informed about skin cancer, its risk factors, symptoms and preventive measures. These results are encouraging and imply that awareness efforts and educational initiatives in the region have been effective in disseminating knowledge about skin cancer.

In contrast, 24.75% of participants fell into the fair knowledge category (scoring 8-11 marks), indicating that there is room for improvement in terms of enhancing understanding about skin cancer. Efforts should be directed towards this group to further educate and raise awareness, with a focus on addressing specific gaps in knowledge.

Additionally, 16.75% of participants exhibited poor knowledge (scoring below 8 marks). This segment represents a vulnerable population concerning skin cancer awareness. It is imperative to prioritize targeted educational campaigns, especially in rural areas where awareness levels tend to be lower, to bridge this knowledge gap effectively.

Comparing these findings to other relevant studies, it is evident that the levels of skin cancer awareness in District Mandi are generally on par with various regions. For instance, a study conducted in a similar Indian context reported that approximately 30% of participants had good knowledge about skin cancer, which aligns with our results (Singh et al¹¹, 2018). Furthermore, a study in the United States indicated that while awareness about skin cancer is generally high, there are disparities in knowledge among different demographic groups (Hay et al¹², 2019). This underscores the importance of tailoring awareness efforts to reach specific populations within District Mandi.

The findings of this study have significant implications for public health initiatives in District Mandi. While a considerable proportion of the population exhibits good to very good knowledge levels, there is still a need for focused awareness campaigns, particularly targeting those with fair or poor knowledge. These initiatives should aim to educate individuals about skin cancer risk factors, the importance of early detection and the adoption of preventive measures.

Furthermore, considering the rural-urban divide in the study, tailored educational programs should be designed to reach the rural population effectively. Leveraging community health workers and local outreach programs can be instrumental in disseminating knowledge about skin cancer in these areas.

In conclusion, this study sheds light on the current state of skin cancer awareness in District Mandi, Himachal Pradesh. While a substantial portion of the population exhibits good to very good knowledge levels, there is still room for improvement, particularly among those with fair or poor knowledge. To bridge this gap, targeted educational initiatives, community outreach and awareness campaigns should be implemented, with a focus on rural areas where awareness levels tend to be lower. By enhancing awareness and understanding of skin cancer, we can empower individuals to prioritize their skin health and engage in preventive measures, ultimately reducing the burden of this preventable disease.

1. World Health Organization. Skin Cancers. 2016. https://www.who.int/uv/faq/skincancer/en/index1.html.

2. Gandini, S. et al. “Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi.” European Journal of Cancer, vol. 41, no. 1, 2005, pp. 28–44. https://doi.org/10.1016/j.ejca.2004.10.015.

3. Cancer Research UK. Skin Cancer Statistics. 2021. https://www.cancerresearchuk.org/health-professional/ cancer-statistics/statistics-by-cancer-type/skin-cancer.

4. World Health Organization. Skin Cancers. 2021. https:// www.who.int/cancer/prevention/diagnosis-screening/ skin-cancer/en/.

5. American Cancer Society. Skin Cancer: Facts & Figures 2021–2023. 2021. https://www.cancer.org/content/dam/ cancer-org/research/cancer-facts-and-statistics/skin-cancer-facts-and-figures/skin-cancer-facts-and-figures-2021-2023.pdf.

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7. Lucas, R.M. et al. “Estimating the global disease burden due to ultraviolet radiation exposure.” International Journal of Epidemiology, vol. 37, no. 3, 2008, pp. 654–667. https:// doi.org/10.1093/ije/dyn017.

8. Gallagher, R.P. et al. “Occupational and recreational sun exposure and skin cancer in an ethnically diverse, community-based sample.” American Journal of Epidemiology, vol. 161, no. 9, 2005, pp. 901–910. https:// doi.org/10.1093/aje/kwi107.

9. Robinson, J.K. “Sun exposure, sun protection and vitamin D.” Journal of the American Medical Association, vol. 300, no. 13, 2008, pp. 1548–1550. https://doi.org/10.1001/ jama.300.13.1548.

10. Apalla, Z. et al. “Skin cancer: Epidemiology, disease burden, pathophysiology, diagnosis and therapeutic approaches.” Dermatology and Therapy, vol. 7, suppl. 1, 2017, pp. 5–19. https://doi.org/10.1007/s13555-016-0165-y.

11. Singh, R. and T.V.S.V.G.K. Tilak. “Knowledge, attitude and practice towards skin cancer and sun exposure among beachgoers in Puducherry, India.” Indian Dermatology Online Journal, vol. 9, no. 3, 2018, pp. 186–191. https://doi.org/10.4103/idoj.IDOJ_294_17.

12. Hay, J.L. et al. “Psychosocial mediators of a nurse intervention to increase skin self-examination in patients at high risk for melanoma.” Cancer Epidemiology and Prevention Biomarkers, vol. 28, no. 1, 2019, pp. 154–162. https://doi.org/10.1158/1055-9965.EPI-18-0455.