SciELO - Scientific Electronic Library Online

vol.20 número2Saturación y hacinamiento del servicio de emergencia de un hospital urbanoFactores asociados al consumo de tabaco en estudiantes universitarios de lima metropolitana índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados




  • Não possue artigos citadosCitado por SciELO

Links relacionados

  • Não possue artigos similaresSimilares em SciELO


Revista de la Facultad de Medicina Humana

versão impressa ISSN 1814-5469versão On-line ISSN 2308-0531

Rev. Fac. Med. Hum. vol.20 no.2 Lima abr./jun 2020 

Original article

Risk perception of skin cancer at a high-altitude hospital

Nuria Leticia Huanca-Huirse1  2 

Joel Sack Roque-Roque1  2 

Verónica Nélida Laurel-Vargas1  2 

Alan Wenceslao Quispe-Sancho1  2 

1Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú.

2ASOCIEMH CUSCO Asociación Científica de Estudiantes de Medicina Humana del Cusco, Universidad Nacional de San Antonio Abad del Cusco. Cusco, Perú



To determine the level of risk perception of skin cancer in a population from Cusco.


It is an observational descriptive cross-sectional study and was aplied in a skin cancer screening campaign in Cusco. The applied questionnaire was designed and validated by Morales-Sánchez M and Cols, and it measures the risk perception of skin cancer. The reported Cronbach's alpha value is 0.824.


The majority of patients were female (64.7%), average age was 44.9 years (SD: 14.2) and the 51.0% had higher education level. The median hours of sun exposure was 4 (95% CI: 1-6), the most frequent origin was from Cusco (77.6%) and most of the population have normal risk perception of skin cancer (65.8%).


The risk perception of skin cancer was normal in the majority of the population.

Key words: Neoplasms; Perception; Health Behavior; Attitude (source: MeSH NLM).


Exposure to prolonged solar ultraviolet (UV) radiation has the potential to damage skin cells and cause neoplasms. The incidence of skin cancer is increasing despite prevention strategies; thus, the American Cancer Society estimated 96,480 new cases of invasive Melanoma for 20191with an increasing trend since 19992,5. In Peru, skin cancer was the fourth most common type of cancer in 2012 and in 2017 it was the second (7.9 % vs 10.4%)4,5. More than 66,000 new cases are diagnosed each year and more than 32,000 people are estimated to die from the disease6. Most types of skin cancer are highly curable; however, unplanned treatment has repercussions on the patient such as disfigurement and emotional disorders7.

Preventive measures and early diagnosis of skin cancer would help to decrease the above indicators8. Skin cancer is potentially preventable through appropriate behaviours such as avoiding sun exposure, using sunscreen, accessories, and protective clothing9. Diagnosis of skin cancer is common in young Hispanic people and the survival rate is lower compared to the American population3,10. For this reason, measuring skin cancer perception is important from an early age and influences the adoption of these prevention measures11,12. Although there are studies on skin cancer prevention perception and attitude, there are some deficiencies in the design of the questionnaires used13.

The Andes region of Peru is considered from 1000 meters above sea level and has particular climatic and meteorological characteristics14. One of the characteristics is that the UV radiation indices are "extremely high" with an index of 12 and 18 in these zones and 18 in the city of Cusco15. The incidence of malignant melanoma in the city of Cusco is 13 according to the latest report16. No published studies were found on skin cancer perception in high-population. For this reason, the objective of our study was to determine the perception of risk of skin cancer in patients who attended a skin cancer screening campaign in a hospital in Cusco.



Observational study of descriptive cross-sectional type.

Population and sample

A questionnaire was applied to all patients attending the "Mole Day" campaign of the Antonio Lorena del Cusco contingency hospital located at 3400 masl. This campaign was carried out on February 2, 2019 in the facilities of the aforementioned hospital.

The health campaign consisted of preventive care by a dermatology specialist. Each care consisted of a complete dermatological examination, determination of skin phototype and counseling. The questionnaire was applied before the patients were admitted to the office. The skin phototype information was provided by the dermatologist, after each care. The methodology for the application of the questionnaire was standardized at a meeting the day before the campaign.

Procedures and variables

All adult patients who agreed to participate in the study were included with informed consent. Patients with incomplete survey, who responded with an irregular pattern or who were physically or mentally unable to respond to the questionnaire were excluded from the study.

The questionnaire applied was designed and validated by Morales-Sánchez M and Cols, and measures the perception of risk of skin cancer(17). This questionnaire has 18 items grouped in 4 areas: affective (consisting of 5 statements), behavioral (consisting of 5 statements), gravity (consisting of 3 statements), susceptibility (consisting of 3 statements) and probability indicator (consisting of 2 propositions). The reported alpha value of Cronbach is 0.824(17). According to the validation study, a normal risk perception score ranges from 68 to 96 points, having a lower score implies a lower risk perception and having more than 96 points means a high risk perception.

In addition, additional information was collected such as sociodemographic characteristics: sex, age, marital status, level of education, occupation, place of origin; and clinical characteristics such as hours of sun exposure, skin phototype, previous skin disease, family history of skin cancer, use of sunscreen accessories and previous information on skin cancer.

Each survey was assigned an alphanumeric code and entered into a database in Microsoft Excel 2013 by three members of the study team. A fourth member of the team carried out quality control of the information, reviewing all the questionnaires and their correct filling in the database.

Statistical Analysis

Descriptive analysis was performed using absolute and relative frequencies for categorical variables. To describe the numerical variables the mean and median were used together with the standard deviation (SD) or interquartile range (IQR) respectively.

Ethical considerations

The application of the research instrument was preceded by an informed consent given to each participant, the data handled by the investigators were kept in the strictest confidentiality and no information was published that would allow the identification of any participants.


The total number of respondents was 56. 4 questionnaires were excluded due to incomplete information. The majority of patients were female (64.7%) and of higher education level (51.0%), the average age was 44.9 years (SD: 14.2), the median hours of solar exposure was 4 (95% CI: 1. 6), the most frequent origin was from Cusco (77.6%) and with a normal perception of skin cancer (65.8%) (Table 1).

Table 1.  General characteristics according to the skin cancer risk perception score. 

Variables Skin cancer risk perception score
Normal (n=33) Major (n=16) Minor (n=3)
N (%) N (%) N (%)
Male 12 (66,7) 6 (33,3) 0
Female 20 (60,6) 10 (30,3) 3 (9,1)
Marital status      
Single 11 (61,1) 7 (38,9) 0 (0,0)
Married 13 (72.2) 4 (22,2) 1 (5,6)
Cohabiting 6 (85,7) 1 (14,3) 0 (0,0)
Widower 2 (40,0) 3 (60,0) 0 (0,0)
Degree of instruction      
Illiterate 1 (100,0) 0 (0,0) 0 (0,0)
Primary 3 (42,9) 4 (57,1) 0 (0,0)
High school 11 (68,8) 5 (31,2) 0 (0,0)
Higher 17 (68,0) 6 (24,0) 2 (8,0)
Housewife 9 (56,3) 7 (43,7) 0 (0,0)
Student 4 (80,0) 1 (20,0) 0 (0,0)
Nurse 4 (80,0) 0 (0,0) 1 (20,0)
Others 16 (61,5) 8 (30,8) 2 (7,7)
Place of origin      
Cusco city 25 (65,8) 12 (31,6) 1 (2,6)
Outside of Cusco 7 (63,4) 3 (27,3) 1 (9,1)

Most participants had a normal perception of skin cancer (n=33; 63.5%) followed by higher perception (n=16; 30.8%). The participants with low perception were three (5.8%).

The most common phototypes were types 3 and 4 (46% each). Similarly, the majority of patients with phototype 3 (60.9%) and phototype 4 (73.9%) had a normal cancer risk perception. The largest proportion of participants had no dermatological disease (72.6%), and had a normal perception (59.5). On the use of accessories for sun protection, 70.6% of participants used an accessory, and 63.9% of this group had a normal perception of cancer risk (Table 2)

Table 2.  Clinical characteristics according to the skin cancer risk perception score 

Variables Skin cancer risk perception score
Normal (n=33) Major (n=16) Minor (n=3)
N (%) N (%) N (%)
Type 2 2 (66,8) 1 (33,3) 0 (0,0)
Type 3 14 (60,9) 7 (30,4) 2 (8,7)
Type 4 17 (73,9) 6 (26,1) 0 (0,0)
Type 5 0 (0,0) 1 (100,0) 0 (0,0)
Skin illness      
Yes 11 (78,6) 2 (14,3) 1 (7,1)
No 22 (59,5) 13 (35,1) 2 (5,4)
Use of accessories for sun protection      
Yes 23 (63.9) 10 (27,8) 3 (8,3)
No 10 (66,7) 5 (33,3) 0 (0,0)
Skin cancer background information      
Yes 14 (63,4) 6 (27,3) 2 (9,1)
No 19 (65,5) 9 (31,0) 1 (3,5)

The most frequent dermatological disease was rosacea (33.3%) followed by mycosis (25.0%) (Table 3).

Tabla 3.  Types of skin disease in the respondents 

  N (%)
Rosacea 4 (33,3)
Mycosis 3 (25,0)
Acne 2 (16,7)
Allergy 1 (8,3)
Melasma 1 (8,3)
Melanoma 1 (8,3)

*Two patients did not report the type of disease.


Perception was normal in 63.5% and high in 30.8% of participants. This may be due to an adequate knowledge of the risk of skin cancer. The level of knowledge has been shown to influence the perception and change of attitudes in patients18. The studio of Alfredo A et al. reports that there is little perception of risk and poor knowledge about the dangers of irresponsible solar exposure19. The majority of participants (51.0%) had higher education level, so we assume the access information and awareness about the disease is greater

The majority of participants (72.6%) had no skin disease, and of this group, more than 90% had a normal or high risk perception. This could be explained by the high proportion of participants using photo-protection measures (70.6%). In a study that included veterans in the treatment of skin disease, they reported that they understood the risk of skin cancer but were confused about the use of sunscreen and other measures19,20. Similarly, a study conducted in France reports that having a skin history increases photo-protective behavior21. The adoption of photo-protection measures depends on the personal perception of risk, which in the majority of study participants is normal or high22.

The predominant phototype in our study was 3 and 4 (46% each). These phototypes have a greater amount of melanin, which has the ability to absorb broad spectrum UV radiation, antioxidant and radical remover23. In addition, the cancer perception of these groups was normal or high in more than 90% of them. This result could be explained again by the educational level of the participants and access to information.

The limitations of the study are that it included a non-representative group, so the results cannot be extrapolated to other populations that go to other hospitals in the city. It is suggested to carry out studies that include the population of the different health systems. It is the first study carried out in the high Andean population that evaluates the perception of risk on skin cancer, using a validated survey.


The perception of skin cancer risk was from normal to high in most patients. The level of education could be an influential factor in the perception of skin cancer.

Acknowledgment :

We thank Dr. M. A. Morales Sanchez for providing us with the data collection form that we use in this work


1. American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2019-2020. Atlanta: American Cancer Society; 2019. Disponible en [ Links ]

2. Anderson RN, Kohler BA, Scott S, Lake AJ, Cronin KA, Jemal A, et al. Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer. 2018;124(13):2785-800. Disponible en [ Links ]

3. Perez MI. Skin Cancer in Hispanics in the United States. J Drugs Dermatol. 2019;18(3):117-20. Disponible en [ Links ]

4. Ministerio de Salud DG de E. Análisis de la situación del cáncer en el Perú. Serie Herramientas Metodológicas en Epidemiología y Salud Pública N° 015. 2013: 57 Disponible en [ Links ]

5. Perú EDEL. Boletín epidemiológico del perú. 2018;2. Disponible en [ Links ]

6. Epidemiológica S. Boletín Epidemiológico Del Perú. Minsa (Internet). 2019;28:1-31. Disponible en: ISSN 2415-076 [ Links ]

7. Mermelstein RJ, Riesenberg LA. Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychol. 1992;11(6):371-6. [ Links ]

8. de Haas ER, Nijsten T, de Vries E. Population education in preventing skin cancer: from childhood to adulthood. Journal of Drugs in Dermatology : JDD. 2010 Feb;9(2):112-116 Disponible en: [ Links ]

9. Kornek T, Augustin M. Prävention von Hauttumoren. JDDG - J Ger Soc Dermatology. 2013;11(4):283-98. Disponible en: [ Links ]

10. Spradlin K, Bass M, Hyman W, Keathley R. Skin cancer: Knowledge, behaviors, and attitudes of college students. South Med J. 2010;103(10):999-1003. Disponible en: [ Links ]

11. Defranc A, Van Den Broucke S, Leroy R, Hoppenbrouwers K, Lesaffre E, Martens L, et al. Measuring oral health behaviour in Flemish health care workers: An application of the theory of planned behaviour. Community Dent Health. 2008;25(2):107-14. Disponible en: [ Links ]

12. Janssen E, Van Osch L, De Vries H, Lechner L. Measuring risk perceptions of skin cancer: Reliability and validity of different operationalizations. Br J Health Psychol. 2011;16(1):92-112. Disponible en: [ Links ]

13. Toro-Huamanchumo CJ, Burgos-Muñoz SJ, Burgos-Muñoz RM, Perez-Fernandez J, Zentner-Guevara JA, Vargas-Tineo LM, et al. Awareness, behavior and attitudes concerning sun exposure among beachgoers in the northern coast of Peru. PeerJ. 2019;7:e6189. Disponible en: [ Links ]

14. Javier Pulgar Vidal . Las ocho regiones naturales del Perú. Terra Brasilis ( Nova Série ). 2003;5(2007):4-5. Disponible en: [ Links ]

15. [ Links ]

16. Gutiérrez Villafuerte CA, Alarcón Isidro EE, Valle R, Calderón G. Epidemiología del melanoma maligno en el Instituto Nacional de Enfermedades Neoplásicas, Perú, 2000-2004. Folia dermatol peru. 2007;18(1):2000-4. Disponible en: [ Links ]

17. Morales-Sánchez MA, Peralta-Pedrero ML, Domínguez-Gómez MA. Diseño y validación de un cuestionario para medir percepción de riesgo de cáncer de piel. Actas Dermosifiliogr (Internet). 2014;105(3):276-85. Dispoible en: [ Links ]

18. Brewer NT, Chapman GB, Gibbons FX, Gerrard M, Mccaul KD, Weinstein ND. Meta-Analysis of the Relationship Between Risk Perception and Health Behavior?: The Example of Vaccination. 2007;26(2):136-45. Disponible en: [ Links ]

19. Guerra Castro MM, Alemán Bacallao AD, Román Manrique Y. Fotoprotección y fotodaño en la niñez y la adolescencia. MEDISAN 2018; 22(8): 804-815.15. Disponible en: [ Links ]

20. McGrath JM, Fisher V, Krejci-Manwaring J. Skin Cancer Warnings and the Need for New Preventive Campaigns: A Pilot Study. Am J Prev Med (Internet). 2016;50(2):e62-3. Disponible en: [ Links ]

21. Stoebner-Delbarre A, Thezenas S, Kuntz C, Nguyen C, Giordanella JP, Sancho-Garnier H, Guillot B. Sun exposure and sun protection behavior and attitudes among the French population. Ann Dermatol Venereol(Internet). 2005;132(8-9 Pt 1):652-7 Disponible en: [ Links ]

22. Ramos C RM. Conocimientos actitudes y practicas eb fotoproteccion y fototipo cutaneo en asistentes a una campaña preventiva del cancer de piel. Callao -Perú. Febrero 2010. Dermatol Peru. 2010;20(1):169-73. Disponible en: [ Links ]

23. Michaela Brenner VJH. The protective role of melanin against UV. Photochem Photobiol. 2009;84(3):539-49. Disponible en: [ Links ]

Financing: Self-financed

Received: March 05, 2020; Accepted: March 19, 2020

Correspondence: Nuria Leticia Huanca Run away. Address: Av. de La Cultura 773, Cusco 08000 - Peru. Telephone: +51 957 072 120

Authorship contributions: The authors participated in the genesis of the idea, project design, data collection and interpretation, analysis of results and preparation of the manuscript of this research paper

Conflict of interest: The authors declare that they have no conflict of interest.

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons