06 | SUNTEL program: first experience of school integration of the ugly duckling sign with e-learning and peer education for melanoma awareness

Giorgia Ravaglia¹, Serena Magi², Elisabetta Costa³, Matelda Medri², Franca Gentilini⁴, Chiara Scutellà⁴, Daniela De Zerbi⁵, Silvia Gerosa¹, Federica Zamagni⁶, Chiara Doccioli⁷, Sara Gandini⁸, Maria Costanza Cipullo⁹, Saverio Caini⁷, Ignazio Stanganelli^1|2 | ¹Dermatology Resident Training Program, Department of Medicine and Surgery, University of Parma, Parma; ²Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" – IRST Meldola, Forlì-Cesena; ³Graphic Design and Multimedia "Good Sun Good Skin" project, Istituto Oncologico Romagnolo, Forlì; ⁴IOR Scuola, Istituto Oncologico Romagnolo, Forlì; ⁵Scientific High School "Alfredo Oriani", Ravenna; ⁶Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS IRST Romagnolo Institute for the Study of Tumors "Dino Amadori", Meldola, Forlì-Cesena; ⁷Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network, ISPRO, Florence; ⁸Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan; ⁹Directorate General for Student Affairs, Inclusion, and Career Guidance, Prevention and Health Education Unit, Ministry of Education, Rome, Italy.

Background: Educational initiatives among young people are pivotal in promoting healthy behaviors, yet only a few studies to date have used peer education in schools to convey health messages for melanoma prevention. We report the results of a peer-education-based skin cancer prevention program combined with teledidactics (SUN Education and TELematic Learning – SUNTEL) targeting high school students in Italy, developed within the Italian Melanoma Intergroup (IMI) project.

Methods: In 2023-2024, thirty third-year high school students attended training sessions to become peer educators and then conducted interventions across first-year students using a multimedia platform “Sole per amico for Young” by IMI. Students targeted by the peer-education intervention completed pre- and post-intervention questionnaires to assess changes in their knolwedge, attitudes and behaviours regarding melanoma prevention. Marginal homogeneity tests were used to compare responses in the pre- vs. post-intervention questionnaires.

Results: The study population included 323 students (56.7% boys) mostly aged 14-16 years. Most participants had fair/light dark skin (>97%); 24% had freckles, and over one third developed skin rash often/always after UV exposure. Students’ knowledge about melanoma risk factors, prevention, and attitude about UV exposure, changed significantly after the intervention, e.g., students wanting to use a tanning bed/lamp dropped from 9.6% to 3.8% (p-value <0.001), and those aware that using a tanning bed/lamp is as risky as tanning in the sun rose from 75.4% to 90.5% (p-value <0.001). Knowledge of the ABCDE rule rose from 7.5% to 96.6%; for the ugly duckling sign, the change was from 9.1% to 91.2%.

Conclusions: E-learning/web-based tools and peer education proved highly effective in improving students’ knowledge of melanoma prevention, performing as well as or even better than traditional teacher- or physician-led approaches. This first school-based program combining peer education with a dedicated web platform also introduced the “ugly duckling” sign for early melanoma detection, highlighting that sustained multimedia reinforcement and parental involvement are key to lasting sun-safe behaviors.