Partnerships and program advocates are important for successfully implementing and sustaining sun-safety programs. Innovative strategies for reaching school administrators are likely needed to effectively implement sun-safety programs and policies. School policy and environmental change are important and valued components of sun-safety programs.

This is another in a series of occasional MMWR reports titled CDC Grand Rounds. These reports are based on grand rounds presentations at CDC on high-profile issues in public health science, practice, and policy. Information about CDC Grand Rounds is available at http:// www.cdc.gov/about/grand-rounds. December 4, 2015/64(47);1312-1314Skin cancer is the most common cancer in the United States, and most cases are preventable (1). Persons with certain genetic risk factors, including having a lighter natural skin color; blue or green eyes; red or blonde hair; dysplastic nevi or a large number of common moles; and skin that burns, freckles, or reddens easily or becomes painful after time in the sun, have increased risk for skin cancer (1). Persons with a family or personal history of skin cancer, especially melanoma, are also at increased risk. Although these genetic factors contribute to individual risk, most skin cancers are also strongly associated with ultraviolet (UV) radiation exposure. Most UV exposure comes from the sun, although some persons use UV-emitting indoor tanning devices (e.g. beds, booths and lamps).The three most common types of skin cancer, in descending order, are basal cell carcinoma, squamous cell carcinoma, and melanoma (1). Basal cell carcinoma alone is thought to be more common than any other cancer, but central cancer registries * (CCRs) do not collect data on basal cell carcinoma, so incidence is unknown. Squamous cell carcinoma is less common than basal cell carcinoma and can cause death, although most cases are treatable. Melanoma is the least common of the three main types of skin cancer, but causes the most deaths. In 2012, CCRs in the United States reported approximately 67 000 new melanoma cases and 9000 deaths from melanoma (2).Overall, rates of melanoma incidence are approximately 60% higher among men than women (25.5 and 15.9 per 100 000, respectively, in 2012), and rates increase rapidly after age 50 years. However, among persons aged <50 years, melanoma is more common among women (2).Rates of skin cancer have tripled since the early 1970s. Although much of the increase has been among early stage cancers, and mortality has remained relatively stable, more recent analyses have found increases among later stage cancers, and mortality rates for males have begun to increase (3).Differences by race in skin cancer risk are largely related to differences in skin type and other genetic risk factors. The rate of melanoma in non-Hispanic whites (whites) is approximately 25 times higher than the rate in blacks and six times higher than the rate in Hispanics. However, a diagnosis of melanoma in blacks and Hispanics often occurs later than in whites, which has led to poorer survival rates (1).The causal relationship between UV exposure and skin cancer among populations with comparatively more sunsensitive skin is well established, and recent genetic research has found a UV exposure signature among mutations specific to melanoma (4). However, 37% of persons in the United States report getting...

Skin cancer is the most common cancer in the United States, and most cases are preventable. Persons with certain genetic risk factors, including having a lighter natural skin color; blue or green eyes; red or blonde hair; dysplastic nevi or a large number of common moles; and skin that burns, freckles, or reddens easily or becomes painful after time in the sun, have increased risk for skin cancer. Persons with a family or personal history of skin cancer, especially melanoma, are also at increased risk. Although these genetic factors contribute to individual risk, most skin cancers are also strongly associated with ultraviolet (UV) radiation exposure. Most UV exposure comes from the sun, although some persons use UV-emitting indoor tanning devices (e.g., beds, booths, and lamps).

Introduction: The endoscopy Global Rating Scale (GRS) is a web based self-assessment quality improvement tool providing a framework for service improvement. Widespread use of the GRS in adult endoscopy services in the United Kingdom (UK), has led to a demonstrable improvement in quality. The adult GRS is not directly applicable to paediatric endoscopy services. Objectives: To develop and pilot a paediatric endoscopy GRS (P-GRS) as a quality improvement tool. Methods: Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Endoscopy Working Group collaborated with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) to develop the P-GRS. After a period of consultation this was piloted nationally in 9 centres and data was collected prospectively at two census points, May and December 2016. Results: The P-GRS mirrors the adult GRS by dividing care into four domains and includes 19 standards with several measures that underpin the standards. Eight services completed the online P-GRS return in May 2016 and six in December 2016. All pilot sites identified areas that needed improvement and post-pilot reflected on the key challenges and developments. Several positive developments were reported by the pilot sites. Conclusions: The national pilot helped ensure that the P-GRS developed was relevant to paediatric endoscopy services. The pilot demonstrated that even in the first year of engaging with this quality improvement tool, services were starting to identify areas that needed improvement, share best practice documents, put in place quality improvement plans and support greater patient involvement in services.

We have demonstrated that routine capture of patient-reported symptom severity is technically feasible in a real-world care environment. We share our experiences to provide others with a model for similar programs, and to accelerate implementation nationwide by helping others avoid pitfalls. We believe expansion of similar programs nationally may lead to more robust quality infrastructure.