Melanoma and Indoor Tanning

Consent

 
1. EXPLANATION OF RESEARCH

Title of Project: Survey of Patients who have Acquired Melanoma in Association with Indoor Tanning

Principal Investigators: Chauncey Caldwell, Morgan Stines and Jennifer Nergard

Faculty Supervisor: James A. Solomon, MD PhD

You are being invited to take part in a research study. Whether or not you chose to participate is up to you.

• The purpose of this research is to clarify the relationship between indoor tanning and the onset of Melanoma.

• You will be asked to answer a series of questions about your history of Melanoma, use of indoor tanning and social habits.

• You will need approximately 40 minutes to complete the survey. Answer each question to the best of your ability.

• You will provide no personal identifiers beyond age, sex and the name of the State in which you reside. If you do not reside in the US, list only your country’s name.

To participate in the research study, you must be 18 years of age or older, have a history of melanoma which occurred after you started indoor tanning.

Study contact for questions about the study or to report a problem: If you have questions, concerns, or complaints: Dr. James A. Solomon, Faculty Supervisor University of Central Florida, Directory of Ameriderm Research 386.523.0768, or by e-mail drjsolomon@ameridermresearch.com

IRB contact about your rights in the study or to report a complaint: Research at the University of Central Florida involving human participants is carried out under the oversight of the Institutional Review Board (UCF IRB). This research has been reviewed and approved by the IRB. For information about the rights of people who take part in research, please contact: Institutional Review Board, University of Central Florida, Office of Research & Commercialization, 12201 Research Parkway, Suite 501, Orlando, FL 32826-3246 or by telephone at (407) 823-2901.

Do you agree to continue with the study?
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