Level of education completed:   Elem HS College Grad School When you go in the sun, do you: --- Select --- Always burn, never tan Usually burn, tan with difficulty Sometimes burn, usually tan Occasionally burn, usually tan darkly Rarely burn, tan easily (if you have dark skin) darken, rarely burn Have you ever had skin cancer? Yes No   If yes, was it melanoma? Yes No Has a family member ever had skin cancer? Yes No   If yes, was it melanoma? Yes No Do you have a parent, sibling or child who has had a melanoma (cancerous mole)? Yes No   If more than one relative, how many? - 1 2 3 or more How many dark spots do you have that are larger than 3 mm across (3 mm is roughly half the width of a pencil eraser)? --- Select --- None Less than 20 20 to 29 30 to 39 40 to 49 50 or more How many dark spots do you have that are larger than 6 mm across (6 mm is roughly the size width of a pencil eraser)? --- Select --- None 1 - 5 6 - 9 10 or more Before five years ago, did you sunburn frequently? Yes No In the last five years have you sunburned? --- Select --- Frequently Occasionally Never Hair Color (natural, before gray): --- Select --- Black Brown Blonde Red   Eye Color: --- Select --- Green Blue Hazel Brown Gray Total score: