Melanoma Prevention Among Children of Melanoma Survivors: A Randomized Clinical Trial.

Importance: Children of melanoma survivors have a 2-fold increased lifetime risk of melanoma, yet they inconsistently practice sun protection and experience preventable sunburns. Objective: To evaluate a telehealth-delivered behavioral intervention for skin cancer prevention among children of melanoma survivors. Design, Setting, and Participants: This parallel-group randomized clinical trial assigned survivor-child dyads to the family, lifestyles, actions, and risk education (FLARE) intervention or a control condition between April 2020 and October 2023. Participants were recruited through a cancer registry and statewide and clinical databases. Eligible survivors had a confirmed melanoma diagnosis and at least 1 child aged 8 to 17 years with 1 or more sunburns during the previous year. Of 520 eligible survivors, 364 dyads enrolled, completed baseline assessment, and were randomized. Data were analyzed from 2025 to 2026. Interventions: Both conditions were telehealth education modules delivered over 4 weeks. FLARE included familial melanoma risk education and skills building that targeted child sun protection. The control included general skin cancer education on identifying reputable sources of health information. Main Outcomes and Measures: The primary outcome was child sunburn occurrence, which was evaluated as the change from baseline through the 2 postintervention assessments. Secondary outcomes included child sun-protective behaviors and tanning. Results: A total of 364 survivor-child dyads were recruited and randomized (parents: mean [SD] age, 45.1 [6.2] years; 228 female individuals [62.6%]; children: mean [SD] age, 12.9 [2.6] years; 189 female individuals [51.9%]). The primary analysis, which included 364 dyads (180 FLARE [49.5%], 184 control [50.5%]) in the intention-to-treat analyses, found no significant between-group differences in rate of sunburn change across time. However, at the first postintervention assessment, child-reported sunburn occurrence was lower in the FLARE group compared with the control group (B = -0.17; 95% CI, -0.30 to -0.04; P = .01). Relative to the control group, FLARE participants demonstrated greater increases in child sun-protective behaviors from baseline through the second postintervention assessment (B = 0.26; 95% CI, 0.14-0.38; P < .001). No significant between-group differences were observed for intentional or unintentional tanning, which were infrequently reported at baseline. Conclusions and Relevance: In this randomized clinical trial, FLARE failed to reduce child sunburn over time compared with an active educational control. Although FLARE improved sun-protective behaviors and was associated with lower child-reported sunburn immediately postintervention, additional strategies may be needed for sustained reductions in high-risk children. Trial Registration: ClinicalTrials.gov Identifier: NCT04201223.