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Environmental Exposures & Skin Health Survey

Instructions: Please answer all questions. If you prefer not to answer any item, leave it blank.


Estimated time: 5–7 minutes.

Section A - Basic info

Age group
Under 18
18-34
35-49
50-64
65+
Gender
Male
Female
Nonbinary
Other
Prefer not to say
Have you ever been diagnosed with a skin cancer?
Yes
No
Other
Have you ever been diagnosed with Merkel cell carcinoma (MCC)?
Yes
No
Other

Section B - Sun & skin history

Do you have frequent sun exposure for work or leisure?
Never
Occasionally
Often
Daily
Do you use sunscreen regularly when outside?
Never
Sometimes
Always
History of severe sunburns (blistering) in childhood or adulthood?
Yes
No

Section C - Immune & medical factors

Do you have a medical condition that weakens the immune system (e.g., transplant, HIV, chronic steroids)?
Yes
No

Section D - Environmental & occupational exposures

Do you work or volunteer in any of these settings? (select all that apply)
Do you frequently handle cigarette butts or other smoked‑material litter?
Never
Occasionally
Often
Daily
How often do you contact beach or parks and/soil with bare skin (feet/hands)?
Never
Occasionally
Often
Daily
Do you regularly launder/clean work clothes separately after outdoor/dirty work?
Never
Occasionally
Often
Daily
Have you been occupationally exposed to chemical smoke, soot, heavy metals, or industrial fumes?
Yes
No

Section E - Lifestyle & household exposures

Do you or household members use products with PFAS (stain‑resistant fabrics, certain nonstick cookware, firefighting foam)?
Yes
No
Don't know
Do you smoke tobacco or use vaping products?
Never
Occasionally
Often
Daily
Do you frequently dispose of cigarette butts or see many butts in your local beach/park?
Yes
No

Section F — Cleanup participation & sample consent

Have you participated in this cleanup before?
Yes
No

Would you be willing to:

Provide a brief surface wipe (hand or shoe) for pollutant testing?
Yes
No
Allow anonymous linkage of your survey with optional environmental sample results from this site?
Yes
No

Section G — Perceptions & suggestions

On a scale of 1–5, how concerned are you that pollution may affect skin cancer risk?
1 (Not concerned)
2
3
4
5 (Very concerned)


DISCLAIMER: THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The purpose of this website is to promote broad consumer understanding and knowledge of various health and environmental topics. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Cleaning4SkinCancer Inc. does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on this website. The information, data, opinions, and statements linked to from this website are not necessarily those of Cleaning4SkinCancer Inc. or its founder and should not be interpreted, acted on, or represented as such. Cleaning4SkinCancer Inc., its founder and members assume no legal liability for the accuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed herein. Reliance on any information appearing on this website is solely at your own risk.

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All volunteer activities are at your own risk. Cleaning4SkinCancer Inc. and its founder assume no liability for any acts or events that may occur. Gloves will be provided as a courtesy.  ​

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