MHN-a-1021/ Melanoma-nat Question Title * 1. MURRAY HILL CENTER A NATIONAL MARKET RESEARCH COMPANY HAS BEEN COMMISSIONED TO INTERVIEW PARTICIPANTS FOR AN UPCOMING PROJECT. THIS IS A 30 MINUTE ON LINE SURVEY WITH THE COMPENSATION OF $75. Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. What is your age range? 18-24 25-34 35-44 45-54 55-64 65-74 74-84 85 and Older Question Title * 3. What is your exact age? Question Title * 4. Have you been diagnosed with any of these? ( We are looking for multiple types of patients) Skin Cancer COPD Cancer Uterine Fibroids Autism Psoriatic Arthritis Rheumatoid Arthritis Ankylosing Spondylitis Uveitis Multiple Myeloma Dry Age Related Demacular Dengeration Multiple Sclerosis Stroke Diffuse Large B-Cell Lymphoma Bronchiectasis Bronchitis Sickle Cell Parkinson's Disease Diffuse Large B-Cell Lymphoma Epilepsy High Blood Pressure High or problem cholesterol Arthritis Schizophrenia Incontinence Migraines Huntington's Disease Multiple Sclerosis Rheumatoid Arthritis Ankylosing Spondylitis Psoriatic Arthritis Skin Cancer Uveitis Stroke Sickle Cell Bronchiectasis Bronchitis Type 1 Diabetes Type 2 Diabetes Incontinence Epilepsy Migraines High Blood Pressure Bipolar or Schizophrenia Sickle Cell Hemophilia Huntington Disease Beta Thal Question Title * 5. Are you a caregiver for an autistic patient? Yes No Question Title * 6. If not mentioned in the last question, Please let me know what else you have been diagnosed with. We are always researching new topics and may be able to use you in future studies. Question Title * 7. Have you ever been told by a doctor that you have skin cancer? Yes No Question Title * 8. There are several kinds of skin cancer. Which kind(s) of skin cancer did your doctor tell you that youhad? (Please check all that apply). Actinic keratosis Atypical moles Basal cell carcinoma Melanoma Merkel cell carcinoma Squamous cell carcinoma I don’t know Question Title * 9. When cancer is diagnosed, doctors will often describe the “stage” of the cancer. Thedescriptions below match different stages of melanoma. Please pick the description below that bestdescribes your condition when you were first diagnosed. If you have been diagnosed more than onetime, pick the category that describes the most severe initial diagnosis you received. Stage 0: Melanoma cells are found only in the outer layer of skin. Stage 1: Melanoma that is still only in the skin and is very thin. Stage 2: Melanoma that is thicker than stage 1 melanoma, extending through the epidermis(outer layer of skin) and further into the dermis, the dense inner layer of the skin. Stage 3: Melanoma that has spread through the lymphatic system either to aregionallymphnode located near where the cancer started or to a skin site onthe way to a lymph node. Stage 4: Melanoma that has spread through the blood stream to other parts of the body, such as distant locations on the skin or soft tissue, distant lymph nodes, or other organs like the lung,liver, brain, bone, or gastrointestinal tract. DO NOT KNOW Question Title * 10. Has a doctor ever told you that the melanoma has spread to another part ofyour body? When melanoma spreads to another part of the body, it is called metastatic melanoma. Yes No Do Not Know Done