Knowledge of Jimmy Buffett's Merkel cell carcinoma and the impact on self-reported expected skin cancer prevention behaviours

Abstract

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumour of the skin.¹ The incidence of MCC has been increasing in recent decades, with elderly males most commonly affected.¹ Risk factors include ultraviolet (UV) exposure, increased age, immunosuppression, fair skin tones and infection with Merkel cell polyomavirus.¹ However, due to MCC's relatively low incidence, many people are unaware of this form of skin cancer.

In September 2023, Jimmy Buffett passed away from MCC after a 4-year battle.² Mr. Buffett was famous among Americans amassing $1 billion in net worth with over 20 million albums sold.³ Given the intersection of dermatology and pop culture associated with Mr. Buffett's death, we evaluated how the knowledge of his cause of death impacted the general public's perception of skin cancer prevention measures.

Following Institutional Review Board approval, 210 individuals were recruited on Amazon Mechanical Turk (mTurk), an online survey platform. Participants completed an online survey study through Qualtrics. Respondents were asked if they were familiar with Jimmy Buffett's cause of death and subsequently asked their likelihood (more, less or no change) to practice certain sun protective behaviours in the next year. Statistical analysis was performed using SPSS Version 29.0.2.0 (20). Cross-tabulation and chi-square tests were used to analyze how these demographic variables and personal factors related to participants' behaviours after learning about MCC. An alpha significance threshold of 0.05 was utilized.

The majority of the 210 participants were male (64%), aged between 25 and 34 years (60%), were college educated (including advanced degrees) (73%), and from the Midwest region of the United States (41%) (Table 1).

Awareness of Jimmy Buffett's cause of death was reported by 65.7% of respondents (n = 138). Those aware of his cause of death were more inclined to schedule a dermatologist appointment within the next year (p ≤ 0.001). Of those aware, 67.4% were more likely to schedule an appointment, 24.6% were less likely, and 8.0% reported no change. Conversely, among those unaware (n = 72), 22.5% were more likely, 50.0% were less likely and 27.8% reported no change (Figure 1).

Similarly, awareness of Jimmy Buffett's cause of death correlated with increased likelihood of wearing sunscreen when going outside (p = 0.048) and conducting self-skin exams or seeking assistance for skin inspection (p ≤ 0.001). Among those aware, 91.3% initiated a self-skin exam or sought assistance versus 40.3% of those unaware. Of aware participants, 62.3% reported they were more likely to wear sunscreen, 32.6% were less likely and 5.1% reported no change, compared to participants who did not report awareness: 47.2%, 40.3% and 12.5%, respectively (Figure 1).

The impact of pop culture and social events can change how patients view their health and well-being.⁴ Participants surveyed in this study were more likely to seek healthcare or partake in skin cancer protective behaviours if they reported knowledge of Jimmy Buffett's condition. Providers can leverage these culturally relevant events to help improve patient education.⁴ Anecdotal evidence, like Mr. Buffett's battle with cancer, can be utilized as an aspect of patient education, as it is often more compelling and relatable for patients.⁵

Katie K. Lovell: Conceptualization; methodology; writing—original draft; writing—review and editing; visualization; project administration. Max E. Oscherwitz: Methodology; investigation; writing—review and editing. Anthony Marcelletti: Formal analysis, writing—original draft; visualization. Matthew C. Johnson: Resources; writing—review and editing. Steven R. Feldman: Writing—review and editing; supervision; project administration.

Feldman has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alovtech, vTv Therapeutics, Bristol-Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, Leo Pharma, Mylan, Celgene, Ortho Dermatology, Menlo, Merck & Co, Qurient, Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Teladoc, BMS, Ono, Micreos, Eurofins, Informa, UpToDate and the National Psoriasis Foundation. He is the founder and part owner of Causa Research and holds stock in Sensal Health. All other authors have no conflicts of interest to disclose.

All patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details for publication. Ethical Approval: Reviewed and approved by Wake Forest School of Medicine IRB #00102457.