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Betz-Stablein B, D'Alessandro B, Koh U, Plasmeijer E, Janda M, Menzies SW, Hofmann-Wellenhof R, Green AC, Soyer HP. Reproducible Naevus Counts Using 3D Total Body Photography and Convolutional Neural Networks. Dermatology 2021; 238:4-11. [PMID: 34237739 DOI: 10.1159/000517218] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The number of naevi on a person is the strongest risk factor for melanoma; however, naevus counting is highly variable due to lack of consistent methodology and lack of inter-rater agreement. Machine learning has been shown to be a valuable tool for image classification in dermatology. OBJECTIVES To test whether automated, reproducible naevus counts are possible through the combination of convolutional neural networks (CNN) and three-dimensional (3D) total body imaging. METHODS Total body images from a study of naevi in the general population were used for the training (82 subjects, 57,742 lesions) and testing (10 subjects; 4,868 lesions) datasets for the development of a CNN. Lesions were labelled as naevi, or not ("non-naevi"), by a senior dermatologist as the gold standard. Performance of the CNN was assessed using sensitivity, specificity, and Cohen's kappa, and evaluated at the lesion level and person level. RESULTS Lesion-level analysis comparing the automated counts to the gold standard showed a sensitivity and specificity of 79% (76-83%) and 91% (90-92%), respectively, for lesions ≥2 mm, and 84% (75-91%) and 91% (88-94%) for lesions ≥5 mm. Cohen's kappa was 0.56 (0.53-0.59) indicating moderate agreement for naevi ≥2 mm, and substantial agreement (0.72, 0.63-0.80) for naevi ≥5 mm. For the 10 individuals in the test set, person-level agreement was assessed as categories with 70% agreement between the automated and gold standard counts. Agreement was lower in subjects with numerous seborrhoeic keratoses. CONCLUSION Automated naevus counts with reasonable agreement to those of an expert clinician are possible through the combination of 3D total body photography and CNNs. Such an algorithm may provide a faster, reproducible method over the traditional in person total body naevus counts.
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Affiliation(s)
- Brigid Betz-Stablein
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies, Brisbane, Queensland, Australia.,The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | | | - Uyen Koh
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Elsemieke Plasmeijer
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies, Brisbane, Queensland, Australia.,Netherlands Cancer Institute, Dermatology Department, Amsterdam, The Netherlands
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott W Menzies
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Adele C Green
- QIMR Berghofer Medical Research Institute, Cancer and Population Studies, Brisbane, Queensland, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Di Brizzi EV, Pampena R, Licata G, Calabrese G, Longo C, Argenziano G. Are we born and do we die without nevi? A cross-sectional study. Int J Dermatol 2021; 60:1405-1410. [PMID: 33998695 DOI: 10.1111/ijd.15668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/06/2021] [Accepted: 04/22/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND It is well known that the number of nevi varies with age. However, there are a few data in the literature concerning total nevus count at different ages. The aim of this study was to assess and compare the total nevus count among different age groups. METHODS The total nevus count was assessed in consecutive patients belonging to nine age groups. Median nevus count was calculated and compared for each age group. Multivariate logistic regression analysis was used to define the influence of sex and phototype on the association between nevus count and age. RESULTS We enrolled 900 patients (461, 51.2% females), with a median age of 46 years and a total of 18,136 nevi. Significant differences were found in the median total nevus count among all age groups (P < 0.001), with a significant increase in the first two decades and a significant decrease after the age of 50 years. A similar trend was also observed in subgroups. The differences observed in the total body nevus count among age groups were independent of sex and phototype. CONCLUSIONS We demonstrate that the total nevus count significantly increases during childhood and gradually decreases in the elderly.
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Affiliation(s)
| | - Riccardo Pampena
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Caterina Longo
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Dermatology, University of Modena, Reggio Emilia, Italy
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Ribero S, Zugna D, Osella-Abate S, Glass D, Nathan P, Spector T, Bataille V. Prediction of high naevus count in a healthy U.K. population to estimate melanoma risk. Br J Dermatol 2015; 174:312-8. [DOI: 10.1111/bjd.14216] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Ribero
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
- Section of Dermatology; Department of Medical Sciences; University of Turin; Torino Italy
- Imperial College London; London U.K
- Department of Dermatology; London North West Healthcare NHS Trust; London U.K
| | - D. Zugna
- Unit of Cancer Epidemiology - CERMS; Department of Medical Sciences; University of Turin; Torino Italy
| | - S. Osella-Abate
- Section of Dermatology; Department of Medical Sciences; University of Turin; Torino Italy
| | - D. Glass
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
- Imperial College London; London U.K
- Department of Dermatology; London North West Healthcare NHS Trust; London U.K
| | - P. Nathan
- Mount Vernon Cancer Network; West Herts NHS Trust; Herts U.K
| | - T. Spector
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
| | - V. Bataille
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
- Department of Dermatology; West Herts NHS Trust; Herts U.K
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4
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Winkler A, Plugfelder A, Weide B, Leiter U, Held L, Garbe C, Eigentler T. Screening for skin cancer in bank and insurance employees: risk profile and correlation of self and physician's assessment. Int J Dermatol 2015; 54:419-23. [DOI: 10.1111/ijd.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Angelika Winkler
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
| | - Annette Plugfelder
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
| | - Benjamin Weide
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
| | - Ulrike Leiter
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
| | - Laura Held
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
| | - Claus Garbe
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
| | - Thomas Eigentler
- Department of Dermatology; University-Hospital-Tübingen; Tübingen Germany
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5
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Cust AE, Pickles KM, Goumas C, Vu T, Schmid H, Nagore E, Kelly J, Aitken JF, Giles GG, Hopper JL, Jenkins MA, Mann GJ. Accuracy of self-reported nevus and pigmentation phenotype compared with clinical assessment in a population-based study of young Australian adults. Cancer Epidemiol Biomarkers Prev 2015; 24:736-43. [PMID: 25628333 DOI: 10.1158/1055-9965.epi-14-1203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/17/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Awareness of individual risk may encourage improved prevention and early detection of melanoma. METHODS We evaluated the accuracy of self-reported pigmentation and nevus phenotype compared with clinical assessment, and examined agreement between nevus counts from selected anatomical regions. The sample included 456 cases with invasive cutaneous melanoma diagnosed between ages 18 to 39 years and 538 controls from the population-based Australian Melanoma Family Study. Participants completed a questionnaire about their pigmentation and nevus phenotype, and attended a dermatologic skin examination. RESULTS There was strong agreement between self-reported and clinical assessment of eye color [κ, = 0.78; 95% confidence interval (CI), 0.74-0.81]; and moderate agreement for hair color (κ = 0.46; 95% CI, 0.42-0.50). Agreement between self-reported skin color and spectrophotometer-derived measurements was poor (κ = 0.12; 95% CI, 0.08-0.16) to moderate (Spearman correlation rs = -0.37; 95% CI, -0.32 to -0.42). Participants tended to underestimate their nevus counts and pigmentation; men were more likely to underreport their skin color. The rs was 0.43 (95% CI, 0.38-0.49) comparing clinical total body nevus counts with self-reported nevus categories. There was good agreement between total body nevus counts and site-specific nevus counts, particularly on both arms. CONCLUSIONS Young adults have suboptimal accuracy when assessing important risk characteristics including nevus numbers and pigmentation. Measuring nevus count on the arms is a good predictor of full body nevus count. IMPACT These results have implications for the likely success of targeted public health programs that rely on self-assessment of these factors.
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Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Kristen M Pickles
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Chris Goumas
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Thao Vu
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helen Schmid
- Centre for Cancer Research, University of Sydney at Westmead Millennium Institute for Medical Research and Melanoma Institute Australia, Sydney, Australia
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - John Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - Joanne F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Graham J Mann
- Centre for Cancer Research, University of Sydney at Westmead Millennium Institute for Medical Research and Melanoma Institute Australia, Sydney, Australia
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Echeverría B, Bulliard JL, Guillén C, Nagore E. Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients. Br J Dermatol 2014; 170:144-9. [DOI: 10.1111/bjd.12692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 01/10/2023]
Affiliation(s)
- B. Echeverría
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - J.-L. Bulliard
- Cancer Epidemiology Unit; University Institute of Social and Preventive Medicine; Lausanne Switzerland
| | - C. Guillén
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
| | - E. Nagore
- Department of Dermatology; Instituto Valenciano de Oncología; Valencia Spain
- Facultad de Medicina; Universidad Católica de Valencia ‘San Vicente Martir’; Valencia Spain
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7
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Glanz K, Schoenfeld E, Weinstock MA, Layi G, Kidd J, Shigaki DM. Development and reliability of a brief skin cancer risk assessment tool. CANCER DETECTION AND PREVENTION 2004; 27:311-5. [PMID: 12893080 DOI: 10.1016/s0361-090x(03)00094-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to develop and pilot test a brief skin cancer risk assessment tool (BRAT), a self-administered instrument that can be reliably used to assess skin cancer risk. To develop the BRAT, we critically reviewed published literature on risk factors; formulated a draft questionnaire; pilot tested the questionnaire; and retested 1 month later. The BRAT items address the key risk factors for melanoma and other keratinocyte skin cancers: ethnicity, personal and family history of skin cancer, mole count, freckles, childhood residence, sunburn history, and sun sensitivity factors (skin color, natural hair color, ease of sunburning and tanning). One hundred sixty-five persons completed the initial BRAT pilot study, and 52 additional people at moderate- or high-risk completed a second BRAT pilot study. Results were as follows: using a dichotomous risk measure, about 90% of subjects would be correctly classified at baseline and follow-up. Weighted kappa for the total BRAT score (0.41-0.68) and for individual items (0.57-0.99) were fair to good, as were correlation coefficients. The BRAT has acceptable to good reproducibility. Reliability statistics compared favorably with those reported in the literature for similar measures.
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Affiliation(s)
- Karen Glanz
- Cancer Research Center of Hawaii, University of Hawaii, 1960 East-West Road, Biomed C-105, Honolulu, HI 96822, USA.
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Abstract
The incidence of skin cancer has been rising at an alarming rate for the past several years. This poses a significant public health problem in the United States. Detection and treatment of melanoma early in its course is critical for improved outcome. Of the approaches to cancer control that can reduce mortality from melanoma and nonmelanoma skin cancer, screening holds the greatest promise for a rapid and major impact. Prevention and early detection are crucial in reducing morbidity and mortality from skin cancer. For a number of reasons, however, the full effect of screening for both melanoma and nonmelanoma skin cancers has not been achieved. Controversy exists regarding who should perform screening, who should be screened, and whether screening should be performed at all. It is clear that melanoma and nonmelanoma skin cancer control programs combining primary prevention, education, and screening are in developmental stages. This review will discuss the advantages and disadvantages of screening for skin cancer.
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Affiliation(s)
- J T Wolfe
- Department of Dermatology, University of Pennsylvania Hospital, Philadelphia 19104-4283, USA
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9
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Koh HK, Geller AC. Public health interventions for melanoma. Prevention, early detection, and education. Hematol Oncol Clin North Am 1998; 12:903-28. [PMID: 9759586 DOI: 10.1016/s0889-8588(05)70030-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Worldwide melanoma control programs that include some combination of primary prevention, education, and screening activities have only recently begun to undergo an evaluation process. More studies with rigorous design and evaluation are needed. Until then, the proper public health policy guidelines for melanoma control, especially screening, are open to debate. Future studies must determine how screening, early detection, case finding, and education can best be used to reduce mortality and achieve optimal melanoma control.
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Affiliation(s)
- H K Koh
- Department of Dermatology, Boston University School of Medicine, Massachusetts, USA
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10
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Farmer ER, Gonin R, Hanna MP. Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists. Hum Pathol 1996; 27:528-31. [PMID: 8666360 DOI: 10.1016/s0046-8177(96)90157-4] [Citation(s) in RCA: 312] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The reliability of a diagnostic test depends on the reproducibility of the result. Many clinical diagnostic tests can be quantified with established ranges and standard deviations. Other tests are more subjective, such as those that depend on analysis of a visual image with an increased possibility of variance in the result. To study this variance, the authors analyzed the performance of expert pathologists in the interpretation of cutaneous melanocytic tumors. A panel of expert pathologists was convened to review anatomic pathology specimens from melanocytic tumors. Each pathologist submitted five specimens, from which 37 were selected for review. Only one slide was used for each case. All specimens were interpreted by each pathologist without consultation with each other. In addition to standard diagnostic terms, each specimen was designated as benign, malignant, or indeterminate. Statistical analysis was used to determine the degree of concordance. The combined kappa statistic for the eight observers and three possible outcomes (benign, malignant, or indeterminate) was 0.50. A kappa statistic of this magnitude, is defined as being moderate. In 62% of the specimens, there was unanimous agreement or only one discordant designation. Thirty-eight percent had two or more discordant interpretations. No single pathologist had a disproportionate number of discordant designations. This study mimics the consultation practice of anatomic pathology and shows the variability and discordance in diagnostic language and designation of biological behavior. The results suggest the criteria for the diagnosis of melanomas and melanocytic nevi need to be refined and more consistently applied.
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Affiliation(s)
- E R Farmer
- Department of Dermatology, Indiana University School of Medicine, Indianapolis 46202, USA
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11
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Affiliation(s)
- J M Elwood
- Hugh Adam Cancer Epidemiology Unit, Faculty of Preventive and Social Medicine, University of Dunedin, New Zealand
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12
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Whited JD, Horner RD, Hall RP, Simel DL. The influence of history on interobserver agreement for diagnosing actinic keratoses and malignant skin lesions. J Am Acad Dermatol 1995; 33:603-7. [PMID: 7673492 DOI: 10.1016/0190-9622(95)91278-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Quantifying interobserver diagnostic agreement is necessary to evaluate skin cancer screening programs, but estimates of variability are incomplete. OBJECTIVE We sought to measure agreement between dermatologists for diagnosing actinic keratoses (AKs) and malignant skin lesions and to determine the way in which blinding examiners to patient history affects agreement. METHODS We varied the amount of historical information available to examiners in two consecutive patient series (n = 50) presenting to a Veterans Affairs Medical Center dermatology clinic. Two dermatologists examined each patient independently. RESULTS Assessing historical features increased the kappa statistic for malignancy recognition from -0.04 to 0.76. kappa Statistics for diagnosing single AKs were 0.17 and 0.15, respectively, and 0.62 and 0.55 for multiple AKs. CONCLUSION Agreement was high for diagnosing malignant skin lesions when history was included in the evaluation. Agreement for multiple AKs was higher than for single AKs, although neither was influenced by inclusion of historical features.
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Affiliation(s)
- J D Whited
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, NC 27705, USA
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13
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Koh HK, Geller AC, Miller DR, Lew RA. The Current Status of Melanoma Early Detection and Screening. Dermatol Clin 1995. [DOI: 10.1016/s0733-8635(18)30068-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Hanrahan PF, Hersey P, Watson AB, Callaghan TM. The effect of an educational brochure on knowledge and early detection of melanoma. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995; 19:270-4. [PMID: 7542928 DOI: 10.1111/j.1753-6405.1995.tb00442.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Men over the age of 45 present with thicker, more advanced melanomas than younger people. A randomised trial was conducted in this group to evaluate whether an educational brochure would increase knowledge about melanoma and the ability to recognise and discriminate between pigmented skin lesions. Men in an industrial complex were allocated to an intervention group (n = 110) and two control groups (n = 96 and n = 108). The intervention group was given two educational brochures about melanoma. Their effect on knowledge and ability to detect pigmented lesions was assessed by a questionnaire and a self-examination body chart given before the brochure, and at four weeks and three months after return of the brochure. The control groups did not receive any educational material, but control group 2 received the questionnaire and chart. At the end of the study all participants were examined for pigmented lesions by doctors, whose counts were compared with those of the participants. There was a significant (19.8 per cent) increase in knowledge about melanoma in the intervention group (but not in the control groups), except for discrimination of photos of benign and malignant lesions. The educational material did not improve the ability of those in the intervention group to recognise and count their pigmented lesions nor to discriminate between benign and malignant pigmented lesions. The increased knowledge about melanoma was retained for at least three months.
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Affiliation(s)
- P F Hanrahan
- Newcastle Melanoma Unit, Wallsend District Hospital
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Little P, Keefe M, White J. Self screening for risk of melanoma: validity of self mole counting by patients in a single general practice. BMJ (CLINICAL RESEARCH ED.) 1995; 310:912-6. [PMID: 7719184 PMCID: PMC2549294 DOI: 10.1136/bmj.310.6984.912] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To validate self screening by patients of high mole counts, assess the within family association of sun protection behaviour and mole counts, and estimate prevalence of risk factors for melanoma. SETTING AND SUBJECTS Systematic sample of families from a single affluent general practice population in Wessex. DESIGN Subjects completed a questionnaire about risk factors for melanoma and counted their moles. Subsequently a mole count was done by a general practitioner trained at dermatology clinics. MAIN OUTCOME MEASURES Validation of self counts by observer's count. Within family association of sun protection behaviour and mole counts; self reported risk factors. RESULTS 199/237 subjects (84%) returned the questionnaire; 212/237 (89%) were examined. High counts by patients on the front of the trunk (> 7 moles of > or = 2 mm) were reasonably sensitive (79%), predictive (75%), and specific (97%) of the observer's mole counts (kappa = 0.74), unlike arm or total body counts. Sun protection behaviour correlated between individuals and other family members (Spearman's coefficient r = 0.50, P < 0.01). In the past three months 15/114 adults (13.2%, 95% confidence interval 7.0% to 19.4%) reported any change in a mole and 6/114 (5.3%, 2.0% to 11.1%) "major" changes; 6/109 adults (5.5%, 2.1% to 11.6%) had both high mole counts and freckling. CONCLUSIONS Asking patients to count trunk moles could be a feasible way of identifying patients at high risk of melanoma. Concentrating on reported major changes in moles should avoid considerable workload in general practice. The generalisability of these findings and the adverse effects, net benefit in earlier diagnosis and prevention, and workload implications of such self screening need further research.
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Affiliation(s)
- P Little
- Faculty of Medicine, University of Southampton, Aldermoor Health Centre
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