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Laypersons' perceptual discrimination of pigmented skin lesions,☆☆,

https://doi.org/10.1067/mjd.2002.120463Get rights and content

Abstract

Background: Most cutaneous malignant melanomas of the skin are visible and should, at least in theory, be possible to detect with the naked eye. Objective: This study was conducted to learn more about laypersons' ability to discriminate between benign pigmented lesions and malignant ones. Methods: Four groups of laypersons (n = 120) were asked to evaluate pictures of different types of pigmented skin lesions, before and after they received information about the ABCD (asymmetry, border irregularity, color variegation, and diameter greater than 6 mm) criteria, with respect to the necessity of action. Results: The respondents made adequate assessments of melanomas but overestimated the danger of benign pigmented skin lesions. Information about the ABCD criteria enhanced their ability to make adequate assessments. Conclusion: People seem to make adequate decisions concerning how to act if they have a melanoma. On the other hand, common moles and dysplastic nevi were harder to discriminate. Providing information to the public about the features of melanomas, in accordance with the ABCD criteria, might help laypersons in their perceptual discrimination of skin lesions. (J Am Acad Dermatol 2002;46;667-73.)

Section snippets

The sample

The subjects were 120 male and female adults recruited from 3 different patient groups and one sample from the general population. The groups were chosen for the purpose of reflecting different degrees of experience and knowledge of the appearance of pigmented skin lesions. The patients were recruited consecutively from the Departments of Dermatology and Oncology at the Karolinska Hospital in Stockholm, Sweden. The population sample was randomly selected from the National Census Register in

Assessment of skin lesions

All subjects interviewed made adequate assessments of melanomas, except for one or two respondents in each group (Fig 2).

. Distribution of assessments of the 3 different types of skin lesions by 4 different groups before and after subjects received information on the ABCD criteria. Boxes contain 50% of the values. Whiskers extending from boxes show highest and lowest values, excluding outliers. A line across a box indicates the median, circles are outliers (between 1.5 and 3 box lengths from

Discussion

In this study, the population-based sample, with no previous medical education, made assessments of skin lesions that were as adequate as those made by the 3 patient groups. This is somewhat unexpected, because all patient groups had recently visited a medical setting. This could indicate that the patient education is either inadequate or scanty and that it is therefore possible to improve it. However, there were some differences between the different patient groups. The MM group exaggerated

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    Thomas et al22 reported that when testing dermatologists, the sensitivity and specificity of MM recognition when using any 2 of the ABCDE criteria were 89.5% and 65.3%, respectively, which are values similar to those for laypersons in the ABCD group of our study. Additionally, Branstrom et al23 reported that when laypersons were tested, teaching the ABCD criteria enhanced their sensitivity in recognizing malignant pigmented lesions; yet, benign pigmented lesions were often overestimated as being dangerous. These findings are consistent with those regarding the participants in the ABCD group of our study, explaining the high sensitivity and relatively low specificity and accuracy for MM recognition.

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    In a study addressing the variables associated with self-detected melanomas, knowledge of the ABCD rule and the habit of performing skin self-examinations were present, suggesting educational information such as the ABCDE criteria can help laypersons self-detect suspicious lesions.10 Bränström et al12 evaluated laypersons' ability to discriminate between benign and malignant pigmented lesions and found that, although knowledge of ABCD criteria enhanced participants' ability to make adequate action assessments, the danger of benign pigmented lesions was often overestimated. Other studies have focused on which of the ABCDEs patients notice more when distinguishing melanoma from benign lesions, with results suggesting that “E” features (including change in color, size, elevation), or other symptoms such as bleeding or itching, are the concern that most often prompts medical attention.3,24-31

  • Visual images for patient skin self-examination and melanoma detection: A systematic review of published studies

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    Having access to baseline photographs of their own moles increased accuracy of SSE and improved detection of changing and new moles.39 Two multicomponent interventions, which included ABCD photographs, improved the ability of patients to identify lesions accurately26 and recognition of border, color, and diameter criteria of lesions41 compared with before the interventions. Gender differences in visual discrimination of lesions were noted in 1 study: females recognized color changes and decided to see a physician for a concerning lesion more than males; males recognized border irregularities more than females.41

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Funding sources: None.

☆☆

Conflict of interest: None.

Reprint requests: Richard Bränström, Department of Cancer Prevention, M8, Karolinska Hospital, SE, 171 76 Stockholm, Sweden. E-mail: [email protected].

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