Examination of the ability of people to identify early changes of melanoma in computer-altered pigmented skin lesions

Objectives: To examine whether older people were less able to distinguish changes of melanoma than younger people, and to test whether an educational brochure illustrating changes of melanoma would increase their ability to detect the changes. Design: Photographic images of pigmented skin lesions were altered using computer graphics software. Images of typical changes of melanoma were shown to groups of volunteers younger than 30 years (n=52) and older than 45 years (n=41). Short intervals (seconds) between viewing of the original and changed lesions were used to test ability to distinguish the changes, and longer intervals (29 and 60 days) were used to test their ability over more realistic intervals. All participants were randomized to receive an educational brochure (designed using the same technology) to evaluate whether this would assist in identifying early changes of melanoma. Setting: A cross section of volunteers employed in a large semigovernment utility. Intervention: An educational brochure that illustrated typical changes of melanoma. Main Outcome Measure: Score of correct or incorrect detection of changed or unchanged skin lesions. Results: Tests at short intervals showed that both age groups were able to detect early changes of melanoma but had poor ability to detect changes of melanoma at longer intervals. Repeated viewing of the original lesions enabled the participants to once more recognize the changes. Both groups had low ability to detect the appearance of new pigmented lesions. The educational brochure improved the ability of participants to detect change. Conclusions: The main difficulty people have in self-detection of melanoma is limited ability to recall the appearance of their skin. This ability did not differ between the age groups. Educational material that focused on change was effective in increasing the ability to detect changes over short intervals. Photographic records may be the most effective aid for detection of changes at longer intervals.