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.

A randomised trial of skin photography as an aid to screening skin lesions in older males.

OBJECTIVES: We have previously shown that photographs assist in detection of change in skin lesions and designed the present randomised population based trial to assess the feasibility of photographs as an aid to management of skin cancers in older men. SETTING: 1899 men over fifty, identified from the electoral roll in two regions in New South Wales (NSW), Australia, were invited by mail to participate. METHODS: A total of 973 of 1037 respondents were photographed and randomised into intervention (participants given their photographs) or control groups (photographs withheld by investigators). At one and two years from the time of photography, all participants were advised to see their primary care practitioner for a skin examination. Those in the intervention group were examined with their photographs and those in the control group without their photographs. RESULTS: The results indicated that the practitioners were more likely to leave suspicious lesions in place for follow up observation (37% v 29%) (p=0.006) and less likely to excise benign non pigmented lesions (20 v 32%). There was little difference in excision rates for benign pigmented lesions (21% v 23%). Lesions excised were more likely to be non-melanoma skin cancer (58% v 42%) from patients who had photographs compared to those without photographs (p=0.005). The use of skin photography resulted in a substantial savings due to the reduced excision of benign lesions. CONCLUSIONS: These results suggest that it would be feasible to conduct a large scale randomised trial to evaluate the value of photography in early detection of melanoma and that such a trial could be cost effective due to the reduced excision of benign skin lesions.

Participation of older males in a study on photography as an aid to early detection of melanoma.

OBJECTIVE: To examine the acceptability of photography as an aid to skin examinations in men over 50 years of age. METHODS: A randomised trial of men selected from the electoral roll. All participants were photographed, but only half received their photographs. Skin examinations by GPs at years one and two. RESULTS: 55% of men consented to have photographs taken and 51% did so. 86% of respondents had risk factors for melanoma (compared to 68% of non-responders) and 47% had two or more risk factors (compared to 23% of non-responders). At year one, 91% of participants remaining in study regions had been examined. Photographs were lost by only six participants. CONCLUSIONS: Men over 50 years of age respond to personalised health messages about melanoma and respondents include a high proportion of males with risk factors for melanoma. IMPLICATIONS: These initial results suggest that photography may be a logistically acceptable approach for assisting in the early detection of melanoma.

'It would be good to know you're not alone': the health care needs of women with menstrual symptoms.

OBJECTIVES: We aimed to explore how menstrual symptoms affect women, women's health care needs, and their expectations and experiences when seeking care; to identify ways to assist women in having their needs met. METHODS: Qualitative research using focus group methodology was carried out. Identification of women experiencing menstrual symptoms through a random community survey of 200 women aged 30-50 years in the Hunter region of New South Wales. Focus group discussions were recorded and transcripts were analysed. RESULTS: All women attending focus groups had sought medical advice for their menstrual problems. Having one doctor with whom they felt comfortable was important. Women expressed difficulties asking questions and were concerned that symptoms may not be taken seriously or may be dismissed as psychological. There was widespread acceptance of alternative 'natural' therapies. CONCLUSIONS: Interactions between doctors (particularly GPs) and women with menstrual symptoms are central to how women perceive the care they receive. There is a need for doctors to demonstrate empathy. For many women, what they needed most from their doctors was to be understood and 'to know they weren't alone'.

Factors involved in presentation of older people with thick melanoma.

OBJECTIVE: To examine whether presentation of older people with thick melanoma is a result of the site and histological type or of their reduced ability to identify melanoma. DESIGN AND SETTING: Retrospective analysis of the Newcastle Melanoma Unit patient database. PATIENTS: 2154 patients with melanoma for whom complete data (histological type, thickness and site of melanoma) were available and who presented from February 1981 to April 1997. MAIN OUTCOME MEASURES: Histological type and site of melanoma in older (> or = 50 years) versus younger men and women; frequency with which these groups identified melanoma and the first changes of melanoma that were noticed. RESULTS: Patients aged > or = 50 years, particularly men, were more likely to present with thicker lesions. Older men and, to a lesser extent, older women were more likely to present with nodular melanoma, which were more frequent on the scalp and face in older, compared with younger, men, and scalp and back in older men compared with older women. Failure to identify melanoma was associated with older age, sites on the scalp and back and histological type of the lesion, but was independent of sex once histological type, age, site and thickness were taken into account. Multivariate analysis indicated that the association of older age of patients with failure to identify melanoma applied irrespective of the site, type and thickness of their melanoma. CONCLUSION: The higher frequency of thick melanoma in older people is accounted for by an increased proportion of nodular melanoma and decreased ability to recognise the changes of melanoma. These findings have important implications for examination of older patients by doctors and for design of strategies for early detection of melanoma in this age group.

The effect of an educational brochure on knowledge and early detection of melanoma.

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.