Wondering if that mole is cancerous? Look at illustrations, not photos

September 13, 2017 by Andrea Christensen, Brigham Young University
Credit: Savanna Richardson/BYU Photo

After a summer of cumulative sunburn, you find yourself extra paranoid about the newfound mole on your shoulder. So you Google "signs of skin cancer" and spend an hour wading through mortality stats and one disturbing image after the next—more overwhelmed than when you started.

Nearly 75 percent of melanomas are initially detected by patients or other laypeople, so promoting effective self-examination (SSE) is a top priority for dermatologists and the U.S. Preventive Services Task Force. Problem is, studies show current SSE training materials—whether in brochure or online form—are often ineffective.

"Dermatology is a highly visual field, so we need to look more closely at our visual training," said BYU communications professor Kevin John, who used eye-tracking technology to show that illustrations are actually more effective than photos in helping people spot problematic moles.

For this study, recently published in the Journal of Health Communication, John and colleagues at the University of Utah showed participants SSE brochures, some with illustrated visuals and some with photographic. As with his prior eye-tracking studies, which he has been doing for more than a decade, he focused on people's fixation points—the spots where "their eyes have stopped long enough for their brain to figure out what they're looking at."

The two primary SSE methods both offer visual or illustrated examples of moles and have patients look out for specific characteristics. The ABCDE method teaches people to look at asymmetry, border, color, diameter and evolving features of their mole to get a sense of whether it might be cancerous. More straightforward is UDS, or ugly duckling sign. "That basically says look at all of the moles on your body and if you see one that looks different from the others, get it checked out," John said.

Regardless of the method, John and his co-authors found that photographs helped participants become more confident in telling whether a normal mole is normal. On the flip side, illustrations led participants to fixate on atypical moles longer than photographs did.

The takeaway? "If you are trying to make somebody more effective at determining that a mole is atypical, which means potentially cancerous, then you use illustrations," John said. "And if the average person is equipped with basic criteria to tell whether a mole is suspicious or not, hopefully that will get them to a doctor," said John. That, in turn, can save lives.

The risk of developing melanoma in the United States is one in 55, up from one in 120 three decades ago—and Utah consistently ranks No. 1 in the nation for new melanoma cases. The disease kills more than 50,000 people worldwide annually. And though early detection dramatically improves prognoses, it can be hard to come by for two reasons: first, said John, people aren't always cognizant of their skin, and second, not everyone has access to or makes time to go see a dermatologist.

As such, John hopes these findings will be used to develop more effective SSE training guidelines. "It can inform pamphlets that are in doctors' offices, it can inform advertisements that are looking at skin cancer—it can be used to inform any kind of messaging related to moving forward."

Explore further: Why some moles become melanoma still a mystery

More information: Kevin K. John et al. Do Pattern-Focused Visuals Improve Skin Self-Examination Performance? Explicating the Visual Skill Acquisition Model, Journal of Health Communication (2017). DOI: 10.1080/10810730.2017.1344750

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