“Does she or doesn’t she? Only her hairdresser knows for sure.”
This 1957 advertising slogan for Clairol hair coloring products could take on new meaning following results from a new study that found that hair stylists could be easily trained to check their clients for signs of neck and scalp melanoma.
In a single-group study of 100 hairdressers in California, watching a 5-minute educational video significantly improved the hairdressers’ skill at detecting hard-to-observe scalp and neck melanoma. It also dramatically increased their confidence about identifying melanoma and could potentially save lives, say Neda Black, MD, a Los Angeles dermatologist, and colleagues.
The authors report their findings in a research letter published online December 6 in JAMA Dermatology.
After watching the educational video, the proportion of hairdressers who could correctly use the ABCDE criteria (asymmetry, irregular borders, >1 color, diameter >6 mm, and elevation) went from 59% before viewing the video to 71% after seeing it (P =.008).
Importantly, 41% of the hairdressers said they felt “very confident” about their ability to detect potential skin cancer lesions compared to 19% who said they felt that way prior to viewing the video (P = .001).
“More research is needed to determine if such knowledge and self-efficacy gains are maintained over longer periods of time and against an active control condition in a randomized controlled trial,” the researchers write. “Based on our initial testing of an educational video intervention, training hairdressers in melanoma screening and referral seems to be a promising avenue for future research.”
The authors point out that there are an estimated 86,000 hair salons in the United States and that the average beauty professional could potentially identify as many as 120 cases of skin cancer over the course of his or her career.
Melanoma Caught Early
Dr Black knows first hand the impact that hairdressers can have on early melanoma detection. Three of her patients scheduled skin checks after their hairdressers spotted a suspicious scalp lesion, and all three were subsequently diagnosed with melanoma.
“Luckily, these cases were caught early, and the patients have been successfully treated,” said Dr Black, who developed the educational video. “Early detection of melanoma saved their lives,” she told Medscape Medical News.
“Scalp and neck melanomas are often asymptomatic and are hidden by the patients’ hair, making it difficult to be detected by the patient or their family members,” she noted. “Hairdressers make daily observations of the scalp and neck and can act as educators. I saw this as an excellent educational opportunity to promote public health.”
Importantly, the video increased hairdressers’ “self-efficacy,” said coauthor David S. Black, MD, who is assistant professor of preventive medicine at the Keck School of Medicine at the University of Southern California, Los Angeles, and the spouse of lead author Dr Black. “Hairdressers felt more confident that they were noticing potentially malignant skin lesions,” he told Medscape Medical News.
The current study was launched to “address a major gap in previous research,” the researchers say, pointing to a Texas study of 203 Houston hair professionals that was published in 2011. That study reported that 37% of hairdressers were already on the lookout for suspicious scalp, neck, and face lesions and that 50% wanted to learn more about how to detect skin cancer.
In 2012, the California researchers reported results from an earlier study involving 108 hairdressers who were working at 45 local hair salons. It showed there was “room for improvement” in how much the hair professionals knew about melanoma.
For the current study, a video link to 20 beauty schools in Los Angeles County was sent out by Eyes on Cancer, an organization that trains hair and beauty professionals to detect skin cancer. The link included access to the researchers’ questionnaire, which was based on the 2013 American Cancer Society Facts and Figures report. Participants received a $5 gift card.
The vast majority of participants (92%) were women (mean age, 26 years). Most had a high school diploma and a year or two of college education. Eighty-one percent of participants said that clients rarely asked them to examine their scalp.
Because 79% of participants indicated they had previously received training about skin cancer at cosmetology school, the researchers were not able to determine whether the educational video reinforced existing knowledge, gave the participants new information, or both.
“Next steps include further disseminating the video and related scalp and neck melanoma detection videos among hairdressers,” said Dr David Black. “Future research should see if the educational video approach can be applied to other professions, such as massage therapy.”
The study was supported by the Los Angeles Metropolitan Dermatologic Society. Dr Black and coauthors have disclosed no relevant financial relationships.
JAMA Derm . Published online December 6, 2017. Full text
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