Passive versus active educational interventions for nevus and melanoma classification: A randomized controlled study

Backgrounds: Patients or family members first notice around 50% of primary melanoma lesions. Targeted educational campaigns for non-medical individuals improve melanoma detection rates, but the most effective initiatives are unclear. Objectives: To compare the efficacy of passive versus active intervention for non-medical individuals in classifying nevi and melanomas. Methods: A multicentric randomized controlled study randomly assigned subjects to receive active intervention (a dermatologist explaining basic rules for melanoma detection) or passive intervention (subject independently reading the basic rules). Subjects were asked to classify 60 clinical photos of nevi and melanomas as ‘at risk’ of malignancy and nominated the rule(s) they applied at 3 time points—before (T0), immediately following (T1), and 30 ± 2 days after (T2) the educational intervention. Results: We randomized 364 patients. We included in the analysis 336 subjects (female 61.3%, 156 in the passive and 180 in the active intervention group) with a mean age of 44.5 years. Overall, detection rates of lesions ‘at risk’ improved from 71.2% (T0) to 86.4% (T1). At T2, detection rates were significantly higher after active intervention (83.7% vs. 86.8%, p = 0.017). Although an overall improvement was described after both interventions, rates of correct responses according to lesion-specific features were significantly higher in the active intervention group for lesions that met ugly duckling (UD) rule criteria at T1 and both rules (ABCDE and UD rules) criteria at T2. Correct (full or partial) rule applications were observed in 80% at T1 (40.2% and 38.4%, respectively) and at T2 (40.4% and 37.8%, respectively), with significantly higher correct rule application in the active group at T1 (p = 0.001) and T2 (p = 0.03). Conclusions: Active educational intervention is more effective than passive education in improving nevi and melanomas classification and correct rule application in non-medical individuals, with stable performance observed over time.