Girardi Sophie, Gaudy Caroline, Gouvernet Joanny, Teston Jacques, Richard Marie Aleth, Grob Jean-Jacques
Department of Dermatology Hôpital Ste Marguerite, Assistance Publique des hôpitaux de Marseille andResearch unit LIMP EA 3291 Université de la méditerranée, Marseille, France.
Int J Cancer. 2006 May 1;118(9):2276-80. doi: 10.1002/ijc.21351.
Most education campaigns for melanoma (MM) detection in the general population have used the "ABCD" algorithm, although recognition of objects in the real life is based on a holistic image recognition rather than on analytic criteria. The objective was to compare analytic (ABCD) and cognitive (photographs) strategies for teaching self-recognition of MM. A prospective 4-arm stratified randomized trial in 255 individuals compared 3 realistic educative interventions by leaflets: 1) ABCD algorithm ("ABCD"), 2) a set of photographs chosen to stimulate recognition of MM among benign pigmented lesions ("Cog"), 3) photographs + explanations ("Cog-Ex" arm) and 4) no intervention ("NI"). A 40-slides test was performed before intervention (T0), 1 week after (T1) and after induction of anxiety (T2). In the "ABCD" arm, sensitivity slightly improved (80 to 83.8%, p = 0.04), but specificity dropped from 65.1 to 56.3% (p < 0.001), with no benefit in accuracy as compared to "NI". In "Cog" arm, there was no change in sensitivity, but a strong increase in specificity (65.9 to 81.1%, p < 0.001) and accuracy (42.1 to 53.1%, p < 0.001). "Cog-ex" resulted in similar although lower benefit. Under stress (T2), there was a dramatic loss of specificity and accuracy in "ABCD" arm (65.1 to 44.1%, p < 0.001 and 40.8% to 35.8%, p < or = 0.001) without higher gain in sensitivity, while sensitivity and accuracy increased (p < 0.005) after "Cog" leaflet, without decreasing specificity. Finally, the "ABCD" message alone does not seem efficacious and is even worse in the context of anxiety, whereas a quick look at a few photographs is sufficient to improve the ability of the laymen to recognize a MM just by optimizing their spontaneous image recognition capacities. Education by photographs is a realistic strategy which should replace or complete "ABCD" message in the campaigns for self-detection of MM.
大多数针对普通人群黑色素瘤（MM）检测的教育活动都采用了“ABCD”算法，尽管在现实生活中对物体的识别是基于整体图像识别而非分析标准。目的是比较用于教授自我识别MM的分析（ABCD）和认知（照片）策略。一项针对255人的前瞻性四臂分层随机试验比较了三种通过传单进行的现实教育干预措施：1）ABCD算法（“ABCD”组），2）一组旨在促进在良性色素沉着病变中识别MM的照片（“认知”组），3）照片+解释（“认知-解释”组）和4）不进行干预（“无干预”组）。在干预前（T0）、干预后1周（T1）和诱发焦虑后（T2）进行了一次40张幻灯片的测试。在“ABCD”组中，敏感性略有提高（从80%提高到83.8%，p = 0.04），但特异性从65.1%降至56.3%（p < 0.001），与“无干预”组相比，准确性没有提高。在“认知”组中，敏感性没有变化，但特异性大幅提高（从65.9%提高到81.1%，p < 0.001），准确性也提高了（从42.1%提高到53.1%，p < 0.001）。“认知-解释”组的效果类似但益处较小。在压力状态下（T2），“ABCD”组的特异性和准确性急剧下降（从65.1%降至44.1%，p < 0.001；从40.8%降至35.8%，p ≤ 0.001），而敏感性没有更高的提高，而在“认知”组传单发放后，敏感性和准确性提高了（p < 0.005），且特异性没有降低。最后，仅“ABCD”信息似乎无效，在焦虑情况下甚至更糟，而快速浏览几张照片就足以通过优化外行人的自发图像识别能力来提高他们识别MM的能力。通过照片进行教育是一种现实的策略，在MM自我检测活动中应取代或补充“ABCD”信息。
