October 17, 2011 — Hair care professionals can alert clients to suspicious skin lesions and advise follow-up with healthcare practitioners, according to a study published in the October issue of the Archives of Dermatology.
The difficulty of finding cancers in scalp skin may contribute to morbidity and mortality resulting from delayed detection. Barbers and hairdressers can serve a gatekeeper function for detecting these cancers because they regularly examine areas of the skin that are difficult for people to see.
Elizabeth E. Bailey, MD, from Brigham and Women's Hospital, Boston, Massachusetts, and colleagues suggest that hair care specialists be educated to screen for skin cancer. To test appropriateness and feasibility, they administered a 43-item instrument derived from established surveys probing self-exam and professional scalp examinations to 304 hair professionals attending an educational conference in Houston, Texas. The 17 salons represented serve both men and women in economically diverse neighborhoods. Of the attendees, 203 (66.8%) completed the survey.
The study evaluated 4 independent factors that measured the ability of hair professionals to screen for cancer: "applied skin care knowledge" (recognizing bleeding, itching, and color and size change), personal protection (use of hats and sunscreen), familiarity with the "ABCD" rule of asymmetry-border-color-diameter to identify potential melanomas, and how often and to what extent they discuss health topics with clients.
Personal skin protection practices and health communication skills varied among individuals and were significant predictors (P = .05 and P < .001, respectively) of customer lesion observation. Skin cancer knowledge did not emerge as a significant factor (P = .48), the researchers suggest, because all of the professionals are familiar with the characteristics of skin cancer.
Results indicated that the surveyed hair professionals already screen customers for suspicious lesions, and thus function informally as lay health advisors. For example, during the month preceding the survey, 37.1% of the participants reported examining more than 50% of their customers' scalps, 28.8% looked at more than 50% of necks, and 15.3% examined more than 50% of customers' faces, which is consistent with the fact that practitioners predominantly view the back of the head. Fifty-eight percent reported suggesting consultation with a physician for a suspicious mole, and more than 90% agreed or strongly agreed that this is necessary for a mole that is bleeding or enlarging.
The demographics of the salon customers represented in the study suggest that hair professionals can reach communities underserved by healthcare. A skin cancer education program, the investigators hypothesize, could maximize the abilities of hair care professionals to screen their clientele for suspicious lesions. If successful, the program could expand to others who regularly encounter skin, such as massage therapists, aestheticians, and nail technicians. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators," the researchers conclude.
Study weaknesses include the cross-sectional design; limited generalizability, given that all the hair professionals were from one US city; and lack of survey tool validation for the participant population (ie, the tool has been used with other groups but has not been validated with hair professionals). In addition, the response rate was good, but respondents were older and more likely to be white than nonrespondents.
"This study represents a preliminary estimation of current practices," the authors write. "[F]urther studies with validated measures should be used to better estimate the prevalence of skin cancer screening within the salon."
The study was supported by the Melanoma Foundation of New England.
Arch Dermatol. 2011;147:1159-1165.
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