Introduction

Melanoma, a skin cancer of melanocytes, accounts for only 1% of all skin cancers, but causes the most deaths amongst all skin cancers.1 While advancements in staging, surgical techniques, and other treatments have improved the ten-year survival rate, the incidence of melanoma continues to rise.2,3 Therefore, it is important to educate the public on the etiology of melanoma to promote risk-reducing behaviors.

YouTube is an open-access video-sharing platform that is increasingly used by patients to obtain health information and medical advice. Given that an estimated 75% of patients acquire disease-related information through web-based searches, social media platforms such as YouTube may serve as an effective tool for patient education.4,5 A prior study conducted in 2010 analyzed 61 videos related to melanoma on YouTube from an initial result of 704. The total view count on all 61videos was 134,068.6 At the time of writing in 2023, with the massive growth of the YouTube platform, the most viewed singular video on Melanoma had over 13 million views. This massive growth in video content has been further amplified with applications like TikTok and Instagram adopting their own video sharing platforms. With such wide access to both medical and non-medical content on these platforms, the lines between entertainment and medical advice have become blurred.

In terms of patients receiving e-Health communication, another prior study from 2017 analyzed the value of e-Health videos and determined that 92% of patients preferred receiving information via verbal communication from their physicians. After watching these e-Health videos, patients were still vastly undereducated on melanoma, as only 5% of the patients were able to identify 4 tumor characteristics, demonstrating the need for improved education on the identification of melanoma.7 With e-Health videos specifically designed to educate patients shown to be ineffective, it raises the question of the value of Melanoma content on YouTube. Therefore, the aims of this study were to: 1) examine the characteristics of YouTube videos on melanoma and 2) evaluate the educational content.

Methods

YouTube was searched with the keyword “melanoma” in November 2021. The top 100 search results with English language titles were included in our analysis, excluding any duplicates. Eligible videos had to contain references to cutaneous melanoma in humans, be accessible for free, and presented in English. Videos were excluded if they featured non-human subjects, taught medical procedures, or lasted less than one minute in duration. Based on this criteria, six videos were excluded, and the remaining 94 videos were analyzed for characteristics such as popularity (number of views: number of days on YouTube), views, likes, comments, length of video, and days on YouTube. Videos intended for education were further evaluated with a dichotomous coding scheme (ie yes/no) for their content in five areas: general information, risk factors, prognosis, treatment, and prevention.

Results

Most videos about melanoma were presented by physicians (41.5%) (Table 1). All in all, 28.7% featured the perspectives of patients; 11.7% featured academic institutions or non-profit organizations; 10.6% featured media outlets; 5.3% featured other health professionals; and 2.1% featured the pharmaceutical industry. Channels and organizations that had more merit or reputation were pushed to the top of the search results including Mayo Clinic, Northwell Health, and UC San Diego. Videos that featured a thumbnail or cover of a physician speaking or a patient speaking had the most views. In contrast, videos that had a cover photo of melanoma itself had less viewership on average. In our study, we did not analyze gaps in education or melanoma information. However, informational videos directed towards healthcare professionals often used medical terminology that the general population may find difficult. Patient experiences and personal anecdotes were more digestible and relatable for the general population.

Table 1.Characteristics of YouTube Videos on Melanoma
Video Speaker N (%) Popularity*, median (range) Views, median (range) Likes, median (range) Comments, median (range) Video Length (min),
mean (SD)		 Days on YouTube, mean (SD)
All 94 (100%) 7.4
(0.1 to 8537.2)		 8980
(139 to 461,008)		 55.5
(0 to 35,000)		 3.5
(0 to 2596)		 10.17
(13.75)		 1,714 (1198.4)
Patient perspective/blogger 27 (28.7%) 8.7
(0.3 to 8537.2)		 15,325
(945 to 461,008)		 88
(2 to 35,000)		 6
(0 to 2596)		 6.45
(8.9)		 1988.6 (1174.7)
Physician 39 (41.5%) 4.4
(0.1 to 114.3)		 6143
(139 to 387,004)		 38
(2 to 2100)		 2
(0 to 279)		 16.5
(17.3)		 1683 (1175.4)
Other Health Professionals (MPH, PhD, RN) 5
(5.3%)		 34.9
(5.3 to 110.3)		 29,406
(1071 to 171,596)		 91
(10 to 2,300)		 36
(12 to 113)		 13.1
(15.1)		 809.4 (675.7)
Media 10 (10.6%) 9.9
(0.2 to 58)		 11,947
(285 to 110,857)		 68
(1 to 316)		 4
(0 to 30)		 2.35
(1.26)		 2272.6 (1477)
Academic Institution and/or Non-Profit Organization 11 (11.7%) 9.2
(0.4 to 60.6)		 9329
(176 to 98,421)		 53
(0 to 565)		 1
(0 to 58)		 4.19
(2.53)		 1002.7 (933)
Pharmaceutical 2
(2.1%)		 2.8
(2.77 to 2.82)		 5631.5
(5690 to 5573)		 17.5
(16 to 19)		 - 1.78
(0.53)		 2011
(0)

*Popularity was measured as the number of views per number of days on YouTube

Educational Content of YouTube Videos on Melanoma

Of the 94 videos, 76.6% presented information about melanoma (Table 2). When analyzed by content, 43.6% featured general information pertaining to melanoma; 29.8% discussed risk factors; 29.8% discussed prognosis; and 38.3% discussed treatment options. In terms of specific risk-reducing practices, 36.2% discussed the ABCDE method for identifying atypical nevi; 29.8% explicitly recommended regular skin examinations by a physician; 25.5% recommended the use of sunscreen; 19.1% recommended wearing protective clothing; 14.9% explicitly mentioned the dangers of tanning; and 6.4% featured a tutorial for performing self-examinations.

Table 2.Information Presented in YouTube Videos on Melanoma
Total N
(%)		 Patient perspective/
Blogger		 Physician Other Health Professionals (MPH, PhD, RN) Media Academic Institution and/or Non-Profit Organization Pharmaceutical
Provide information 72 (76.6%) 6
(22.2%)		 39
(100%)		 5
(100%)		 9
(90%)		 11
(100%)		 2
(100%)
Content
General 41 (43.6%) - 20
(51.3%)		 3
(60%)		 9
(90%)		 7
(63.6%)		 2
(50%)
Risk factors 28 (29.8%) - 17
(43.6%)		 3
(60%)		 4
(40%)		 4
(36.4%)		 -
Prognosis 28 (29.8%) - 17
(43.6%)		 1
(20%)		 7
(70%)		 2
(18.2%)		 1
(50%)
Treatment 36 (38.3%) - 27
(69.2%)		 2
(40%)		 3
(30%)		 4
(36.4%)		 -
Risk Reduction
Referral to Physician for Skin Check 28 (29.8%) 2
(7.4%)		 16
(41%)		 1
(20%)		 5
(50%)		 4
(36.4%)		 -
Teaches how to perform a self-examination 6
(6.4%)		 - 4
(10.3%)		 - 1
(10%)		 1
(9.1%)		 -
Use of sunblock 24
(25.5)		 6
(22.2%)		 10
(25.6%)		 2
(40%)		 4
(40%)		 2
(18.2%)		 -
Protective clothing 18 (19.1%) 5
(18.5%)		 8
(20.5%)		 2
(40%)		 2
(20%)		 1
(9.1%)		 -
ABCDE method 34 (36.2%) 1
(3.7%)		 17
(43.6%)		 4
(80%)		 5
(50%)		 7
(63.6%)		 -
Dangers of tanning 14 (14.9%) 3
(11.1%)		 5
(12.8%)		 1
(20%)		 2
(20%)		 3
(27.3%)		 -

Note: (%) represents the relative proportion of all videos included in the study (n=95)

Presentation of Melanoma Information to Viewers

Of the 72 videos with educational content pertaining to melanoma, 24.7% featured a formal series on melanoma as part of a lecture or conference; 16.4% featured animations; 15.1% featured a physician interview; 13.7% featured a series intended for health professional training and continued education; 12.3% featured a series intended for patient education; 9.6% featured a news report; and 8.2% featured a patient perspective/narrative. The majority of the physicians who presented the videos were dermatologists or oncologists. With the largest median and mean popularity score of 12 and 23.2 respectively, animations were the most viewed format for presenting information.

Discussion

To our knowledge, our study is the first report that examines both the characteristics and educational content of videos on melanoma, especially within recent years. This study illustrates the vast amount of health information that is readily available on YouTube for patients diagnosed with melanoma. Videos that feature patient narratives can bring significant visibility to the impact of melanoma on a patient’s life, and some may even find a sense of support in their shared struggles. The general population may find more information and understanding from videos presented by healthcare professionals/physicians. However, there is often significant value for patients to hear another patient’s perspective and experience. Certain videos may highlight more statistics and information, while others appeal to the emotional and lifestyle aspects of the disease state. One approach to mitigate the incidence of melanoma may be to better educate patients on melanoma and the preventive measures that would limit ultraviolet damage of the skin. With an estimated 75% of patients acquiring health information through web-based searches, we believe that video-sharing platforms such as YouTube may serve as an effective tool for patient education. Although the credibility of information varies between videos, the creation of national regulations and moderation of health content on social media platforms can standardize the quality of disease-related information. Especially given that many patients will acquire disease-related information through web-based searches, social media platforms such as YouTube may serve as an effective tool for patient education. With improved access to quality health information, patients can make better informed decisions regarding their care. Thus, educational and personal melanoma content on YouTube may be utilized as a tool for clinicians to provide a more comprehensive care for patients who may benefit from such information.

Corresponding Author

Peter Lio, MD
Medical Dermatology Associates of Chicago
363 W. Erie Street, Suite #350
Chicago, IL 60654
peterlio@gmail.com