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Transillumination for Improved Diagnosis of Digital Myxoid Cysts
Myxoid cysts are among the most common space-occupying lesions involving the nail unit. Transillumination is a valuable techique that may aid...
To the Editor:
Nail biopsy is an important surgical procedure for diagnosis of nail pathology. YouTube has become a potential instrument for physicians and patients to learn about medical procedures.1,2 However, the sources, content, and quality of the information available have not been fully studied or characterized. Our objective was to analyze the efficiency of information and quality of YouTube videos on nail biopsies. We hypothesized that the quality of patient education and physician training videos would be unrepresentative on YouTube.
The term nail biopsy was searched on January 29, 2019, and filtered by relevance and rating using the default YouTube algorithm. Data were collected from the top 40 hits for the search term and filter coupling. All videos were viewed and sorted for nail biopsy procedures, and then those videos were categorized as being produced by a physician or other health care provider. The US medical board status of each physician videographer was determined using the American Board of Medical Specialties database.3 DISCERN criteria for assessing consumer health care information4 were used to interpret the videos by researchers (S.I. and S.R.L.) in this study.
From the queried search term collection, only 10 videos (1,023,423 combined views) were analyzed in this study (eTable). Although the other resulting videos were tagged as nail biopsy, they were excluded due to irrelevant content (eg, patient blogs, PowerPoints, nail avulsions). The mean age of the videos was 4 years (range, 4 days to 11 years), with a mean video length of 3.30 minutes (range, 49 seconds to 9.03 minutes). Four of 10 videos were performed for longitudinal melanonychia, and 5 of 10 videos were performed for melanonychia, clinically consistent with subungual hematoma. Dermatologists, plastic surgeons, and podiatrists produced the majority of the nail biopsy videos. The overall mean DISCERN rating was 1.60/5.00 (range, 1–3), meaning that the quality of content on nail biopsies was poor. This low DISCERN score signifies poor consumer health information. Video 2 (published in 2015) received a DISCERN score of 2 and received almost 1 million views, which is likely because the specific channel has a well-established subscriber pool (4.9 million subscribers). The highest DISCERN score of 3, demonstrating a tangential shave biopsy, was given to video 4 (published in 2010) and only received about 17,400 views (56 subscribers). Additionally, many videos lacked important information about the procedure. For instance, only 3 of 10 videos demonstrated the anesthetic technique and only 5 videos showed repair methods.
YouTube is an electronic learning source for general information; however, the content and quality of information on nail biopsy is not updated, reliable, or abundant. Patients undergoing nail biopsies are unlikely to find reliable and comprehensible information on YouTube; thus, there is a strong need for patient education in this area. In addition, physicians who did not learn to perform a nail biopsy during training are unlikely to learn this procedure from YouTube. Therefore, there is an unmet need for an outlet that will provide updated reliable content on nail biopsies geared toward both patients and physicians.
