10.5826/dpc.1201a66
Introduction: With the increase in the use of social media, there is a steady increase in demand for medical, surgical, and cosmetic procedures. Dermatologists and other physicians are leaving their cosmetic practice to non-physician service providers to keep up with the growing demand for cosmetic procedures.
Objectives: To examine the gender, professions, and the method of nevi treatment of the profiles using #bensilme and #moleremoval hashtags on Instagram and to investigate the extent of cosmetic procedures comparing Turkey’s situation with other countries.    
Methods: In Instagram, the most frequently used hashtags about nevus treatment were scanned by two dermatologists. We recorded profession, gender, country of origin, and the treatment method of nevi of profiles sharing the related posts.
Results: The countries with the highest share of the #moleremoval hashtag were the United Kingdom (15%), India (12%), and the United States of America (10.5%), and the proportion of physicians in these countries was 16.7%, 100%, and 71.4%, respectively. In the non-physician group, plasma pen method in our country is the most used method (Turkey: 97.9%, world: 75% respectively), but the use of radiofrequency cautery (world: 12.5%, Turkey: 1% respectively) and cryo pen (world: 7.5%, Turkey: 0.0%) methods were significantly more abroad.
Conclusions: We demonstrated that non-physicians mostly perform nevus destruction procedures. Physicians must use social media more actively to share educational, quality, and accurate information. We suggest that the hashtags used by physicians in their social media posts should be chosen from the words used in the folk language.
text/xml
2160-9381
1820
en
Hüsna Güder
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
non-physicians practice
"Mole removal" on Instagram hashtags: A cross-sectional analysis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Original Article
2022-02-02
2021-06-02
2022-02-02
2022-02-09
e2022066
Dermatol Pract Concept
Introduction: With the increase in the use of social media, there is a steady increase in demand for medical, surgical, and cosmetic procedures. Dermatologists and other physicians are leaving their cosmetic practice to non-physician service providers to keep up with the growing demand for cosmetic procedures.
Objectives: To examine the gender, professions, and the method of nevi treatment of the profiles using #bensilme and #moleremoval hashtags on Instagram and to investigate the extent of cosmetic procedures comparing Turkey’s situation with other countries.    
Methods: In Instagram, the most frequently used hashtags about nevus treatment were scanned by two dermatologists. We recorded profession, gender, country of origin, and the treatment method of nevi of profiles sharing the related posts.
Results: The countries with the highest share of the #moleremoval hashtag were the United Kingdom (15%), India (12%), and the United States of America (10.5%), and the proportion of physicians in these countries was 16.7%, 100%, and 71.4%, respectively. In the non-physician group, plasma pen method in our country is the most used method (Turkey: 97.9%, world: 75% respectively), but the use of radiofrequency cautery (world: 12.5%, Turkey: 1% respectively) and cryo pen (world: 7.5%, Turkey: 0.0%) methods were significantly more abroad.
Conclusions: We demonstrated that non-physicians mostly perform nevus destruction procedures. Physicians must use social media more actively to share educational, quality, and accurate information. We suggest that the hashtags used by physicians in their social media posts should be chosen from the words used in the folk language.
Hüsna Güder
2022/02/02
10.5826/dpc.1201a66
e2022066
Department of Dermatology, Medical Faculty, Maltepe University, Maltepe, Istanbul, Turkey 
2160-9381
non-physicians practice
en
e2022066
St Claire KM, Rietcheck HR, Patel RR, Dellavalle RP. An assessment of social media usage by dermatology residency programs. Dermatol Online J. 2019;25(1):13030/qt5v62b42z. PMID: 30710898.
"Mole removal" on Instagram hashtags: A cross-sectional analysis
https://dpcj.org/index.php/dpc/article/download/1820/1494
            “Mole removal” on Instagram Hashtags:
          A Cross-sectional Analysis: Nevus Treatment
                    Methods on Instagram
                                                Semih Güder1, Hüsna Güder2


1 Department of Dermatology, Medical Faculty, Bezmialem Vakif University, Fatih, Istanbul, Turkey
2 Department of Dermatology, Medical Faculty, Maltepe University, Maltepe, Istanbul, Turkey



Key words: Instagram, nevus treatment, plasma energy devices, cauterization, social media, non-physicians practice
Citation: Güder S, Güder H. “Mole removal” on instagram hashtags: a cross-sectional analysis: nevus treatment methods on instagram.
Dermatol Pract Concept. 2022;12(1):e2022066. DOI:https://doi.org/10.5826/dpc.1201a66
Accepted: September 13, 2021; Published: January 2022
Copyright: ©2022 Güder and Güder. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: Both authors have contributed significantly to this publication.
Corresponding author: Semih Güder, Department of Dermatology, Medical Faculty, Bezmialem Vakif University, Fatih, Istanbul, Turkey.
E-mail: semihguder@gmail.com




  ABSTRACT             Introduction: With the increase in the use of social media, there is a steady increase in demand for med-
                       ical, surgical, and cosmetic procedures. Dermatologists and other physicians are leaving their cosmetic
                       practice to non-physician service providers to keep up with the growing demand for cosmetic procedures.
                       Objectives: To examine the gender, professions, and the method of nevi treatment of the profiles using
                       #bensilme and #moleremoval hashtags on Instagram and to investigate the extent of cosmetic proce-
                       dures comparing Turkey’s situation with other countries.
                       Methods: In Instagram, the most frequently used hashtags about nevus treatment were scanned by
                       two dermatologists. We recorded profession, gender, country of origin, and the treatment method of
                       nevi of profiles sharing the related posts.
                       Results: The countries with the highest share of the #moleremoval hashtag were the United Kingdom
                       (15%), India (12%), and the United States of America (10.5%), and the proportion of physicians in
                       these countries was 16.7%, 100%, and 71.4%, respectively. In the non-physician group, plasma pen
                       method in our country is the most used method (Turkey: 97.9%, world: 75% respectively), but the
                       use of radiofrequency cautery (world: 12.5%, Turkey: 1% respectively) and cryo pen (world: 7.5%,
                       Turkey: 0.0%) methods were significantly more abroad.
                       Conclusions: We demonstrated that non-physicians mostly perform nevus destruction procedures.
                       Physicians must use social media more actively to share educational, quality, and accurate information.
                       We suggest that the hashtags used by physicians in their social media posts should be chosen from the
                       words used in the folk language.




Original Article | Dermatol Pract Concept. 2022;12(1):e2022066                                                                        1
Introduction                                                        The most shared hashtags related to nevus treatment. were
                                                                    selected in Turkish and English One hundred posts using the
Instagram is a free social networking service for sharing           #bensilme hashtag in Turkish and 100 posts using the #mol-
photos and videos [1]. The number of daily users reached            eremoval hashtag, which may have an English equivalent,
500 million on the platform, which reached 1 billion active         were planned to be examined. The analysis was started from
users per month in the last month of 2018 [2,3]. Hashtags           current posts to old-dated posts, and especially melanocytic
are keywords those social media users utilize to tag their          nevus-looking posts were examined. The compatibility of the
posts. They are used to organize the share content, search and      shared images with melanocytic nevus was determined by the
collect data [4,5]. More than 40% of people in the United           joint decision of the two dermatologists. We ended the study
States use social media to get health information. Many peo-        when we reached 100 posts from each hashtag. Information
ple decide to receive healthcare services based on their social     on profession, gender, country of origin were collected from
media posts [5].                                                    the profiles that shared them. The profession information
    With the increase in social media usage, there is a steady      specified in the profiles that share related posts was taken as
increase in demand for medical, surgical, and cosmetic proce-       a basis for the distinction between physicians and non-physi-
dures. This has increased in people applying to non-­physicians     cians and for the determination of other professions. In order
for cosmetic procedures and aesthetic medical treatments.           to determine the professions of the profile owners who did
Dermatologists and other physicians leave cosmetic proce-           not have information of professions and gave their own web-
dures to non-physician service providers to keep pace with          site information in their profiles we reached their websites.
the growing demand for cosmetic procedures. Non-physician           If information of profession is specified in the “about us” sec-
groups (aestheticians, nurses, doctor assistants, nurse assis-      tion of the website, we have recorded it. The information on
tants, make-up experts, hairdressers, etc.) harass the specialty    the nevus destruction method used by the practitioners was
of medical science. This situation is directly related to patient   obtained from the related posts. In data entry, we classified
health and safety. In addition, patients treated by non-physi-      dermatologists and plastic surgeons as physicians. We defined
cians experience more burns and pigmentation problems than          the other specialists as doctors. Approval for this study was
patients treated by physicians [6]. This situation is beyond the    obtained from the Ethics Committee of Maltepe University
development of blemishes and burns. Melanoma, which is              Faculty of Medicine (Approval number: 2021/900/69).
evaluated and destroyed by non-physicians as a simple nevus,
can shorten the patient’s life span and increase the treatment      Inclusion and Exclusion criteria
costs significantly [7].                                            Melanocytic nevi, which have photos or videos both before
    While using Instagram, we observe non-physicians also           and after destruction, were selected from publicly accessible
do that nevus destruction in our searches related to nevus          posts. The selected posts included gender, profession, and
treatment. We anticipate that such practices performed in           destruction method information in the practitioner’s profile
incompetent hands may endanger patient health and safety.           and posts. Duplicate profiles and posts missing at least one of
Therefore, we aimed to evaluate the professions of the profile      the above information were not included in the study.
owners and methods by using the most two hashtags related
to nevus treatment on Instagram.                                    Statistical Analysis
                                                                    We used the Shapiro-Francia test to evaluate the compati-
Objectives                                                          bility of univariate data to normal distribution. According
                                                                    to quantitative data, the Mann-Whitney U test was used
We want to examine the gender, professions, and the method          together with Monte Carlo results to compare two inde-
of nevi treatment of the profiles using #bensilme and #molere-      pendent groups with each other. Pearson Chi-Square, Fisher
moval hashtags on Instagram and to investigate the extent of        Exact, and Fisher-Freeman-Holton tests were tested with the
cosmetic procedures comparing Turkey’s situation with other         Monte Carlo Simulation technique to compare categorical
countries. In particular, we wanted to investigate the rate of      variables. In addition, column proportions were compared
non-physician practices in this regard.                             and expressed according to Benjamini-Hochberg corrected P
                                                                    value results. Quantitative variables were represented in the
Methods                                                             tables as mean (± standard deviation) and median (25° and
                                                                    75° percentile). Categorical variables were shown as n (%).
Study Design                                                        Variables were analyzed at a 95% confidence level, and a P
On May 01, 2021, two dermatologists scanned the most                value of less than 0.05 was considered significant. SPSS 27.0
frequently used hashtags for nevus treatment on Instagram.          (IBM Corporation) program was used to analyze variables.




2                                                                       Original Article | Dermatol Pract Concept. 2022;12(1):e2022066
Results                                                             In our country, 21% of practitioners were male, and 79%
                                                                 were female. Abroad, this rate was similar to our country
There were 21,711 posts in the #bensilme hashtag and 47,085      (30% and 70% respectively). We compared physician and
posts in the #moleremoval hashtag. The countries with the        non-physician groups in terms of gender. The number of
highest share of the #moleremoval hashtag in the world were      male physicians in the world was significantly higher than
the United Kingdom (15%), India (12%), and the United            in our country (respectively 93.3%-19.0%, P <0.001). There
States of America (10.5%) (Table 1).                             was no physician among female practitioners in our country.


                                                  Table 1. Demographic Data
                                                                    n                           %
                  Gender
                      Male                                          51                        25.5%
                      Female                                       149                        74.5%
                  Profession
                      Esthetician                                  108                        54.0%
                      Dermatologist                                 28                        14.0%
                      Doctor                                        21                        10.5%
                      Hairdresser                                   18                         9.0%
                      Plastic Surgeon                               15                         7.5%
                      Nurse                                         5                          2.5%
                      Masseur                                       4                          2.0%
                      Make-up artist                                1                          0.5%
                  Physician / Non-physician
                      Physician                                     64                        32.0%
                      Non-physician                                136                        68.0%
                  Method
                      Plasmapen                                    136                        68.0%
                      Surgical excision                             23                        11.5%
                      Radiofrequency cautery                        18                         9.0%
                      Laser                                         16                         8.0%
                      Electrocautery                                4                          2.0%
                      Cryopen                                       3                          1.5%
                  Country
                      Turkey                                       100                        50.0%
                      United Kingdom                                30                        15.0%
                      India                                         24                        12.0%
                      United States of America                      21                        10.5%
                      Australia                                     7                          3.5%
                      Malaysia                                      4                          2.0%
                      Pakistan                                      3                          1.5%
                      Indonesia                                     2                          1.0%
                      Venezuela                                     1                          0.5%
                      Philippines                                   1                          0.5%
                      Canada                                        1                          0.5%
                      Nepal                                         1                          0.5%
                      Russia                                        1                          0.5%
                      Spain                                         1                          0.5%

                                                                                             Table 1 continues




Original Article | Dermatol Pract Concept. 2022;12(1):e2022066                                                            3
                                         Table 1. Demographic Data (continued)
                                                                                n                                    %
                      Albania                                                       1                               0.5%
                      Iran                                                          1                               0.5%
                      Egypt                                                         1                               0.5%
                  Turkey / World
                      Turkey                                                   100                                  50.0%
                      World                                                    100                                  50.0%
                                                                    Mean (SD)               Min q1         q2        q3     Max
                  Follower                                 8842.03 (23025.14) 59                    930   2612      ###     2E+05

                SD=Standard deviation; q1=percentile 25; q2=percentile 50(median); q3=percentile 75.



                                                                  TURKEY    WORLD
         90
                81
         80

         70

         60

         50

         40

         30           27                          27

         20                         18
                                                                     15        14

         10
                                                                                        4            4               5
                                3
                                             1                0                                 0               0               1    0
          0
               ESTHETICIAN      DOCTOR    DERMATOLOGIST   PLASTIC SURGEON    HAIRDRESSER       MASSEUR           NURSE       MAKE-UP ARTIST




         Figure 1. Distribution of the professions we have identified in Turkey and in the world. (numbers indicate percentages).



In the non-physician group, the proportion of men in our                        In terms of the method of destruction, plasma pen was
country was significantly higher than abroad (respectively                  significantly higher in our country compared to abroad
81.0%-6.7%, P < 0.001). In the non-physician group, the rate                (96% - 40%, respectively). Abroad, rate of laser (14%-2%,
of women in our country was also significantly higher than                  respectively), surgical excisions (22%-1%, respectively),
abroad (100%-54.3%, respectively) (P < 0.001) (Table 2).                    radiofrequency cauterizations (17%-1%, respectively), and
    When physicians and non-physicians were compared,                       electrocauterizations (4%-0%, respectively) were signifi-
96% of the practices in our country were performed by                       cantly higher than in our country (Table 2), (Figure 3).
non-physicians and only 4% were performed by physicians                         The methods used by the physicians were similar in our
(P < 0.001). Abroad, this rate was 60% and 40%, respectively                country and abroad without significant difference (P = 0.577).
(Table 2) (Figure 1). The countries that have the most shares               In the non-physician group, plasma pen usage is more frequent
of the #moleremoval hashtag abroad were UK, India, and the                  in our country (Turkey: 97.9%, world: 75.0% respectively),
USA, and the proportion of physicians in these countries was                but abroad radiofrequency cautery (World: 12.5%, Turkey:
16.7%, 100%, and 71.4%, respectively (Table 3).                             1% respectively) and cryo pen (World: 7.5%, Turkey: 0.0%
    Considering the professions, the rate of estheticians and               respectively) usage were significantly more (p<0.001) (Table 2).
hairdressers in our country was significantly higher than
abroad (81%-27% for estheticians, 14%-4% for hairdressers,
                                                                            Discussion
respectively). Abroad, rate of doctors (18%-3% respectively),
dermatologists (27%-1% respectively), plastic surgeons                      We wanted to examine the Instagram accounts using #ben-
(15%-0.0% respectively), masseurs (4%-0.0% respectively)                    silme in Turkish and #moleremoval hashtags in English
and nurses (5%-0.0% respectively) were significantly higher                 regarding gender, professions, and method of destroy-
than our country (P < 0.001) (Table 2), (Figure 2).                         ing nevus of profile owners. We planned this study to




4                                                                                   Original Article | Dermatol Pract Concept. 2022;12(1):e2022066
                                                   Table 2. Statistical Analysis
                                                 Turkey (n=100) n (%)               World (n=100) n (%)                        P
 Gender                                                                                                                     0.194 c
    Male                                                 21 (21.0)                         30 (30.0)
    Female                                               79 (79.0)                         70 (70.0)
 Physician / Non-physician                                                                                                 <0.001 c
    Physician                                              4 (4.0)                        60 (60.0) A
    Non-physician                                       96 (96.0)    B
                                                                                           40 (40.0)
 Male                                                                                                                      <0.001 c
    Physician                                             4 (19.0)                        28 (93.3) A
    Non-physician                                       17 (81.0) B                          2 (6.7)
 Female                                                                                                                    <0.001 c
    Physician                                              0 (0.0)                        32 (45.7) A
    Non-physician                                       79 (100.0) B                       38 (54.3)
 Profession                                                                                                                <0.001 ff
    Esthetician                                         81 (81.0) B                        27 (27.0)
    Doctor                                                 3 (3.0)                        18 (18.0) A
    Dermatologist                                          1 (1.0)                        27 (27.0) A
    Plastic Surgeon                                        0 (0.0)                        15 (15.0) A
    Hairdresser                                         14 (14.0) B                          4 (4.0)
    Masseur                                                0 (0.0)                          4 (4.0) A
    Nurse                                                  0 (0.0)                          5 (5.0) A
    Make-up artist                                         1 (1.0)                           0 (0.0)
 Methods used by physician’s                                                                                               0.577 ff
    Plasmapen                                             2 (50.0)                         10 (16.7)
    Laser                                                 1 (25.0)                         13 (21.7)
    Surgical excision                                     1 (25.0)                         22 (36.7)
    Electrocautery                                         0 (0.0)                           3 (5.0)
    Radiofrequency cautery                                 0 (0.0)                         12 (20.0)
 Methods used by non-physician’s                                                                                           <0.001 ff
    Plasmapen                                           94 (97.9) B                        30 (75.0)
    Laser                                                  1 (1.0)                           1 (2.5)
    Electrocautery                                         0 (0.0)                           1 (2.5)
    Radiofrequency cautery                                 1 (1.0)                         5 (12.5) A
    Cryopen                                                0 (0.0)                          3 (7.5) A
 Summary of methods                                                                                                        <0.001 ff
    Plasmapen                                           96 (96.0) B                        40 (40.0)
    Laser                                                  2 (2.0)                        14 (14.0) A
    Surgical excision                                      1 (1.0)                        22 (22.0) A
    Electrocautery                                         0 (0.0)                          4 (4.0) A
    Radiofrequency cautery                                 1 (1.0)                        17 (17.0) A
    Cryopen                                                0 (0.0)                           3 (3.0)
 Follower                                             median (q1/q3)                    median (q1/q3)
                                                  3313 (1850.5 / 7021)               1372 (550 / 8197.5)                   0.007 U

c=Pearson Chi-Square Test (Monte Carlo); ff=Fisher Freeman Halton test (Monte Carlo); u= Mann Whitney U Test (Monte Carlo); q1=percentile 25;
q3=percentile 75. A=significance in the world population compared to Turkey, B=significance in the Turkish population compared to world.




Original Article | Dermatol Pract Concept. 2022;12(1):e2022066                                                                             5
                         Table 3. Distribution of Physicians and Non-Physicians in the World
                                                                         n (%)
                                United Kingdom                      India                United States of America           Other countries
 Physician                            5 (17)                      24 (100)                        15 (71)                             16 (64)
 Doctor                              4 (13.4)                      1 (4.2)                        4 (19)                              9 (36)
 Dermatologist                        1 (3.3)                      18 (75)                        4 (19)                              4 (16)
 Plastic Surgeon                           0                      5 (20.8)                        7 (33.3)                            3 (12)
 Non-Physician                       25 (83)                             0                        6 (29)                              9 (36)
 Esthetician                        17 (56.6)                            0                        3 (14.3)                            7 (28)
 Hairdresser                         4 (13.4)                            0                            0                                 0
 Masseur                              1 (3.3)                            0                        2 (9.6)                              1 (4)
 Nurse                                3 (10)                             0                        1 (4.8)                              1 (4)



                                                                  TURKEY     WORLD
          120


          100


           80


           60


           40


           20


             0
                                     PHYSICIAN                                                     NON-PHYSICIAN


          Figure 2. Distribution of physicians and non-physicians we have identified in Turkey and in the world. (numbers indicate
          percentages).



                                                                   TURKEY    WORLD

           120




           100      96




            80




            60



                           40
            40


                                                                    22
            20                                                                                                 17
                                                   14

                                                                                           4                                      3
                                       2                    1                        0                    1                 0
             0
                    PLASMAPEN              LASER        SURGICAL EXCISION        ELECTROCAUTERY    RADIOFREQUENCY CAUTERY   CRYOPEN




       Figure 3. Distribution of destruction method we have identified in Turkey and in the world. (numbers indicate percentages).



­investigate the extent of non-physician practices and to                        Nevus treatment options include total surgical excision,
compare the situation in our country with abroad. As a                       shave excision, lasers, radiofrequency, electrocautery, and
result of our research, we found that high rates of non-phy-                 cryotherapy. However, the possibility of recurrence is high
sician practices are performed in our country and overseas                   after non-specific thermal or cold damage methods, and
to treat nevi.                                                               recurrent lesions are confused with atypical melanocytic nevi



6                                                                                Original Article | Dermatol Pract Concept. 2022;12(1):e2022066
or melanoma. Due to the cosmetic appearance, it is necessary            Wong et al have compiled some suggestions for physicians
to eliminate the risk of dysplasia and melanoma in the nevus         on how create a professional Instagram account. These are
before starting nevus treatment. Thus, dermoscopy is a good          as follows: must be an official account, the content must be
tool in skilled hands, but it is still a more reliable method to     short and precise, supported with images and videos, must be
biopsy in doubtful cases. In general, it is accepted that all nevi   online frequently, stories and posts must be share regularly,
should be examined histologically as medicolegal. An average         a disclaimer must be prepared for followers with medical
of 2.3% of melanocytic nevi considered to be clinically benign       concerns, a good patient consent form should be prepared to
was reported as microscopic malignant [8-10]. While meth-            share patient information [2].
ods in which pathological examination cannot be performed
are controversial for nevus treatment, it is unacceptable for
                                                                     Conclusions
non-physicians to treat nevus.
    In terms of professions, the high number of estheticians         We have demonstrated that non-physicians widely use nevus
and hairdressers in our country and in the UK may be because         destruction procedures. However, wrong only disappears
this group uses social media more actively or may prefer             when the right turns out. Therefore, we think physicians must
#bensilme and #moleremoval hashtags than physicians. On              use social media more actively and share quality and accu-
the other hand, the low rate of physicians in our country and        rate information. We suggest that physicians in Turkey use
the UK may be because physicians in these countries do not           #bensilme and other related tags in their social media posts
use social media actively, or it may also be since the doctor        on this issue, which may fill the gap in this area. In addition,
group in these countries use hashtags containing medical             physicians must share quality information on social media
words instead of the more preferred hashtags in the spoken           for educational purposes that tissue destruction devices are
language.                                                            medical devices and must be used by physicians.
    We have seen that dermatologists produce a small por-
tion of the #bensilme and #moleremoval hashtags posted on            Data Availability Statement: Data sharing not applicable to
Instagram. However, in India, no one except the doctor used          this article as no datasets were generated or analyzed during
the #moleremoval disease. This may be since estheticians use         the current study.
more local languages than English, or India has provided this
with its laws. There were only physician shares in Albania,          Transparency Statement: The lead author (Semih Güder),
Canada, Egypt, Iran, Nepal, and Pakistan, where 1 to 3 shares        affirms that this manuscript is an honest, accurate, and trans-
were examined, but no comment could be made because the              parent account of the study being reported that no important
number was low.                                                      aspects of the study have been omitted; and that any discrep-
    Plasma pen use was common in the non-physician group,            ancies from the study as planned (and, if relevant, registered)
especially in our country. This may be due to the fact that          have been explained.
plasma pen devices are easily accessible, inexpensive, and
practical to implement. However, it can also be caused by            References
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