Online Patient Health Resources in Nonmelanoma Skin Cancer: An Assessment of Readability, Quality, and Comprehensiveness

Main Article Content

Terri Shih
Allison Brimacombe
Vivian Shi
Jennifer Lin Hsiao


hidradenitis suppurativa


Background: Nonmelanoma skin cancer (NMSC), the most prevalent skin cancer, affects over 3 million in the United States annually. Although most patients search for health information on the internet, the readability and quality of NMSC online resources is unknown.

Objective: We examine the readability, quality, and comprehensiveness of content in NMSC websites.

Methods: Top 50 Google search results for “nonmelanoma skin cancer”, “basal cell skin cancer”, and “squamous cell skin cancer” were evaluated. Advertisements, blogs, scientific articles, and non-comprehensive, professional, and irrelevant sites were excluded. Six readability scales assessed readability. JAMA Benchmark and Discern Instrument assessed quality. Content was evaluated for comprehensiveness. Pearson’s correlation examined the relationship between readability and quality.

Results: Seventy-nine websites met inclusion criteria. Average readability level was 11th grade (range 6.8-17.9). No websites met the full criteria of JAMA Benchmark. Only 16.4% had “good”/“excellent” quality per Discern Instrument. Quality and readability scores were not correlated. Most websites discussed risk factors (87.3%), prevention (73.4%), and surgical (87.3%) and nonsurgical (82.3%) treatments. 50.6% included skin cancer images, of which only 17.5% were of skin of color patients.

Conclusion: Online NMSC resources need improved readability, quality, and diversity in their representation of skin types.


1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

2. Rogers HW, Weinstock MA, Feldman SR, et al. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol. 2015 Oct;151(10):1081–6.

3. Ciążyńska M, Kamińska-Winciorek G, Lange D, et al. The incidence and clinical analysis of non-melanoma skin cancer. Sci Rep. 2021 Feb 22;11(1):4337.

4. Diviani N, van den Putte B, Giani S, et al. Low health literacy and evaluation of online health information: a systematic review of the literature. J Med Internet Res. 2015 May 7;17(5):e112.

5. Fox S. The Social Life of Health Information, 2011 [Internet]. Pew Research Center’s Internet & American Life Project; 2011. Available from:‐Life‐of‐Health‐Info.aspx

6. Ibrahim AMS, Vargas CR, Koolen PGL, et al. Readability of online patient resources for melanoma. Melanoma Res. 2016 Feb;26(1):58–65.

7. Alshaikh EA, Almedimigh AF, Alruwaili AM, et al. Patient-Focused Online Resources for Melanoma: Highly Variable Content and Quality. J Cancer Educ. 2019 Aug 1;34(4):775–781.

8. Modiri O, Yee D, Shi VY, et al. Readability, Quality, and Timeliness of Online Health Resources for Atopic Dermatitis. Dermat Contact Atopic Occup Drug. 2020 Dec 1;

9. Weil AG, Bojanowski MW, Jamart J, et al. Evaluation of the quality of information on the Internet available to patients undergoing cervical spine surgery. World Neurosurg. 2014 Aug;82(1–2):e31-39.

10. Basch CH, Fera J, Ethan D, et al. Readability of online material related to skin cancer. Public Health. 2018 Oct 1;163:137–140.

11. Weiss BD. Health Literacy and Patient Safety: Help Patients Understand. Manual for Clinicians. 2nd ed. [Internet]. [cited 2021 Jul 27]. Available from:

12. Kutner M, Greenberg E, Jin Y, et al. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy [Internet]. National Center for Education Statistics; 2006 [cited 2021 Jul 27]. Available from:

13. Delcambre M, Haynes D, Hajar T, et al. Using a Multimedia Tool for Informed Consent in Mohs Surgery: A Randomized Trial Measuring Effects on Patient Anxiety, Knowledge, and Satisfaction. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2020 May;46(5):591–8.

14. McWhirter JE, Hoffman-Goetz L. Visual images for patient skin self-examination and melanoma detection: a systematic review of published studies. J Am Acad Dermatol. 2013 Jul;69(1):47–55.

15. Davis DS, Robinson C, Callender VD. Skin cancer in women of color: Epidemiology, pathogenesis and clinical manifestations. Int J Womens Dermatol. 2021 Mar;7(2):127–134.

16. Kurtti A, Austin E, Jagdeo J. Representation of skin color in dermatology-related Google image searches. J Am Acad Dermatol. 2021 Mar 17;S0190-9622(21)00582-X.

17. Hogue L, Harvey VM. Basal Cell Carcinoma, Squamous Cell Carcinoma, and Cutaneous Melanoma in Skin of Color Patients. Dermatol Clin. 2019 Oct;37(4):519–26.

18. Search engine market share worldwide [Internet]. Statista. [cited 2021 Aug 6]. Available from:

19. Shelton K. Council Post: The Value Of Search Results Rankings [Internet]. Forbes. [cited 2021 Aug 4]. Available from:

Most read articles by the same author(s)