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Patient-led melanoma surveillance may lead to earlier melanoma detection




Patient-led melanoma surveillance may lead to earlier melanoma detection.

Clinical Pearls:

  • This was a pilot study for a randomized control trial among 100 Australian patients previously treated for localized melanoma who were capable of performing skin self-examinations (described as standard of care plus reminders to perform self-examinations, patient-performed dermoscopy, teledermatology assessment, and fast-tracked unscheduled clinic visits) for a 6 month period between November 2018 and January 2020.

  • 8 new melanomas (5 melanoma in situs, 1 local recurrence, 2 stage IA) were discovered in the intervention group compared to 3 (1 MIS, 1 stage IA, 1 stage IIC) in the control group. The time from randomization to surgical removal was 1 month shorter for intervention group.

  • Authors found that for patients who performed patient-led screenings, the odds of performing regular self-examinations more frequently (OR 3.5, 95% confidence interval 0.9-14.0) and thoroughly (OR 2.2, 95%CI 0.8-5.7) trended towards being higher.

  • Authors also found among patient-led screenings a slight increase in clinic visits (risk ratio 1.5, 95%CI 1.1-2.1) but no increase in fear of cancer recurrence (mean difference -1.3, 95%CI -3.1 to 0.5) or skin lesion excision (RR 1.1, 95%CI 0.6-2.0).


Discussion

Cutaneous melanoma (CM) is (one of if not the) most lethal form of skin cancer with an average of 1 in 44 Americans expected to develop CM in their lifetime and 7650 Americans expected to die in 2022 alone (up from 7180) from CM. Given morbidity and mortality increase with increasing American Joint Committee on Cancer 8th edition staging (AJCC8), early detection and intervention is the cornerstone of care. This is especially true among patients with a history of melanoma and are clinically surveilled with increased scrutiny after initial diagnosis.


This pilot study examined how a patient-led initiative (as opposed to physician-led) with several additional resources, including instructions on proper self-examination technique, mobile dermatoscope-attachment for self-examination, regular self-examination reminders, an application to facilitate store-and-forward (SAF) clinical photos for teledermatology, and a fast-track into additional as-needed clinic visits. This increase in patient-led screenings did discover more melanomas than the control group an average of 1 month earlier, however sample size was prohibitive for additional analysis. These interventions also lead to a statistically significant increase in patients self-examining their buttocks (OR 4.5 95%CI 1.1-18.5) but not any other area, using a mirror to check “difficult-to-see” areas, nor including a skin check partner in self-examination. While there were no significant differences in measured psychological burdens, the intervention group did require three times as many unscheduled visits as the control group.


Limitations of the study are primarily that of a pilot study, namely small sample size further exacerbated by relatively large attrition (Control, n=10; Intervention, n=14). Approximately 20-25% of all participants who withdrew cited time commitments, confusion/anxiety regarding protocol, or lacked proper device for the study.


It will be interesting to see the outcomes from a larger version of this study to determine how this may minimize time between tumor discovery and surgical removal and affect CM thickness on histopathological diagnosis. Patient-led screening in conjunction with proper patient education may have the ability to maximize the equitable allocation of healthcare resources whilst empowering patients.

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