Self-Examination Key to Fewer Follow-Up Visits After Melanoma Excision

Some patients with a recently excised, localized early-stage melanoma prefer to have fewer scheduled follow-up clinic visits, provided they receive increased support for skin self-examination (SSE), according to the results of a recent Australian survey published in JAMA Dermatology.

The investigators sought to compare characteristics of the proportion of adults treated for localized melanoma who preferred the standard, currently recommended schedule of follow-up clinic visits with those of patients who opted for fewer scheduled clinic visits. The study used a telephone interview for patient surveillance following the excision of a localized melanoma at an Australian specialist center. The main study outcomes included the proportion of patients who preferred standard vs fewer scheduled clinic visits, the median delay between detection and treatment of melanoma, and SSE practices used.

A total of 262 participants agreed to be interviewed. The mean patient age was 64.3±14.3 years; 36% of the participants were women. Among the 230 individuals who did not experience a recurrent or new primary melanoma, 149 preferred the standard schedule of visits and 81 preferred fewer scheduled clinic visits (70% vs 30%, respectively, after adjustment for sampling frame).

A number of factors were independently associated with a preference for fewer follow-up visits, including a higher stage of disease, having melanoma on a limb, living with others rather than living alone, not having private health insurance, and consulting with a specialist for another chronic medical condition.

The median delay between initial detection and treatment of a recurrent or new primary melanoma was 7 weeks and 3 weeks, respectively. Only 8% of participants missed a scheduled clinic visit.

Among those without a recurrent or new primary melanoma, 30% did not perform SSE (95% CI, 25%-35%) and an additional 14% performed SSE at intervals that were >3 months apart (95% CI, 10%-19%). Moreover, 47% of participants with a recurrent or new primary melanoma did not perform SSE at all (95% CI, 29%-65%).

The investigators concluded that among patients with a recently excised localized melanoma, those who prefer fewer scheduled follow-up clinic visits need to be supported to perform SSE and to report any findings that cause them concern.

Reference

Lim WY, Morton RL, Turner RM, et al. Patient preferences for follow-up after recent excision of a localized melanoma [published online February 28, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.0021