Patient-Led Surveillance After Treatment of Localized Melanoma
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Patients undergoing patient-led melanoma surveillance had more positive attitudes toward and more confidence in doing self skin exams (SSE) than patients receiving usual care. They were also more likely to perform regular SSEs and use a mirror and/or their SSE partner when necessary. There was no difference in psychological outcomes in the intervention and control groups. Over the 6-month study period, 5 of the 8 new primary melanomas and local recurrences in the intervention group were detected prior to regularly scheduled follow-up appointments while none of 3 were detected prior to regularly scheduled follow-up in the usual care group.
- Patient-led surveillance showed improved SSEs and sooner detection of new melanomas. Larger studies are needed to evaluate the impact of this promising model of surveillance on outcomes in patients with localized melanomas.
abstract
This abstract is available on the publisher's site.
Importance
Patient-led surveillance is a promising new model of follow-up care following excision of localized melanoma.
Objective
To determine whether patient-led surveillance in patients with prior localized primary cutaneous melanoma is as safe, feasible, and acceptable as clinician-led surveillance.
Design, Setting, and Participants
This was a pilot for a randomized clinical trial at 2 specialist-led clinics in metropolitan Sydney, Australia, and a primary care skin cancer clinic managed by general practitioners in metropolitan Newcastle, Australia. The participants were 100 patients who had been treated for localized melanoma, owned a smartphone, had a partner to assist with skin self-examination (SSE), and had been routinely attending scheduled follow-up visits. The study was conducted from November 1, 2018, to January 17, 2020, with analysis performed from September 1, 2020, to November 15, 2020.
Intervention
Participants were randomized (1:1) to 6 months of patient-led surveillance (the intervention comprised usual care plus reminders to perform SSE, patient-performed dermoscopy, teledermatologist assessment, and fast-tracked unscheduled clinic visits) or clinician-led surveillance (the control was usual care).
Main Outcomes and Measures
The primary outcome was the proportion of eligible and contacted patients who were randomized. Secondary outcomes included patient-reported outcomes (eg, SSE knowledge, attitudes, and practices, psychological outcomes, other health care use) and clinical outcomes (eg, clinic visits, skin surgeries, subsequent new primary or recurrent melanoma).
Results
Of 326 patients who were eligible and contacted, 100 (31%) patients (mean [SD] age, 58.7 [12.0] years; 53 [53%] men) were randomized to patient-led (n = 49) or clinician-led (n = 51) surveillance. Data were available on patient-reported outcomes for 66 participants and on clinical outcomes for 100 participants. Compared with clinician-led surveillance, patient-led surveillance was associated with increased SSE frequency (odds ratio [OR], 3.5; 95% CI, 0.9 to 14.0) and thoroughness (OR, 2.2; 95% CI, 0.8 to 5.7), had no detectable adverse effect on psychological outcomes (fear of cancer recurrence subscale score; mean difference, -1.3; 95% CI, -3.1 to 0.5), and increased clinic visits (risk ratio [RR], 1.5; 95% CI, 1.1 to 2.1), skin lesion excisions (RR, 1.1; 95% CI, 0.6 to 2.0), and subsequent melanoma diagnoses and subsequent melanoma diagnoses (risk difference, 10%; 95% CI, -2% to 23%). New primary melanomas and 1 local recurrence were diagnosed in 8 (16%) of the participants in the intervention group, including 5 (10%) ahead of routinely scheduled visits; and in 3 (6%) of the participants in the control group, with none (0%) ahead of routinely scheduled visits (risk difference, 10%; 95% CI, 2% to 19%).
Conclusions and Relevance
This pilot of a randomized clinical trial found that patient-led surveillance after treatment of localized melanoma appears to be safe, feasible, and acceptable. Experiences from this pilot study have prompted improvements to the trial processes for the larger trial of the same intervention.
Trial Registration
http://anzctr.org.au Identifier: ACTRN12616001716459.
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Copyright © 2021 Elsevier Inc. All rights reserved.
Additional Info
Assessing the Potential for Patient-led Surveillance After Treatment of Localized Melanoma (MEL-SELF): A Pilot Randomized Clinical Trial
JAMA Dermatol 2021 Nov 24;[EPub Ahead of Print], DM Ackermann, M Dieng, E Medcalf, MC Jenkins, CH van Kemenade, M Janda, RM Turner, AE Cust, RL Morton, L Irwig, P Guitera, HP Soyer, V Mar, JK Hersch, D Low, C Low, RPM Saw, RA Scolyer, D Drabarek, D Espinoza, A Azzi, AM Lilleyman, AK Smit, P Murchie, JF Thompson, KJL BellFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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