Patient-led melanoma surveillance is safe, feasible

Patient-led surveillance following melanoma surgery was safe and feasible, according to a pilot study.

“After surgical excision of localized melanoma, patients are recommended to undergo long-term follow-up at routinely scheduled clinic visits (clinician-led surveillance). However, the frequency and duration of clinician surveillance varies widely, leading to substantial differences in health care utilization and costs and unclear clinical benefits for higher utilization patterns of care,” Deonna M. Ackermann, MPH, of the University of Sydney School of Public Health in Sydney, Australia, and colleagues wrote.

“Patient-led surveillance is an alternative model of follow-up after treatment of localized melanoma, based on evidence that patients and their partners detect many subsequent new primary or recurrent melanomas ahead of a routinely scheduled clinic visit.”

The MELanoma SELF surveillance study, a randomized clinical trial of patients previously treated for melanoma, randomly assigned 100 patients (mean age, 58.7 years; 53% men) 1:1 to patient-led or clinician-led follow-up for 6 months. Those in the patient-led group were given instructional videos on performing skin self-exams (SSE), reminders to complete the exams, a mobile dermatoscope attached to their smartphone and an app used to store and forward teledermatology, as well unscheduled, fast-tracked clinic visits.

Those in the clinician-led group received regular clinic visits and an instructional booklet.

Of the 49 individuals in the study group, 30 (61%) completed the 6-month questionnaire, as did 36 (71%) of the 51 individuals in the control group.

SSE frequency was associated with patient-led surveillance, with individuals in this group more likely to perform SSE at least every 2 months (OR = 3.5; 95% CI, 0.9-14) with higher rates of thoroughness (OR = 2.2; 95% CI, 0.8-5.7).

The study group also had higher levels of confidence and knowledge concerning SSE, more positive attitudes toward SSE and were more likely to conduct SSE compared to those in the control group.

Dermoscopic images were successfully submitted by 26 of the 49 (53%) study group participants, with a total of 353 images being submitted in the 6-month period.

Lesions that had to be surgically excised were equally as likely in both groups (risk ratio = 1.1; 95% CI, 0.6-2).

Eleven patients were diagnosed with a subsequent new primary melanoma or recurrence during the trial, with eight in the study group and three in the control group. Five of those in the study group were diagnosed ahead of routinely scheduled visits compared with none in the control group.

“This pilot randomized clinical trial found that patient-led surveillance of melanoma appears to be safe, feasible and acceptable,” the authors wrote.

A larger clinical trial is recommended to compare patient outcomes, they added.