Patient-Led Surveillance Safe, Feasible After Localized Melanoma Treatment

By Lisa Rapaport

December 14, 2021

(Reuters Health) - It may be safe and feasible for patients treated for localized melanoma to manage surveillance for future skin lesions at home with the help of a smartphone, telemedicine assistance, and a partner to help with skin exams, a pilot study suggests.

The study included 100 patients treated for localized melanoma at one of two primary skin cancer clinics in Sydney, Australia, who owned smartphones, had a partner to assist with skin self-examinations, and were compliant with attending follow-up visits. Patients were randomized 1:1 to receive usual care alone - which involved clinician-led surveillance - or in combination with a patient-led surveillance program for six months.

Participants in the patient-led surveillance group received regular reminders to perform skin self-examinations, a mobile dermatoscope that could attach to their smartphone for self-dermascopy, telehealth assessments, and fast-tracked in-person appointments with a dermatologist on an as-needed basis.

Compared with usual care, patient-led surveillance was associated with significantly more frequent (odds ratio 3.5) and thorough (OR 2.2) skin self-exams, the authors report in JAMA Dermatology.

"We knew from patient interviews we had previously done that there was interest from some patients in taking on more of a role in their melanoma surveillance, and that many new melanomas are first detected by patients or family members ahead of a routinely scheduled clinic visit," said senior study author Katy Bell, of the faculty of medicine and health and the school of public health at the University of Sydney.

"The pilot trial's findings that patient-led surveillance appeared safe, feasible, and acceptable was reassuring to us, and indicated that it was worthwhile conducting a larger trial of the intervention to assess effects on health outcomes including the early detection of a subsequent melanoma," Bell said by email.

Self-surveillance also didn't appear to have an adverse impact on psychological outcomes, as assessed based on fear of cancer recurrence subscale scores (mean difference -1.3).

In addition, self-surveillance didn't appear to increase the chance of clinic visits compared with usual care (risk ratio 1.5), skin lesion excisions (RR 1.1), or subsequent melanoma diagnoses (risk difference 10%).

Researchers identified new primary melanomas and local recurrence in 8 (16%) of the people in the self-surveillance group, compared with 3 (6%) in the control group that received only clinician-led surveillance.

In the intervention group, these new and locally recurring melanomas were found in 5 people ahead of routinely scheduled visits. None of these new and locally recurring melanomas were detected before routinely scheduled exams in the control group.

One limitation of the study is that researchers only received patient-reported outcomes from 66 participants. The study had both a high dropout and a high non-response rate, as well as suboptimal adherence to the intervention, researchers note.

"Our results from the pilot trial indicate that many patients may be interested in this model of care, and by providing adequate training and support in using the digital technologies, we can support them to try it out to see if it will work for them," Bell said. "Some patients may decide that it is not for them, and that they'd prefer to rely only on the clinician-led surveillance through skin checks by their doctor at routinely scheduled clinic visits."

SOURCE: https://bit.ly/3rULApn JAMA Dermatology, online November 25, 2021.

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