Once a person has had melanoma, would they be more likely to detect the signs of another lesion developing earlier? That’s the idea behind the Melanoma Self Surveillance Study (MEL-SELF), a pilot randomized clinical trial involving patients from 2 specialist-led clinics in Sydney, Australia, and 1 primary care practitioner-led skin cancer clinic in Newcastle, Australia.
A team of researchers sought to determine the potential value of patient-led surveillance for patients with prior localized primary cutaneous melanoma compared with the standard clinician-led model of surveillance. Their findings were published in JAMA Dermatology.
One hundred participants were recruited and randomly assigned 1:1 to the control (usual care) group or the intervention group. The intervention group received usual care plus patient-led surveillance, which entailed ongoing reminders to perform skin self-examination (SSE), a mobile dermatoscope attached to their smartphone to perform self-dermoscopy, fast-tracked unscheduled clinic visits, and teledermatologist assessments.
“At the 6-month follow-up, the intervention group had higher levels of confidence and knowledge of SSE, more positive attitudes and beliefs toward SSE, and were more likely to engage in SSE, compared with the control group,” the researchers reported.
The patients in the intervention group were more likely to perform SSE at least every 2 months, use a mirror to check hard-to-see locations, and check all areas of their bodies, as well as involve a partner to check their skin. They also attended more clinic visits. The intervention also did not result in any adverse psychological outcomes.
A subsequent new primary melanoma or recurrent lesion was diagnosed in 11 participants during this trial. “Most (5 of the 8) new melanoma diagnoses in the patient-led surveillance group were made at fast-tracked unscheduled visits,” observed the researchers. The 3 new melanoma diagnoses in the control group were made at routinely scheduled visits.
These findings suggest that patient-led surveillance is safe, feasible, and acceptable.
The sample size was relatively small and limited the researchers’ ability to interpret potential intervention results on secondary outcomes. Confidence intervals were found to be “generally wide and often crossed null effect.” The researchers also noted withdrawal and nonresponse rates were relatively high, and adherence to the intervention was less than optimal. However, when consulting with members of the intervention group, they gleaned some useful insights about difficulties that those participants experienced and plan to follow up with a future qualitative assessment.
Disclosure: Multiple authors declared an affiliation with a biotech, pharmaceutical, and/or device company. Please see the original reference for a full list of authors’ disclosures.
Ackermann DM, Dieng M, Medcalf E, et al. Assessing the potential for patient-led surveillance after treatment of localized melanoma (MEL-SELF): a pilot randomized clinical trial. JAMA Dermatol. Published online November 24, 2021. doi:10.1001/jamadermatol.2021.4704