Melanoma Institute Australia says it has developed an in-dermatology clinic risk assessment strategy that enables the delivery of personalised melanoma risk estimates with no impact on patient flow.

It’s published data showing the tool was well received by clinicians and patients alike in a trial that incorporated waiting room assessments as part of routine care at the MIA’s dermatology clinic.

Starting in February 2021, the team began issuing iPad-based surveys to all attending patients prior to their appointments, featuring questions from two online risk calculators, other studies and clinical questions.

Answers were used to generate personal scores of lifetime melanoma risk, or, for those people with a previous diagnosis, of developing a subsequent primary invasive or in situ melanoma.

Clinically-trained project managers would then take the patient to a private room, show them a print-out of this information, explain the results, and provide behavioural counselling on prevention and early detection – all before the start of their consultation.

Publishing their results in Cancer Medicine (link here), the study investigators said the study showed the idea had “high feasibility”, although it was believed to be the first to explore the acceptability of providing risk-tailored skin surveillance as part of routine dermatology care.

“Overall, the processes for risk assessment and provision of tailored surveillance recommendations were perceived to enhance patient care,” wrote the study investigators in Cancer Medicine.

“For patients, key facilitators included receiving their personal risk information immediately post- survey completion and in- person, which they found highly acceptable.”

“Patients reported that completing the survey while in the waiting room was a good use of their time and was convenient.”

Reactions from dermatologists and clinic staff, 12 of whom were interviewed as part of the study, were also generally positive.

Dermatologists, in particular, reported the personalised information enhanced their confidence in assessing patient risk and recommending tailored surveillance schedules, the researchers said.

Concerns

Nevertheless, there were some concerns; chiefly relating to patients whose risk deviated from their expectations.

Some of these reported feeling worried, confused or mistrust in the risk information, mostly notably those patients who were found to be at lower risk and were recommended to decrease surveillance frequency, according to the authors.

“Among the patient group with discordant risks, particularly for those whose risk estimate was lower than what they expected, some reported a reluctance to reduce their clinical skin check frequency and to be discharged from the dermatology clinic to the care of a general practitioner in the primary care setting,” they wrote.

“Our findings also highlight a need to further explore how to support informed choice for patients regarding reducing the frequency of skin checks where appropriate to improve acceptability for lower risk patient groups.”

The authors noted there is growing research on the acceptability of risk stratified approaches, including increasing intervals of screening.

“Educational strategies such as providing easy to understand information on the safety of reduced screening frequencies, including details regarding the accuracy of risk estimates and the potential for these to change over time, have been recommended,” they said.

“Given that patients in our study highly valued the face- to- face conversions with clinicians about their risk, this may be an opportunity to build patient confidence in low- risk results by providing additional education regarding the potential benefits of reducing skin surveillance, offering behavioural counselling on skin self- examination and primary prevention behaviours (as done in this study), or offering teledermatology for lesions of concern.”