Patient-led skin surveillance using teledermatology is a promising new model of follow-up care after excision of localised melanoma, according to Australian researchers.
A pilot study of 100 patients previously treated for melanoma found that using a mobile dermatoscope device attached to their smartphone, along with a skin-checker app, and a little help from a partner, was a safe, feasible, and acceptable way to monitor for melanomas.
The MELanoma SELF surveillance (MEL-SELF) study involved patients recruited by nine clinicians from two melanoma specialty clinics and one primary care skin cancer clinic in New South Wales. Of the more than 300 patients invited to participate, 31% were randomised to six months of patient-led surveillance plus usual care (ie, educational booklet and routinely scheduled visits) or to clinician-led surveillance (usual care only).
The intervention group received training in how to undertake skin self-examination using a mobile dermatoscope (MoleScope) attached to their smartphone, and an app that facilitated store-and-forward teledermatology to the DermEngine online platform.
Every two months, participants were asked to take macroscopic and dermoscopic images of three to nine different skin lesions that appeared most concerning and to include information on why the lesion was concerning to them.
Images were reviewed by ‘teledermatologists’ who responded within three days and offered fasttracked unscheduled clinic visits for lesions of concern.
Compared with clinician-led surveillance (usual care), patient-led surveillance was associated with increased skin self-examination frequency (odds ratio [OR], 3.5) and thoroughness (OR, 2.2).
About half of the 49 intervention participants (53%) successfully submitted dermoscopic images and received teledermatology reports on one or more occasions, and 29% successfully submitted images on two or more occasions. In total, 353 images were submitted by 26 participants. Patients in the surveillance groups had 50% more clinic visits than the usual care group, but this was likely because the trial was an add on to usual care, the study investigators said.
New primary melanomas and one local recurrence were diagnosed in 8 (16%) of the participants in the intervention group, including five (10%) ahead of routinely scheduled visits; and in three (6%) of the participants in the control group, with none ahead of routinely scheduled visits (risk difference, 10%; 95% CI, 2% to 19%).
Of the eight intervention group participants diagnosed with a subsequent new primary melanoma or recurrence, five had a new primary melanoma in situ (stage 0 melanoma), one had a locally recurrent melanoma in situ, and two had stage IA melanoma.
Skin self-examination had no detectable adverse effect on psychological outcomes, 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%).
The study investigators, led by Dr Deonna Ackermann and Associate Professor Katy Bell of Sydney University, said the pilot trial had provided promising results and highlighted areas of the protocol that had subsequently been improved and streamlined to make the skin checking and lesion image review process more efficient.
With a larger RCT now underway, patients are getting more training and the frequency of self-examination and teledermatology has been reduced to every three months in response to participant feedback, they said.
Changes had also been made in the criteria for patients submitting images and for teledermatologists in recommending urgent clinical review.
“If the intervention is found to be beneficial [in a larger RCT], it may then be tested in other clinical populations at higher risk of new primary or recurrent melanoma, including patients with stage III disease and organ transplant recipients,” the authors said.
“This evidence may transform melanoma surveillance models of care for diverse patient populations,” they concluded.
The findings are published in JAMA Dermatology.