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Original Investigation
April 2018

Patient Preferences for Follow-up After Recent Excision of a Localized Melanoma

Author Affiliations
  • 1Clinical Research Centre Perak, Ministry of Health Malaysia, Ipoh, Perak, Malaysia
  • 2School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  • 3NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
  • 4School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  • 5Melanoma Institute Australia, Sydney, New South Wales, Australia
  • 6Discipline of Dermatology, The University of Sydney, Sydney, New South Wales, Australia
  • 7The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  • 8Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
  • 9Division of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  • 10Cancer Voices NSW, Sydney, New South Wales, Australia
  • 11Centre for Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia
JAMA Dermatol. 2018;154(4):420-427. doi:10.1001/jamadermatol.2018.0021
Key Points

Question  Do patients with melanoma prefer the currently recommended schedule of follow-up or fewer visits, including not continuing follow-up after the first year for patients with stage 0/1A, and after the second year for those with stage 1B?

Findings  In this survey study of 230 patients without recurrent or new primary melanoma, 149 preferred currently recommended and 81 preferred fewer scheduled visits. Higher stage, melanoma on a limb, living with others, no private health insurance, and another chronic condition were independently associated with a preference for fewer visits.

Meaning  Some patients with early-stage melanoma who do not have a new or recurrent melanoma may prefer fewer scheduled visits.

Abstract

Importance  The standard model of follow-up posttreatment of localized melanoma relies on clinician detection of recurrent or new melanoma, through routinely scheduled clinics (clinician-led surveillance). An alternative model is to increase reliance on patient detection of melanoma, with fewer scheduled visits and increased support for patients’ skin self-examination (SSE) (eg, using smartphone apps to instruct, prompt and record SSE, and facilitate teledermatology; patient-led surveillance).

Objective  To determine the proportion of adults treated for localized melanoma who prefer the standard scheduled visit frequency (as per Australian guideline recommendations) or fewer scheduled visits (adapted from the Melanoma Follow-up [MELFO] study of reduced follow-up).

Design, Setting, and Participants  This survey study used a telephone interview for surveillance following excision of localized melanoma at an Australian specialist center. We invited a random sample of 400 patients who had completed treatment for localized melanoma in 2014 to participate. They were asked about their preferences for scheduled follow-up, and experience of follow-up in the past 12 months. Those with a recurrent or new primary melanoma diagnosed by the time of interview (0.8-1.7 years since first diagnosis) were asked about how it was first detected and treated. SSE practices were also assessed.

Main Outcomes and Measures  Proportion preferring standard vs fewer scheduled clinic visits, median delay between detection and treatment of recurrent or new primary melanoma, and SSE practices.

Results  Of the 262 people who agreed to be interviewed, the mean (SD) age was 64.3 (14.3) years, and 93 (36%) were women. Among the 230 people who did not have a recurrent or new primary melanoma, 149 vs 81 preferred the standard vs fewer scheduled clinic visits option (70% vs 30% after adjusting for sampling frame). Factors independently associated with preferring fewer visits were a higher disease stage, melanoma on a limb, living with others, not having private health insurance, and seeing a specialist for another chronic condition. The median delay between first detection and treatment of recurrent or new primary melanoma was 7 and 3 weeks, respectively. Only 8% missed a scheduled visit, while 40% did not perform SSE or did so at greater than 3-month intervals.

Conclusions and Relevance  Some patients with melanoma may prefer fewer scheduled visits, if they are supported to do SSE and there is rapid clinical review of anything causing concern (patient-led surveillance).

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