Digest Commentators: Chelsea Moran, BSc, MA (c) & Adina Coroiu, MA, PhD (c), Department of Educational
and Counselling Psychology, McGill University
Digest Editor: Mary Ann O’Brien, PhD, Department of Family and Community Medicine, University of Toronto
Early detection and timely treatment of melanoma improves survival. Given that most melanomas are self-detected (by individuals or their partners), skin self-examination (SSE) is an important adjunct to yearly skin examinations by a physician. Partners can help at-risk individuals check body areas that are more difficult to examine carefully, such as the scalp and back. Robinson and colleagues (2016) examined the long-term effect of a structured educational intervention on participant frequency of SSE conducted with a partner.
This study analyzed data from a randomized controlled trial (RCT; NCT01432860), in which melanoma patients with stage 0 to IIB melanoma and their skin-checking partners were randomized to one of three active intervention conditions or a control. The three active conditions included identical content, which was delivered in three different formats: in-person education, workbook education, and electronic tablet education. The active intervention included monthly SSE recommendations, written materials about how to use the ABCDE (asymmetry, border, color, diameter and evolution) criteria to identify suspicious lesions, a diary and body maps to record SSE and track mole history, and reinforcement of skills by dermatologists at 4-month intervals. The control condition included customary education, as per usual care. The aim of the study was to assess the effect of the intervention compared to the control on three outcomes: 1) frequency of SSE (objective 1); 2) patient-detected and physician-detected new or recurrent melanomas (objective 2); and 3) number of unscheduled physician appointments (objective 3). The three outcomes of interest were assessed at 4, 12, and 24-months post-intervention.
In total, 494 dyads were randomized with 59% completion by the 24-month follow-up. Since there were no significant differences in SSE frequency among the intervention groups, the three groups (in-person, workbook, tablet) were collapsed into one group. From baseline to 24-months post-intervention, participants in the intervention groups (in-person, workbook, tablet) performed SSE with a partner at a significantly higher frequency than participants in the control group (objective 1). From baseline to 24-months post-intervention, dyads in the intervention groups identified 43 melanomas compared to none identified in the control group (objective 2). Across the entire sample, approximately 13% of participants developed new melanomas. Finally, 28 participants in the intervention groups and 2 participants in the
control group requested unscheduled appointments with the study physicians due to concerning lesions, accounting for only 1.0% of total physician visits (objective 3). The authors concluded that the interventions led to increased SSE performance and increased detection of melanoma in patient-partner dyads, without leading to unnecessary visits to the dermatologist.
Why we liked this article: We liked this article because it underscored the importance of interventions for the early detection of melanoma, as well as the importance of partner assistance with skin self-examination among high-risk groups. Further, this trial is one of the first studies with a rigorous design to show that interventions targeting SSE did not actually increase the number of unscheduled medical visits lending some support to claims that SSE may be a cost-effective behaviour. This is valuable work that will generate further research on the effect of SSE interventions on melanoma early detection and melanoma-related mortality.
This study is a step forward in melanoma prevention literature in that it shows that receiving education about monthly SSE using the ABCDE criteria and tools such as body maps and checking diaries is associated with an increase in SSE with the help of a partner when compared to customary education. The results of this study have important implications for psychosocial professionals working with melanoma cancer survivors, as they reaffirm the need for specific education to promote regular SSE performance. When possible, practitioners should also encourage patients to obtain assistance from their partners when checking their skin to ensure more complete self-exams.
Article: Robinson, J. K., Wayne, J. D., Martini, M. C., Hultgren, B. A., Mallett, K. A., & Turrisi, R. (2016). Early detection of new melanomas by patients with melanoma and their partners using a structured skin self-examination skills training intervention: A randomized clinical trial. JAMA Dermatology, 152(9), 979-985.
Journal website: http://jamanetwork.com/journals/jamadermatology/