Skin self-examination and long-term melanoma survival

Abstract

To evaluate the effect of skin self-examination (SSE) on melanoma mortality, we estimated the survival for individuals performing SSE compared with those who did not. Participants were from a previously carried out case-control study, who were newly diagnosed melanoma cases in 1987-1989. A 20-year survival analysis was carried out using death (event) and other causes of death (competing). Cumulative incidence functions were evaluated using Gray's test and proportional subdistribution hazards regression models were fitted to study the effect of SSE and other covariates on melanoma survival. Forty-five percent of patients died, with 48.4% melanoma deaths. Individuals who did not perform SSE experienced a continuous increase in the risk of melanoma death trending toward significance for nearly 20 years after diagnosis, whereas melanoma deaths in skin self-examiners plateaued before 10 years after diagnosis (P=0.32). Univariate analyses suggested a 25% lower risk of melanoma death for those who performed SSE [hazard ratio (HR)=0.75, 95% confidence interval (CI)=0.43-1.32, P=0.32]. After adjusting for competing risks, the multivariate risk estimate was above one (HR=1.12, 95% CI=0.61-2.06, P=0.71). Skin awareness (HR=0.46, 95% CI=0.28-0.75, P≤0.01) was associated independently with a decreased risk of melanoma death. Although we did not find a significant association between melanoma mortality and SSE when adjusting for competing mortality and other covariates, we extended previous findings that increased skin awareness and tumor thickness are strongly inversely related to survival. Research is needed to continue developing best practices for melanoma screening and to further explore the components of SSE and long-term melanoma survival.

Histopathologic variables differentially affect melanoma survival by age at diagnosis

“…A comprehensive population‐based study of risk factors for incidence and mortality of cutaneous melanoma in Connecticut was conducted between 1986–1987 (incidence) and 2007 (mortality) (Berwick, Begg, Fine, Roush, & Barnhill, ; Paddock et al, ). Of the 650 individuals newly diagnosed with a first primary melanoma of Northern European ancestry in this study, 280 individuals died of any cause, and 123, or 19%, had died of melanoma at the end of follow‐up on July 1, 2007.…”

Effect of a Skin Self-monitoring Smartphone Application on Time to Physician Consultation Among Patients With Possible Melanoma

“…There is US trial evidence for the efficacy of SSE skills training and reminders among patients recently diagnosed with melanoma 37 and among skin clinic patients without melanoma. 38 Furthermore, the Check It Out randomized clinical trial, set in the United States among a similar population with increased risk of melanoma, reported that increasing SSE practices in the short-term resulted in more abnormal lesions detected and more skin surgical procedures, 39 although, like our trial, it was not powered to detect melanoma diagnosis. In the United States, most studies have been set among people previously treated for a melanoma and, therefore, with very high risk for development of a new primary melanoma as well as recurrence.…”

Is there a role for digital technology in measuring the value of skin self‐examination?

“…One case–control study in the late 1980s found short‐term mortality benefits for people diagnosed with melanoma who conducted skin self‐examination . However, at 20‐year follow‐up, taking into account competing risks, the effect was no longer significant …”

“…6 However, at 20-year follow-up, taking into account competing risks, the effect was no longer significant. 7 Digital technology may now allow a quantum shift in evidence generation. For example, people could be asked to send photographs of specific spots or moles a clinician recommended to monitor, or could take photos of body regions that are common locations for melanoma (back, or back of the neck in men; lower legs in women).…”