Predictors of skin self-examination before and after a melanoma diagnosis: the role of medical advice and patient’s level of education

Abstract

BackgroundCutaneous melanoma is the fastest growing tumor of the skin and the median life span of patients with advanced disease is less than a year. Melanoma-related mortality can be reduced through early detection via clinical skin exams and patient self-examination. Despite the potential to reducing the medical burden associated with clinical skin exams, systematic and regular skin self-examinations (SSE) are rarely performed. The current study examined psychosocial predictors of SSE and changes in SSE behavior from pre- to post-diagnosis in order to guide future melanoma prevention initiatives.FindingsA consecutive sample of 47 melanoma survivors was drawn from a tertiary care clinic. Most melanomas had been detected by patients, spouses and other laypersons. Higher education was related to more frequent SSE at pre-diagnosis, more thorough SSE at post-diagnosis, and more frequent reports of having been advised to perform SSE at post-diagnosis. SSE behaviors increased significantly from pre- to post-diagnosis.ConclusionsThese findings suggest that different patient subgroups display varied knowledge base, readiness for change, and receptiveness for medical advice. Thus, interventions seeking to enhance skin self-exam practice may be most effective when the individual’s psychosocial characteristics are taken into account.

Demographic, behavioural and physician‐related determinants of early melanoma detection in a low‐incidence population

“…4 Several studies have addressed the impact of various clinical, demographic and behavioural parameters in the detection of early vs. late or thin vs. thick melanomas. [6][7][8][9][10][11][12][13] We performed a multicentre survey of 202 Greek patients with newly diagnosed invasive cutaneous melanoma, with the primary aim of identifying differences associated with the diagnosis of thinner vs. thicker tumours in a low incidence population with recent exposure to awareness campaigns. 14 …”

Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care

“…Together, these hospitals treat over 400 new melanoma patients annually [77,78]. Previous psychosocial studies with cancer populations at the same hospitals [30,79,80] and at other sites [81-92] reported participation rates between 57-86%, with a mean of 76%. Attrition rates range between 4% and 24% in psychosocial studies with an assessment up to 18 months after the treatment of patients with melanoma [56,93] or other cancers [67,82,83,94-97].…”

“…With the Medical Information Sheet [30] the RA gathers data such as time since diagnosis, melanoma stage and depth, previous diagnosis of cancer, melanoma treatment and disease progression. The Skin Cancer Prevention Scale [122] captures whether patients performed SSE and have been advised by health care providers about SSE prior to their current melanoma diagnosis.…”

“…About 75% of melanomas are detected by patients themselves or by spouses, friends, or other lay persons [26-30]. Early detection programs have been proven successful for the general public and for high-risk populations.…”

“…In some studies, this information has been collected by simply asking patients if they perform SSE without inquiring about the surface of skin examined or by inquiring ambiguously about frequency (e.g., rarely, sometimes, often) instead of using specific frequency categories (e.g., weekly, monthly, twice a year). As a result, rates of thorough SSE amongst melanoma survivors have ranged between 14% and 75% in different studies [30,34,45,46,60,61]. Another limitation of previous research is that key psychological variables, such as psychological distress, coping and professional/personal support, are widely neglected in relation to SSE.…”