Self-Examination of Patients with Malignant Melanoma in the Aftercare: Relevance of Psychosocial Factors and Instructions by the Physicians

Abstract

Background: Several studies indicate that the prognosis of malignant melanoma (MM) can be improved if tumor progression, e.g. local recurrences and lymph node metastases, is detected at an early stage. Thus, instructed self-examination by the patients is recommended in aftercare. Although clinical experience shows that many patients do not sufficiently perform self-examination, no studies have so far focused on self-examination behavior. Objective: 1) To assess the self-examination behavior of patients with MM in aftercare, 2) to investigate factors that could explain the self-examination behavior. Methods: Cross-sectional study on 324 patients with MM in aftercare. Validated questionnaires evaluating the disease-related strain, coping with illness, and behavior and attitudes towards self-examination were handed to the patients. Results: 62% of the patients consider self-examination important. However, the operation site and pigmented lesions are inspected on a regular basis by only 29.6% of the patients, the lymph nodes are regularly self-examined by 9.9% of the patients. 73.2% of the patients claim that they have not been instructed by the physicians how to perform self-examinations. Patients who had been instructed in self-examinations rated the importance of self-examinations significantly higher. In this group, the frequency of self-examinations correlated with prognostic markers such as tumor depth and Clark level. By contrast, in the group of patients who had not been instructed, the frequency of self-examinations correlated with psychosocial strain. Conclusions: Although self-examinations in the aftercare are of considerable importance, most patients are not instructed and are not used to performing self-examinations. Patients who had been instructed show a more adequate and reasonable self-examination behavior.

Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review

“…Not surprisingly, physician support plays a major role in improving SSE practices among melanoma patients. Patients who have been instructed by physicians on how to practice SSE conducted SSE significantly more often [58].…”

Fear of new or recurrent melanoma after treatment for localised melanoma

“…Only a small proportion of people treated for melanoma perform regular total skin examination (a recent report estimated only 14%), but doing so may enable and empower individuals, with evidence that actively doing something to prevent recurrence or new primary melanoma offsets some of the worry . It is important that the effects of interventions to increase self‐examination on levels of melanoma‐associated fear are tested however, as overly frequent self‐examination may itself be associated with higher levels of anxiety (without randomized control trial evidence, it is difficult to know the direction of any possible causal relationship). Increased psychological support for people diagnosed with localised melanoma may be another way to decrease fear levels, as shown in a recent trial among high risk patients …”

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

“…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. First, while distress is a very well known risk factor for non-compliance with medical advice in general [62-64], only few studies assessing SSE included a measure of psychological distress [65,66]. Second, while research has shown a higher prevalence of avoidant coping in skin cancer patients compared to both other cancer patients and healthy controls [67-72], only one study has examined the potential link between coping strategies and SSE in melanoma survivors [66].…”