Melanoma surveillance on their own device: Can patients identify subsequent melanoma?

Background: Patients may lead their own surveillance for subsequent new primary or recurrent melanoma, but the comparative safety, feasibility and acceptability is unknown.
Aim: To investigate whether patient-led surveillance of subsequent melanoma is safe, feasible and acceptable.
Methods: A total of 100 patients previously treated for localised melanoma were recruited from specialist and primary care clinics in New South Wales, Australia. Participants were randomised (1:1) to6 months of patient-led surveillance (intervention: usual care plus reminders to perform skin self-examination (SSE), patient-performed dermoscopy, teledermatologist assessment and fast-tracked unscheduled clinic visits) or clinician-led surveillance (control: usual care).The primary outcome was the proportion of patients approached to participate who were randomised. Secondary outcomes included patient-reported outcomes (SSE knowledge, attitudes and practice, psychological outcomes, other healthcare use) and clinical outcomes(clinic visits, skin surgeries, subsequent new primary or recurrent melanoma).
Results: Between November 2018 and May 2019, 481 patients were approached to participate, of whom 116 were ineligible and 100(21%; 95% CI: 17%–25%) were randomised to patient-led surveillance (n = 49) or clinician-led surveillance (n = 51). Data were avail-able on patient-reported outcomes for 66 participants, and on clinical POSTER ABSTRACTS 71outcomes for 100 participants. Compared with clinician-led surveillance, patient-led surveillance increased SSE frequency and thoroughness, had no detectable effect on psychological outcomes and increased clinic visits, skin lesion excisions and subsequent melanoma diagnoses. New primary melanomas were diagnosed in eight intervention group participants (16%) and in three control group participants(6%). All five detected at unscheduled visits were in the intervention group (between-group difference: 10%; 95% CI: 2%–19%). No recurrences were diagnosed.
Conclusion: Patient-led surveillance following treatment of localised melanoma appears safe, feasible and acceptable. A larger trial of the same intervention will generate evidence on comparative effects on health, psychological and resource use outcomes and assess whether patient-led surveillance may be translated into policy and practice.