Partner-Aided Skin Exams Increase Early Detection of New Melanomas

July 27, 2016, by NCI Staff

People who have previously been treated for melanoma—and are therefore at high risk for developing a second melanoma—can team up with a spouse, family member, or a friend and be trained to find new melanomas successfully, a new clinical trial showed.

In the trial, patients and their skin-check partners who received training in how to find and track suspicious moles over time found substantially more early-stage melanomas than pairs who only received reminders from their doctors to perform regular skin self-examinations.

The training also reduced the worry often felt by patients who are told to keep an eye on their skin but not offered detailed guidance, explained June Robinson, M.D., of the Northwestern University Feinberg School of Medicine and lead author of the study.

“Because they had very specific training and rules about mole checks to refer to, [pairs] felt comfortable watching suspicious areas over time for changes,” and didn’t feel the need to check in with their doctors frequently for reassurance, she said.

The findings were published June 29 in JAMA Dermatology.

Learning Their ABCDEs

The trial enrolled 494 people who had undergone surgery for stage 0 to stage IIB melanoma. To be eligible for the study, participants needed to have a regular skin-check partner. For many people who enrolled, this was a spouse or significant other, but some participants chose a close friend or adult child. Having a skin-check partner helps people regularly monitor areas that are difficult to see on their own, such as the back, top of the head, or buttocks.

The researchers randomly assigned the pairs to one of four groups. Three groups received training in how to do a skin self-examination that was delivered in person (165 pairs), on a tablet computer (71 pairs), or in a printed workbook (159 pairs). The fourth group (99 pairs) was the control; these pairs received standard in-office education that emphasized the risk of developing a second melanoma and pointed patients to online material on skin self-examination but didn’t teach specific skills. For the three groups that received the training, a dermatologist provided reinforcement of skills and feedback during quarterly visits.

The skills training materials recommended monthly skin self-exams and taught participants to recognize worrisome features of moles using a scorecard based on the ABCDE method for assessing abnormal-looking moles.

Compared with those in the control group, patients and their partners who received the skills training performed more skin self-examinations during each prior 4-month period measured at 4 months (an average of 1.57 more), 12 months (an average of 0.72 more), and 24 months (an average of 0.94 more).

During the 4 years of the trial, participants in the three intervention groups identified a total of 43 new melanomas, and their doctors identified an additional 10. Three of the 10 melanomas found by the doctors occurred in patients whose partner had died during the study.

In contrast, none of the pairs in the control group identified a new melanoma, and their doctors identified 16. (The control group contained only about a quarter of the trial participants). Very few extra visits to the dermatologist—meaning appointments requested outside the regular quarterly visits—for concerning moles occurred in either the control group or the intervention groups.

"We've been saying for a long time that high-risk individuals can benefit from self or assisted self-exams if they know what they are looking for," said Margaret Tucker, M.D., of NCI's Division of Cancer Epidemiology and Genetics, who was not involved in the study.

Although a larger trial is needed to determine whether the approach is successful across multiple centers with a broader range of participants, continued Dr. Tucker, "These are important data for the U.S. Preventive Services Task Force to include in future deliberations about the role of screening for melanoma.

“With the projected increase in melanoma over the next decade, such screening could have a major impact on the cost of melanoma care because of early detection of subsequent melanomas," she added. Early-stage disease is both easier and less expensive to treat than later-stage disease. She also cautioned, however, that training in skin self-exams is unlikely to be cost effective in the general population, who are not at high risk of melanoma.

It’s also important for patients to understand that the training was designed to increase early detection of new melanomas, not decrease the risk of distant recurrences—metastases—from their original melanomas, explained Dr. Robinson.

“They’re two separate things, but since these patients are at high risk [for second melanomas]…it’s worth attending to the thing we can do something about,” she said. 

Dr. Robinson and her colleagues plan to follow the participants for several more years, to see if the intervention groups continue to perform skin self-exams without the reinforcement of regular visits to the dermatologist, and whether early detection contributes to improved outcomes, she said.

The researchers also plan to conduct a pilot study to see if the workbook intervention, delivered by mail without training reinforcement during dermatologist appointments, can help increase the frequency and effectiveness of skin self-examinations.