Melanoma patients frequently lack the knowledge or confidence to perform regular, effective skin self-exams (SSEs), according to recent research.
After a melanoma diagnosis, patients are at risk of recurrence for 10 years or more and have a ninefold greater risk of developing a primary melanoma than someone who has never been diagnosed. About 5 percent of those diagnosed will develop a second primary melanoma at some point. Because over half of all melanomas are detected by patients themselves, regular SSEs to check for abnormal moles or skin changes are vital for early detection.
However, the overwhelming majority of melanoma patients do not regularly conduct thorough SSEs, a study in the journal Melanoma Research found. The study examined the behaviors of patients diagnosed with melanoma and the reasons why many do not routinely perform adequate SSEs.
Barriers to prevention
The study involved 176 patients who had been diagnosed with primary pathologic stage 0-III cutaneous malignant melanoma. Participants completed a written or telephone survey. While over 70 percent of respondents had conducted an SSE in the past two months, only 14.2 percent had examined their entire body.
Many participants did not use techniques found in prior research to improve the efficacy of SSEs, with only 9.2 percent reporting someone always helped them during an SSE and 11.3 percent stating they always used a hand-held mirror. Nearly 90 percent acknowledged they never used photos of their moles to help with an SSE.
“The two overarching reasons [for not completing a thorough exam] were first, a lack of awareness about the need: Some patients had never been told by their physician to complete one,” says Elliot J. Coups, PhD, Associate Professor of Medicine at Rutgers Robert Wood Johnson Medical School, resident member of the Rutgers Cancer Institute of New Jersey and lead author of the study. “Secondly, they had never had sufficient guidance on how to perform one — they had no confidence in knowing what to do. The two together are significant barriers to completing a thorough exam.”
However, that does not necessarily mean patients consider SSEs pointless. Nearly three-quarters of respondents were interested in learning more about how to check their skin for cancer.
Partnering for Better Detection
The first step in boosting the number of patients who perform thorough SSEs is ensuring that they are clear about the need to do so. That entails, in part, dispelling the notion that routine physician visits reduce patients’ need to be vigilant.
“Some patients may be reluctant to perform an exam because they do see their physician regularly, but the important thing to emphasize is that a skin check is a complement to whatever the physician is already doing,” Coups says. “Because so many melanomas are first detected by patients themselves, the goal is to get the patient to be aware of red flags or warning signs and then go to a healthcare provider for follow-up.”
“A lot of patients don’t have sufficient knowledge to be confident in their skin self-exams. However, patients are receptive to receiving this information. Physicians can give patients the tools they need. Then follow up on a regular basis to make sure they get the message from their physician that this is important.”
— Elliot J. Coups, PhD, Associate Professor of Medicine at Rutgers Robert Wood Johnson Medical School and resident member of the Rutgers Cancer Institute of New Jersey
Simply starting the conversation may make a significant difference in whether patients perform proper SSEs. Research regarding pediatric cancer survivors has shown success with this method, says Jerod Stapleton, PhD, Assistant Professor of Medicine at Robert Wood Johnson Medical School, Resident Member of the Rutgers Cancer Institute of New Jersey and co-author of the study.
“Even something as simple as encouraging them and talking about it can be helpful,” Stapleton says. “Once a patient is engaged and interested, there are educational programs that teach patients the skills and what to look for. When you give a patient a short presentation or skills training, they can detect [abnormalities] better and more accurately detect what’s problematic and what’s not.”
Prioritizing fundamentals is also vital.
“Emphasize that patients should check their skin every two to three months at home to look for the ABCDEs,” says Marc Glashofer, MD, MS, FAAD, FAACMS, dermatologist with The Dermatology Group in New Jersey and fellowship-trained Mohs surgeon. “Look for moles with asymmetry, border irregularity, color variation, a large diameter and an evolving mole — all of these are details patients should be educated on.”
Dr. Glashofer also recommends the use of a mirror to check sensitive or hard-to-reach areas of the body, such as the genitals or the bottoms of the feet. A cell phone can be used as well to take pictures and record a mole’s progression over time.