Improving outcomes for people with skin tumours including melanoma

One observational study found that 21.8% of patients with AJCC stage
I MM relapsed. The authors concluded that only clinical examination
is cost-effective in the detection of metastases and recommended that
follow-up should be undertaken three times a year.
Improving Outcomes for
People with Skin Tumours
including Melanoma
Follow-up
One observational study found that 20% of patients diagnosed with
stage I MM developed recurrence. Doctor-diagnosed nodal
recurrences were smaller and were associated with fewer
histologically positive nodes than recurrences that were detected by
patients. However, subsequent survival was identical in patients with
recurrences detected by doctors and patients who detected
recurrences themselves. Anxiety prior to clinic visits was reported by
54% of patients, whereas follow-up was considered worthwhile by
95% of patients.
Observational study evidence suggests that between 47% and 72% of
recurrent MMs are detected by patients, and between 26% and 28% of
recurrent MMs are detected by doctors.
Evidence from clinical guidelines based upon a systematic review
concluded that follow-up of patients with MM should include clinical
examination for a finite period and self-surveillance by patients
throughout life.
Educating patients for self-examination
5
In the patient survey commissioned for this guidance, patients were
happy to check themselves for skin cancer having received training,
although some would prefer professional follow-up because of
difficulty accessing certain areas such as the head and back. With
respect to hospital follow-up, patients expressed a wish that follow-up
be undertaken by the same person on subsequent occasions,
preferably a consultant.
One RCT compared nurse education for self-performed skin
examination plus provision of skin photographs with nurse education
and provision of a standard brochure in patients with five or more
atypical naevi, with or without a history of melanoma. The mean
group scores for knowledge, awareness and confidence increased
significantly in both groups at immediate follow-up, but there were
no significant differences in scores between the photography group
and the brochure group.
The RCT described above reported further follow-up at 4 months, and
found that the teaching intervention with the photo book
demonstrated a significantly greater increase in the number of patients
reporting self-examination, compared to the group that received
teaching and a standard brochure.
Guidance on cancer services: skin tumours including melanoma 109