Experts Report Moderate Patient Adherence to Melanoma Screening and Surveillance Program

The implementation of a melanoma screening and surveillance program tailored to individual patient needs yielded a 62%, or moderate, level of adherence, according to a study published in the International Journal of Cancer.¹

Researchers found that decisions to deviate from adherence were more frequently influenced by clinicians than by patients.

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Background and Methods

According to researchers, cancer screening programs traditionally focus on age, sex, and family history. Studies indicate that both health care professionals and the public generally favor more frequent screenings for high-risk individuals, while there is less enthusiasm for reducing or eliminating screenings for those at lower risk.²

The study employed a prospective implementation design and included adult patients of the Melanoma Institute Australia who had received personalized risk assessments and follow-up recommendations between February 2021 and March 2022. These recommendations were based on empirical data and adjusted according to risk thresholds. The study included risk thresholds for scheduling skin checks based on the 10-year melanoma risk.

All patients completed a risk factor questionnaire before their consultations, receiving a personalized risk report and tailored skin check schedule. Clinicians had the option to view these recommendations but made final decisions based on their judgment. Researchers collected data relative to adherence by examining clinic appointment records and clinician documentation of any deviations from the recommended schedules.

Findings

The study included data from 151 randomly-sampled patients and 96 patient cases with clinician-recorded deviations. Additionally, researchers conducted interviews with 29 patients and 11 clinic staff.

From the randomly sampled patients, adherence to the recommended skin check schedules was observed in 62% of cases. Among those who deviated from the recommendations, the majority (79%) had increased their skin check frequency, while 21% had it decreased. Furthermore, deviations toward increased frequency were more common among lower-risk patients, younger individuals, and females. Conversely, those with the highest risk (≥75%) were more likely to have their skin check frequency reduced.

Clinician-recorded deviations mirrored these patterns, with 84% of deviations leading to more frequent checks, especially among lower-risk patients. Researchers reported that deviations were influenced by both patient-driven factors, such as anxiety or preferences for continued specialist care, and clinician-driven factors, including concerns over incomplete risk assessment and specific clinical concerns.

In an assessment of qualitative insights, researchers found that many patients expressed a strong belief in following medical recommendations and valued the reassurance provided by scheduled appointments, particularly those advised to visit more frequently. Some patients preferred more frequent checks due to anxiety about missing potential melanomas or concerns about their ability to detect changes independently.

Additionally, clinicians often tended to adjust recommendations based on their judgment of individual patient risk, which sometimes included factors not fully captured by the risk tools. Concerns about specific lesions or perceived inaccuracies in risk assessments influenced their decisions to recommend more frequent visits.

Patient non-adherence was often attributed to patient anxiety, distrust in risk assessments, or a desire for specialist care. For clinicians, non-adherence often stemmed from concerns about factors not covered by the risk tool or specific clinical judgments about patient needs.

Conclusions

To the knowledge of researchers, this study is the first of its kind aimed at assessing adherence to risk-determined skin checks for melanoma.

The study may have been limited by oversimplified categorization of factors affecting adherence and a potential lack of generalizability to primary care settings.

"Our study adds to the body of evidence that implementation of melanoma risk tools in practice is feasible and can be used to tailor skin check schedules for melanoma screening and surveillance," according to Perera et al.

References

1. Perera MM, Smit AK, Smith AL, et al. Adherence to melanoma screening and surveillance skin check schedules tailored to personal risk. Int J Cancer. August 23, 2024. https://doi.org/10.1002/ijc.35146
2. Dunlop K, Rankin NM, Smit AK, et al. Acceptability of risk-stratified population screening across cancer types: qualitative interviews with the Australian public. Health Expect. 2021; 24: 1326-1336.