Dermatologic Follow-Up Adherence Associated with Reduced Melanoma Mortality

Higher adherence to dermatology appointments after a first melanoma diagnosis is associated with a reduction in melanoma-specific mortality, according to research published in the Journal of the American Academy of Dermatology.¹ The authors said that the findings support exploring different ways to improve adherence rates.

In the United States, melanoma represents the fifth most common cancer. Rates of the disease have been increasing significantly in the country over the past several decades, growing by over 320% since 1975.² Although deaths from melanoma have fallen around 30% in the last 10 years, dermatology follow-up—which is universally recommended by melanoma care guidelines—is lagging among patients.

“A full body skin examination by a physician with appropriate expertise remains the gold standard in skin cancer follow-up, as most recurrences for early stage melanomas are locoregional,” the authors wrote. “Dermatologist-led surveillance facilitates early detection and intervention for recurrences or new primary tumors, as well as psychosocial support and patient education.”

A team of investigators from Queen’s University and the University of Toronto conducted a study to determine the level of adherence to annual dermatologic follow-up in patients with primary cutaneous melanoma. Data for the retrospective inception cohort analysis was gathered from health administrative data sets in Ontario, Canada.

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The study cohort included 10084 adult patients who were diagnosed with their first ever invasive cutaneous melanoma from January 2010 to December 2013. Patients were identified through the Ontario Cancer Registry. Dermatologist follow-up visits were identified via the Ontario Health Insurance Plan. Patients were followed until whichever of these 3 occurred first: death, loss of provincial health insurance coverage, or 5 years after diagnosis.

Patients were excluded from the study if they had a follow-up duration of 1 year or less, if they were not an Ontario resident eligible for the Ontario Health Insurance Plan, if they were under the age of 18, and if they had a previous diagnosis of melanoma. The median age at melanoma diagnosis was 63 and 53.1% of patients were male. The most common melanoma was Stage 1 at 44.7%, followed by unknown stage at 29.5%, stage 2 at 16%, stage 3 at 8.3%, and stage 4 at 1.5%.

Investigators found that, overall, 28% of patients were fully adherent to annual dermatologic examination. However, nearly 27% of patients never saw a dermatologist during follow-up. Two-thirds of the patients saw a dermatologist at least 1 time a year after their initial diagnosis and the median time spent in adherence was 64%. Of patients with stage 1, 28.1% were fully adherent and 25.6% were never adherent; among stage 2, 26.4% were fully adherent and 30.8% were never adherent; among stage 3, 31.8% were fully adherent and 23.8% were never adherent; and among stage 4, 25.8% were fully adherent and 42.4% were never adherent.

Patients who adhered to their annual dermatology assessments for over 75% of the time had a reduced melanoma-specific mortality. Additionally, the strongest independent predictors of becoming adherent included younger age and prior outpatient visits. Other predictors included female sex, higher income, and greater access to dermatology care.

“Our findings support the importance of annual dermatologic assessment for postmelanoma care,” the authors concluded. “Patients, health care providers, and policy-makers should explore opportunities to improve adherence within the constraints of healthcare systems. Further research is needed to confirm a causal association, determine the optimal frequency of follow-up, and address barriers to adherence.”

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References

1. Huang Y, Fleming P, Fung K, et al. Association between dermatology follow-up and melanoma survival: A population-based cohort study. J Am Acad Dermatol. 2024 Jun;90(6):1161-1169. doi: 10.1016/j.jaad.2024.02.015. Epub 2024 Feb 16. PMID: 38368952.

2. Saginala K, Barsouk A, Aluru JS, Rawla P, Barsouk A. Epidemiology of Melanoma. Med Sci (Basel). 2021 Oct 20;9(4):63. doi: 10.3390/medsci9040063. PMID: 34698235; PMCID: PMC8544364.