372 Factors associated with adherence to skin self-examination recommendations for melanoma patients: A prospective cohort study

Abstract

Skin self-examination (SSE) by melanoma patients is an important tool in our armamentarium against this deadly cancer, having been found to be associated with decreased melanoma thickness and improved survival. However, patient adherence to SSE recommendations is imperfect, and little is understood about factors associated with improved adherence. We sought to identify factors associated with adherence to SSE recommendations through a prospective cohort study of newly diagnosed melanoma patients seen at the Pigmented Lesion Clinic(PLC) of the University of Pennsylvania from 2012 to 2018. Eligible subjects had their 1st melanoma within 6 months of original PLC visit and had PLC follow up for at least 2.5 years. Patients with metastases were excluded. At each visit, patients were advised to perform monthly SSE and asked about home SSE practices. A total of 369 melanoma patients fulfilled eligibility criteria. The mean age was 56.4 years (SD=13.9), and 202 (54.7%) were male. At their most recent visit during the study period, 260(60.5%) reported doing home SSE since their prior PLC visit. Using a multivariable logistic model, factors significantly associated with SSE included younger age (OR=0.98 for each year increase in age, p=0.005), female sex (OR=1.60, p=0.049), increased disease severity as assessed by calculating expected 8-year survival (OR=2.17, p=0.009), and having a significant other (a “helper”) assist with the examination (OR=2.51, p=0.001). Having had total body photography, having an increased number of nevi, and having had more than one melanoma were not associated with adherence either on univariate analysis or when included in a multivariable model with the other variables described herein. We have identified characteristics associated with improved adherence to SSE recommendations. Understanding which patients may be non-adherent allows us to improve targeting of efforts aimed towards increasing adherence to patient populations less likely to comply.