LOS ANGELES — Asking patients to perform thorough skin self-examinations and to bring a diagram of moles they observe to their appointment will improve the rates and the accuracy of self-examinations, Dr. Martin A. Weinstock said at the annual meeting of the Society for Investigational Dermatology.
In a randomized study of 88 patients being seen in primary care clinics for routine visits, all were asked to perform skin self-examinations at home for melanoma prevention, of which half were asked to make a diagram of the lesions they observed before their next visit. Dr. Weinstock and his associates photographed the patients' backs, but patients did not see the photos at that time (J.A.A.D. 2006;55:245–50).
When the patients returned 2 weeks later for a follow-up visit, they were shown two photos of their backs and told that one or both photos might contain a phony 5-mm pigmented lesion that had been added using Adobe Photoshop software.
Patients who had been asked to diagram their lesions were better able to detect the “new” lesion on their back photos, reported Dr. Weinstock, professor of dermatology and community health at Brown University, Providence, R.I., and his associates.
“It's a very simple intervention, and something that I now do routinely because it works,” he said. Making the lesion diagram improved the accuracy of skin self-examinations probably because patients had to really look at their back and do a more thorough job of examining the skin in order to diagram the lesions.
In a separate randomized study that has been accepted for publication, Dr. Weinstock and associates compared a multicomponent intervention designed to get people to do thorough skin self-examinations monthly with a control group of people placed on dietary interventions who also were asked to do monthly skin self-examinations.
At baseline there was no difference between groups in the proportion doing thorough skin self-examinations, but at 2, 6, and 12 months after the intervention, significantly more people in the multicomponent intervention group were doing thorough skin self-exams, compared with the control group. Participants were recruited from primary care offices.
Significantly more people in the intervention group went out and bought wall mirrors. “As research funding gets tight, I assure you that for my next grant I will figure out who manufactures these mirrors and see if they have some spare cash,” he said. The National Institutes of Health funded the study.
The proportion of people who underwent some kind of skin surgery was similar between groups in the 6 months prior to the study. Six months after the intervention, significantly more people in the intervention group had skin surgery, compared with the control group, but that difference disappeared by 12 months after the intervention.
“When you get people to look at their skin, they see all sorts of stuff that they never really noticed before, and they ask their doctor about it,” Dr. Weinstock said. That may explain the higher surgery rate after 6 months. Over time, as people become more familiar with what's on their skin, new surgery is less likely, he speculated.
A 1996 study showed that people who do skin self-examinations are about one third less likely to develop melanoma over a 5-year period and two thirds less likely to develop lethal or advanced melanomas, compared with people who don't perform skin self-exams. In general, 80%–90% of people don't do thorough skin self-examinations, he said.
Factors that increase the likelihood of people examining their skin include having a wall mirror, having a partner help with the exam, learning how to do a skin exam with a partner (instead of learning alone), and being advised by a physician to examine one's skin.
“Just tell them,” Dr. Weinstock urged.
“There's a general view among physicians who do a lot of this that patients don't pay attention to you, but in fact many of them do.”