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Partner-assisted skin self-examination may help in early detection of melanoma

Partner-assisted skin self examination (SSE) appears to be beneficial and may aid in the early detection of melanoma, according to Dr. June Robinson, who presented study findings during a presentation at the 23rd World Congress of Dermatology in Vancouver.

The role of a partner in assisting with SSE is helpful in many ways. The partner can see locations on a person that the person themselves cannot see such as the ears, back of neck, top of scalp, back and soles of the feet for example, reported Dr. Robinson, research professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago. She was speaking at the WCD session hosted by the American Academy of Dermatology.

In addition, a partner assisting with SSE can also be useful for encouraging and reinforcing the importance of conducting regular SSE for the early detection of melanoma in these patients, Dr. Robinson said.

A partner can also assist with the management decision regarding when these patients should see a

doctor, she added.

How did the idea of partner-assisted SSE emerge?

The idea of including a patient’s partner in the SSE learning process to detect the early signs of melanoma came to Dr. Robinson while she was seeing a male patient who insisted that his wife attend the medical appointment so that she could learn about SSE.

As a result of her patient’s request, she taught both of them about the use of SSE to detect early melanoma.

“Two years later the wife of my patient came back and of course she dragged her husband into my office. It turned out that she had detected an early melanoma of 0.41 mm located on her husband’s upper back,” said Dr. Robinson.

This patient really became a index case, she said, which lead to the investigation and the formation of the novel concept of partner-assisted SSE.

Survey found females performed SSE more than males

To help focus the research, Dr. Robinson and her colleagues developed a survey form.

“What we did was survey the population of our melanoma patients and the findings suggested that

females performed SSE more than males."

“We also found that younger people performed SSE more and that they were more likely to ask for help from their partner,” Dr. Robinson said.

During her presentation, Dr. Robinson said they continued their research by working on the development of a model of instruction regarding SSE that lay people could understand. They spent about two years conducting qualitative research, focus group testing and cognitive interviews.

Patients experienced some difficulty understanding asymmetry

In the process of collecting data, Dr. Robertson said that she found that most lay people did not know what the term asymmetry meant and it did not seem to matter how many times it was explained to them.

In order to help with the creation of an explanation for the early detection of melanoma that lay people

could understand, Dr. Robinson reviewed original literature on the ABCDE mnemonic (Asymmetry,

Border, Colour, Diameter, and Evolving or Elevation) that has been helpful in identifying early melanoma.

Dr. Robinson added that she and her colleagues conducted a study aimed at helping patients develop their SSE skills by improving the use of the ABCDE criteria in those at risk of developing melanoma. Their research was published in the Archives of Dermatology (Apr. 2006;142(4):447–452).

This investigation involved 100 unrelated adult participants who had either a personal or family history of melanoma and no previous skin self examination counselling. During the study, the participants were divided into 10 groups and they then received a knowledge-based intervention to learn about the ABCDE criteria, followed by skills training.

The study findings revealed that recognition of mole border irregularity, colour variation, and diameter

improved significantly after the participants had learned about the ABCDE criteria.

Data also showed that women participants tended to recognize colour variation more often than men, while men identified irregular borders more often than women.

Also, women most appropriately decided to see a physician more often than men, according to the

study authors.

In their conclusion, the authors noted that skills training aided performance of SSE. The differences in

observations according to gender suggest that if men and women form partnerships for skin checks, they may learn from each other, and their combined strengths could help to promote the detection of early melanomas.

After reviewing data, Dr. Robinson said that they had found that BCD of the melanoma mnemonic were the most important features that needed to be taught to patients to help them to recognize a possible melanoma.

Dyadic learning about SSE more effective than solo learning

Dr. Robinson referenced another study that she and her colleagues were involved in that was published in the Archives of Dermatology, which suggested that dyadic or cooperative learning may be more effective than solo learning in regard to interventions designed to teach and promote health behaviours such as SSE (Jan. 2007; 143(1):37–41).

This study consisted of 130 participants and their cohabiting partners drawn from a melanoma registry. During the investigation the subjects were randomly assigned to receive the intervention either as solo learning or as dyadic learning. The intervention consisted of a 10-minute demonstration of the ABCDE (asymmetry of shape, border irregularity, colour variegation, diameter >/=6 mm, and evolution of the lesion) rule and skills training.

“Findings revealed that those in the dyadic learning group were more likely to report engaging in monthly SSE behaviour,” Dr. Robinson reported.

More awareness about SSE needed

“We have done a wonderful job at creating awareness about melanoma, but just creating awareness has not been enough to support SSE performance,” she said.

“Supporting the SSE performance in a continuous [manner] requires social support from someone who is a relative or a skin check partner,” Dr. Robinson said in conclusion.

This article was previously published in The Chronicle of Skin & Allergy.

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