Targeted Melanoma Detection With Skin Self-Examination During COVID-19 Restricted Physician Access

Not Applicable

Completed

Brief Summary: The purpose of this study is to reduce melanoma mortality by improving early detection of melanoma with skin self-examination (SSE) among people who self-identify as being at risk and seek care for a concerning mole. Because women are more likely than men to perform SSE, women who are engaged in health promotion by having a recent screening mammogram are the focus of this research. Self-management of melanoma detection with SSE depends on ready access to dermatologists when a concerning mole is detected. In March 2020, the Illinois stay at home order (COVID-19) prohibited non-essential health care, including screening mammography and dermatology office-based care, and both are expected to remain limited until fall 2020. This submission explores a) the effectiveness of targeted melanoma detection (TMD) among women, who identify their risk of having a melanoma, learn to perform SSE, and perform SSE, and b) the effectiveness of adhesive patch-based home sample collection for genomic analysis to rule out melanoma in moles identified by women (who received the intervention) as concerning will be explored.

Detailed Description: The proposed work will assess the effectiveness of targeted melanoma detection (TMD) with SSE education delivered remotely to women who had a screening mammogram. The effect of TMD with SSE education will be assessed with a randomized control trial among women served by Northwestern Medicine in rural, suburban and metropolitan communities. Women who identify concerning moles will choose among three options: a) watch the mole to see if the border, color or diameter of the mole changes b) send a picture of the mole to the PI for consideration of mole self-sampling, or c) make an appointment with my healthcare provider to check the mole. As required a physician will supervise women, who will perform non-invasive mole self-sampling with non-invasive adhesive patches for genomic analysis of the concerning pigmented lesion (mole). If the genomic analysis suggests that the concerning mole may be a melanoma, then the recommendation will be to have the mole biopsied.The effectiveness of acquired samples suggestive of melanoma will be examined by the obtaining the pathology reports of biopsied moles. Health care providers' (HCPs) clinical/pathologic assessment of concerning moles will be identified in the Northwestern Medicine electronic health record (EHR) system.

Recruitment & Eligibility

Inclusion Criteria

Adult women (aged 18 and older) with no upper age limit, who had a screening mammogram from January 1, 2019 to February 28, 2020.
Able to read English
Vision enough to read a newspaper
Self-perception of their potential melanoma risk
Willing to perform SSE either alone or with a skin check partner
Willing to complete monthly surveys for 3 months and receive monthly text messages to personal mobile phone
Have home Internet access and phone with ability to take a picture of a mole
Have access to Federal Express or US Postal Service Express Mail to send mole self-sampling kits
Willing to allow the research team access to their electronic health record to abstract physician assessment of concerning moles, biopsy results and treatment
Willing to provide up-to-date email address, mailing address and telephone number

Inclusion criteria of skin check partner, who may be a man or a woman, to have mole self-sampled

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
SSE educational intervention	SSE educational intervention	Women participants receive a SSE brochure and three monthly reminders to perform SSE. In the second month, women select goals for SSE.

Primary Outcome Measures

Name	Time	Method
Number of Participants Who Identified Concerning Moles at Specified Time Points	90 days	Self-reported identification of concerning mole identified by user assigning scores to the border,color and diameter of the mole. A validated scoring system is used to categorize the border, color and diameter as 1 if normal, 2 if not sure, and 3 if abnormal.The sum of the scores indicates if the mole is concerning (sum of 3= benign, stop checking the mole; sum of 4- 7 monitor the mole for change in the next month; sum of 8-9 = concerning mole make an appointment to see a physician.
Number of Participants Who Completed SSE at Specified Time Points	90 days	Self-reported performance of SSE, a custom scale with the frequency and extent of SSE is completed in an online monthly survey

Secondary Outcome Measures

Name	Time	Method
Participants' Confidence Performing Mole Checks	90 days	Self-reported responses to 7 items, each with a 5-point Likert scale (range 7-35) higher score = greater confidence (better outcome).
Pathologic Diagnosis of Concerning Moles	5 months	Electronic medical record review of pathologic diagnosis of biopsied moles that participants identified as concerning
Biopsy Performed	5 months	EMR review of physician performing a biopsy on a concerning mole identified by the participant, percentage of biopsies performed
Participants' Reported Skin Self-examination Anxiety	90 days	Self-reported responses to 6 items, each with a 5-point Likert scale (range 6-30) higher score= more anxiety, a worse outcome
Clinical Diagnosis of Participants Having Any Physician Visits for Concerning Moles	5 months	Electronic medical record review of physician's clinical diagnosis of concerning mole during the 3 months of the study and for 2 subsequent months

Locations (1): Northwestern University Feinberg School of Medicine Department of Dermatology
🇺🇸
Chicago, Illinois, United States