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<p>After a melanoma diagnosis, lifelong annual skin examinations are recommended, but adherence in practice is unclear. In this study, we quantified patient adherence to melanoma surveillance recommendations and the effect on outcomes. We performed a retrospective review of patients diagnosed with cutaneous melanoma at an academic center (2013–2019) with follow-up of at least five years. We reviewed 612 patients (724 melanomas) who were followed for a median 6.7 years. Adherence to annual surveillance was 44%, 19%, and 7% at two, five, and 10 years, respectively. Marriage (hazard ratio [95% confidence interval]: 1.2 [1.1–1.3]), preexisting chronic dermatologic condition(s) (1.2 [1.1–1.3]), family history of melanoma (1.2 [1.1–1.4]), Medicare (1.4 [1.2–1.6]) and Medicare Advantage (1.6 [1.4–1.8]) vs. commercial insurance, and stage III (1.4 [1.1–1.7] vs. stage 0) melanoma were associated with greater adherence (<i>P</i>&lt;.05 for each comparison). Increased age at diagnosis (0.87 [0.86–0.89] per decade), social vulnerability index (0.98 [0.96–0.99] per decile), Medicaid (0.69 [0.54–0.87]) vs. commercial insurance, and distance to nearest dermatology clinic (0.85 [0.73–0.98] for &gt; 19 vs. &lt; 5 miles) were associated with less adherence (each <i>P</i>&lt;.05). Increased adherence correlated with detecting subsequent melanoma (1.3 [1.1–1.5] per decile) but not subsequent melanoma depth (Spearman correlation − 0.03; <i>P</i> = .8) or recurrence (1.1 [0.9–1.4] per decile; <i>P</i> = .3). In conclusion, surveillance adherence declined steeply after melanoma diagnosis and is influenced by patient and tumor factors as well as access and healthcare disparities.</p>

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Determinants of adherence to melanoma surveillance: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年5月22日

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  • Albert T. Young,
  • Rita El Jbeily,
  • Brittany N. Lane,
  • Katia Hermes,
  • Madison Romanski,
  • Flavio Ago,
  • Andrea Dai,
  • J. Gregory Hixon,
  • Martin A. Weinstock,
  • Charles N. Ellis,
  • Natalie H. Matthews

摘要

After a melanoma diagnosis, lifelong annual skin examinations are recommended, but adherence in practice is unclear. In this study, we quantified patient adherence to melanoma surveillance recommendations and the effect on outcomes. We performed a retrospective review of patients diagnosed with cutaneous melanoma at an academic center (2013–2019) with follow-up of at least five years. We reviewed 612 patients (724 melanomas) who were followed for a median 6.7 years. Adherence to annual surveillance was 44%, 19%, and 7% at two, five, and 10 years, respectively. Marriage (hazard ratio [95% confidence interval]: 1.2 [1.1–1.3]), preexisting chronic dermatologic condition(s) (1.2 [1.1–1.3]), family history of melanoma (1.2 [1.1–1.4]), Medicare (1.4 [1.2–1.6]) and Medicare Advantage (1.6 [1.4–1.8]) vs. commercial insurance, and stage III (1.4 [1.1–1.7] vs. stage 0) melanoma were associated with greater adherence (P<.05 for each comparison). Increased age at diagnosis (0.87 [0.86–0.89] per decade), social vulnerability index (0.98 [0.96–0.99] per decile), Medicaid (0.69 [0.54–0.87]) vs. commercial insurance, and distance to nearest dermatology clinic (0.85 [0.73–0.98] for > 19 vs. < 5 miles) were associated with less adherence (each P<.05). Increased adherence correlated with detecting subsequent melanoma (1.3 [1.1–1.5] per decile) but not subsequent melanoma depth (Spearman correlation − 0.03; P = .8) or recurrence (1.1 [0.9–1.4] per decile; P = .3). In conclusion, surveillance adherence declined steeply after melanoma diagnosis and is influenced by patient and tumor factors as well as access and healthcare disparities.