Self-Examination of Patients with Malignant Melanoma in the Aftercare: Relevance of Psychosocial Factors and Instructions by the Physicians

Background: Several studies indicate that the prognosis of malignant melanoma (MM) can be improved if tumor progression, e.g. local recurrences and lymph node metastases, is detected at an early stage. Thus, instructed self-examination by the patients is recommended in aftercare. Although clinical experience shows that many patients do not sufficiently perform self-examination, no studies have so far focused on self-examination behavior. Objective: 1) To assess the self-examination behavior of patients with MM in aftercare, 2) to investigate factors that could explain the self-examination behavior. Methods: Cross-sectional study on 324 patients with MM in aftercare. Validated questionnaires evaluating the disease-related strain, coping with illness, and behavior and attitudes towards self-examination were handed to the patients. Results: 62% of the patients consider self-examination important. However, the operation site and pigmented lesions are inspected on a regular basis by only 29.6% of the patients, the lymph nodes are regularly self-examined by 9.9% of the patients. 73.2% of the patients claim that they have not been instructed by the physicians how to perform self-examinations. Patients who had been instructed in self-examinations rated the importance of self-examinations significantly higher. In this group, the frequency of self-examinations correlated with prognostic markers such as tumor depth and Clark level. By contrast, in the group of patients who had not been instructed, the frequency of self-examinations correlated with psychosocial strain. Conclusions: Although self-examinations in the aftercare are of considerable importance, most patients are not instructed and are not used to performing self-examinations. Patients who had been instructed show a more adequate and reasonable self-examination behavior.