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Sharma AN, Kassels A, Brewer JD, Demer AM. Female Breast Melanomas are Associated With Lower Stage Diagnosis and Decreased Mohs Utilization: A National Cohort Study. Dermatol Surg 2024:00042728-990000000-00851. [PMID: 38900087 DOI: 10.1097/dss.0000000000004296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Ajay N Sharma
- Department of Dermatology, University of California, Irvine, California
| | - Alexa Kassels
- Department of Dermatology, University of California, Irvine, California
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Addison M Demer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Robinson JK, Wahood S, Ly S, Kirk J, Yoon J, Sterritt J, Gray E, Kwasny M. Melanoma detection by skin self-examination targeting at-risk women: A randomized controlled trial with telemedicine support for concerning moles. Prev Med Rep 2021; 24:101532. [PMID: 34976609 PMCID: PMC8683880 DOI: 10.1016/j.pmedr.2021.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 12/04/2022] Open
Abstract
Secondary melanoma prevention remains crucial to reduce morbidity and mortality for the 200,000 people in the United States estimated to develop melanoma in 2021. This 3-month randomized controlled trial of online skin self-examination (SSE) education among 1000 at-risk women who received care at Northwestern Medicine in Illinois sought to determine SSE initiation and monthly performance, SSE anxiety and confidence, and health care practitioner (HCP) visits for concerning moles. Positive responses to a personal history of sunburn, a personal or family history of skin cancer, and/or having 10 or more lifetime indoor tanning sessions identified and informed women of their increased risk of melanoma. At one month, 96.2% of women receiving SSE education (SSE women) initiated SSE compared to 48.1% in the active control arm (control) (p < 0.001). More control women sought HCP visits (n = 107) than SSE women (n = 39). Control women seen by HCPs identified benign lesions, especially seborrheic keratosis, more often than SSE women. More atypical nevi (SSE 38.5%, control 8.4%) and melanomas (SSE 25.6%, control 4.7%) were visually identified by SSE women seeing HPCs (p < 0.001). There was no significant difference in SSE anxiety between the control and SSE arms. Confidence increased significantly in the SSE arm whereas there was no change in the control group (p < 0.001). Women checked someone else for concerning moles [315/ 494 (63.8%) of SSE women]. Targeting at-risk women for SSE education may help reduce melanoma mortality, especially in rural communities where incidence and mortality are greater than in urban areas.
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Affiliation(s)
- June K. Robinson
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Samer Wahood
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sophia Ly
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jessie Kirk
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jamie Yoon
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - James Sterritt
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth Gray
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mary Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Robinson JK, Brown Z, Spring B. Melanoma Skin Self-Examination Education During Mammography: Health Burden of Women Impairs Implementation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:858-864. [PMID: 32090289 PMCID: PMC7483150 DOI: 10.1007/s13187-020-01714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Identification of barriers to seeking health care for a concerning mole found during skin self-examination (SSE) by women educated during screening mammography. In this sequential mixed methods research, interviews with women who found a concerning mole and did not have health-care follow-up were analyzed and a survey was created. One year after SSE education, barriers to having health care for a self-identified concerning mole were assessed. The electronic medical records for all participants, who received education, were reviewed to ascertain who received health care related to a concerning mole or a screening mammogram. Among the 280 women who performed SSE, 85 found a concerning mole. Nine months later 51 women did not receive health care for the mole. Barriers were the burden of other medical concerns, fear of what the doctor will find, feeling like nothing is wrong, and being too busy. A positive screening mammogram (Fisher's two-sided exact test, p < 0.001) and a history of indoor tanning (Fisher's two-sided exact test, p = 0.011) were significantly associated with lack of follow-up for a concerning mole. Targeted melanoma self-identification with SSE relies upon participants initiating performance and seeking medical care for a concerning mole. The burden of a positive screening mammogram reported to women at about the same time as they identified the concerning mole was associated with failing to seek care for their concerning mole. Reminders to check moles for change 4 months after identifying a concerning mole may benefit women. Clinicaltrials.gov NCT03512457.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA.
| | - Zoe Brown
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Suite 1050, Chicago, IL, 60611, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Smetherman DH. Breast Cancer Screening and the COVID-19 Pandemic. JOURNAL OF BREAST IMAGING 2021; 3:3-11. [PMID: 38424843 PMCID: PMC7798968 DOI: 10.1093/jbi/wbaa106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Indexed: 12/15/2022]
Abstract
The novel SARS-CoV2 (COVID-19) pandemic has had a major impact on breast radiology practices. Initially, nonessential imaging studies, including screening mammography, were curtailed and even temporarily halted when lockdowns were instituted in many parts of the United States. As a result, imaging volumes plummeted while health care institutions worked to ensure safety measures were in place to protect patients and personnel. As COVID-19 infection levels started to stabilize in some areas, breast radiology practices sought guidance from national organizations, such as the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and radiology specialty societies, to develop strategies for patients to safely return for screening mammograms and other outpatient imaging studies. Postponement of breast cancer screening has led to delays in cancer diagnosis and treatment that could negatively affect patient outcomes for years to come. In order to continue to provide necessary imaging services, breast radiologists will need to face and overcome ongoing practical challenges related to the pandemic, such as negative financial impacts on practices and patients, the need for modifications in delivery of imaging services and trainee education, and differences in the health care system as a whole, including the shift to telehealth for clinical care. Nonetheless, despite the disruption the COVID-19 pandemic has caused, the need for breast radiology procedures, including breast cancer screening, remains strong.
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Cheng BT. Mammography is an opportunity to promote melanoma education in women. Prev Med 2020; 133:106027. [PMID: 32057957 DOI: 10.1016/j.ypmed.2020.106027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/26/2020] [Accepted: 02/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Brian T Cheng
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America.
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Robinson JK, Perez M, Abou-El-Seoud D, Kim K, Brown Z, Liko-Hazizi E, Friedewald SM, Kwasny M, Spring B. Targeted Melanoma Screening: Risk Self-Assessment and Skin Self-Examination Education Delivered During Mammography of Women. JNCI Cancer Spectr 2019; 3:pkz047. [PMID: 32328556 PMCID: PMC7049996 DOI: 10.1093/jncics/pkz047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 01/27/2023] Open
Abstract
Background Melanoma, which is the sixth most common cancer in women, is visible on the surface of the skin; therefore, self-screening (skin self-examination [SSE]) may be beneficial. Methods A convenience sample of women undergoing mammography was sequentially assigned by week into this two-arm targeted melanoma screening intervention. Both groups saw an informational poster and received a brochure promoting risk self-identification and SSE education. One group received an additional 1-week SSE reminder. Participants completed baseline and 1- and 3-month follow-up surveys assessing SSE performance, identifying a concerning mole, scheduling a dermatology appointment, and anxiety due to the program. Performance of SSE between groups was compared using χ2 analysis. The electronic medical record was reviewed for diagnosis of concerning moles. Results At 1 month, 384 of 420 (91.4% retention) women completed the survey. Of those, 311 (80.9%) performed SSE. Of those who performed SSE, 54 (14%) found a concerning mole at either 1 or 3 months. At 3 months, 346 (82.4% retention) women completed the survey. The number of women who performed SSE did not differ between groups at 1 month (χ2 = 1.64, P = .17) or 3 months (χ2 = 1.58, P = .12). Seven melanomas were found among 34 women who identified a concerning mole; examination of 4.8 women yielded one melanoma. Anxiety was low with a median score of 9.5 (range = 0–42.9). Conclusions Introducing melanoma risks and SSE education during mammography was feasible and did not demonstrate harms; thus, there is an opportunity to reach a large, at-risk population with limited burden for the participant and clinics.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Megan Perez
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Dalya Abou-El-Seoud
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Kathryn Kim
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Zoe Brown
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Elona Liko-Hazizi
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Sarah M Friedewald
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL.,Lynn Sage Comprehensive Breast Center of Northwestern Medicine/Prentice Women's Hospital Northwestern Medicine, Chicago, IL
| | - Mary Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
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Abstract
Melanoma is rapidly evolving because of advances in noninvasive diagnosis, targeted therapies, and improved prognostic methods. This article discusses what is new in melanoma risk factors, prevention, clinical management, and targeted treatment. The incidence continues to increase worldwide, whereas mortality is steadily improving. This trend reinforces the importance of dermatologists comprehensively understanding all aspects of melanoma. Further research is needed to continue making a material impact on outcomes for patients.
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Affiliation(s)
- Giselle Prado
- National Society for Cutaneous Medicine, 35 East 35th Street #208, New York, NY 10016, USA.
| | - Ryan M Svoboda
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | - Darrell S Rigel
- Department of Dermatology, NYU School of Medicine, 35 East 35th Street #208, New York, NY 10016, USA
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