Systematic Automated Population-Based Surveillance to Improve Outcomes in Primary Cutaneous Melanoma

Area of Science:

• Dermatology
• Oncology
• Public Health Surveillance

Background:

• Patients with primary cutaneous melanoma (PCM) face an elevated risk of developing a second primary melanoma (SPM).
• Low compliance with recommended follow-up care and high patient dropout rates hinder effective surveillance for SPMs.
• Existing strategies for population-based SPM surveillance lack comprehensive description.

Purpose of the Study:

• To evaluate if a systematic automated population-based program (SAPP) for total body skin exams (TBSEs) in PCM patients improves follow-up compliance.
• To determine if the SAPP enhances the detection of SPMs and impacts mortality rates compared to pre-automated and pre-database periods.

Main Methods:

• A quality improvement study was conducted within a large integrated healthcare system.
• Included 6317 patients with PCM across three periods: pre-Database (2005-2009), pre-Automation (2009-2015), and post-Automation (2015-2021).
• Interventions involved a manual registry (pre-Automation) and a systematic automated program (post-Automation) for ensuring dermatologist TBSEs.

Main Results:

• The SAPP significantly reduced the median time between TBSEs for both early and advanced stage PCM patients (P < .0001).
• The number of TBSEs per person-year increased across study periods, with a notable rise in the post-automation phase (P < .0001).
• SPM detection rates improved, with SPMs diagnosed at earlier stages (P < .0001 for trend), alongside significant reductions in all-cause and melanoma-specific mortality.

Conclusions:

• Implementation of a systematic, automated population-based program for dermatologist TBSEs enhances follow-up compliance in PCM patients.
• The program led to increased annual TBSEs, earlier SPM detection, and sustained improvements, including significantly lower mortality rates.
• This automated system offers a strategy for prioritizing high-risk patients, improving patient safety, care efficiency, and timeliness.