61429 Adherence to melanoma surveillance guidelines: real-world practice and implications for patient outcomes

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

J Am Acad Dermatol

Abstract

Background: After a melanoma diagnosis, the NCCN recommends at least annual skin examinations for life. We examined how surveillance recommendations are followed in practice and how adherence affects melanoma outcomes. Methods: We reviewed all patients diagnosed with cutaneous melanoma at an academic medical center from 2013-2019 and followed through 2024. Multivariate Cox proportional hazards regression was used for statistical analysis. Results: 612 patients (724 melanomas) were followed for a median 6.7 (IQR 5.4-8.3) years. Median adherence to annual surveillance was 74% (IQR 44-100%). Marriage (HR [95% CI]: 1.2 [1.1-1.3]), preexisting chronic dermatologic condition(s) (1.2 [1.1-1.4]), family history of melanoma (1.2 [1.1-1.4]), and Medicare (1.4 [1.2-1.6]) and Medicare Advantage (1.5 [1.4-1.7]) vs commercial insurance were positively associated with adherence. Increased age at diagnosis (0.87 [0.83-0.92] per decade), social vulnerability index (0.97 [0.96-0.99] per decile), Medicaid (0.66 [0.52-0.85]) vs commercial insurance, distance to nearest dermatology clinic (0.84 [0.73-0.98] for >19 vs <5 miles), stage IB (0.80 [0.72-0.88] vs stage 0; 0.71 [0.55-0.91] vs IA), and follow-up expected during COVID-19 (3/2023-3/2024) (0.80 [0.72-0.88]) associated with decreased adherence. Adherence was positively associated with having >1 primary melanomas (1.3 [1.1-1.5] per decile) but was not significantly associated with depth of subsequent primary melanomas (Spearman correlation –0.03; p=0.8) or detection of melanoma recurrence (1.1 [0.9-1.4] per decile). Conclusion: Adherence to melanoma surveillance in real-world practice is lower than recommended and was associated with various circumstances that highlight access and healthcare disparities. Lower adherence was not linked to depth of subsequent primary melanomas or detection of recurrence.

Volume

93

First Page

AB115

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