Melanoma Skin Self-Examination Education During Mammography: Health Burden of Women Impairs Implementation

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.

Keywords: Early detection of melanoma; Health burden; Skin self-examination.