Dermatologic screening demands may exceed recommended follow-up frequencies

1. Patients with pigmented skin lesions demanded more screening visits than the recommended amount in pigmented lesion clinics (PLCs). 

2. The highest percentages of follow-up requests were associated with patients who had diagnoses of Spitz nevi and atypical nevus syndrome. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Diagnoses of skin cancers such as melanoma often warrant a recommended number of follow-up visits for total body skin examinations (e.g. every 3 months for the first 2 years, every 6 months for the next 2 years, and annually afterwards).  However, patients may request additional screening visits in PLCs, contributing to increased patient volume.  This study sought to quantify these additional screening visits and determine patient characteristics associated with more frequent visits.  Results indicated that 14.9% of visits in PLCs were categorized as additional screening visits and 30% of patients had more frequent screening than the recommended amount.  Additional visits were associated with patients who had a previous diagnosis of Spitz nevus, atypical nevus syndrome, atypical nevus, and invasive melanoma. Strengths of this study included its discussion on possible solutions for increased patient loads in PLCs.  However, as a single-center study, generalization of results may be limited.

Click to read the study in JAMA Dermatology

Relevant Reading: Optimizing the Frequency of Follow-Up Visits for Patients Treated for Localized Primary Cutaneous Melanoma

In-Depth [retrospective cohort]: This study analyzed 584 patients and 1730 visits at the Dermatology PLC at Emory University between October 2010 and January 2012.  Patients with history of MIS, invasive melanoma, dysplastic nevi, atypical nevus syndrome, and Spitz nevi were included in the study, and their electronic medical charts were reviewed for additional visits in excess of recommended follow-ups.  Patient characteristics such as family history of melanoma, other risk factors, and demographic information were also collected.  Results were analyzed using χ² tests.  Of the 1730 visits, 1400 (80.9%) were standard follow-up visits, 257 (14.9%) were additional screening visits, and 73 (4.2%) were classified as “problem-focused” visits.  Additional visits were less associated with patients who had “family history only” and “other risk factors” compared to patients who had personal history of dysplastic nevus, melanoma, atypical nevus syndrome, or Spitz nevus (P=0.04)

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