Better Melanoma Detection and Couples Counseling, Too!

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Early melanoma (CTV.CA) Early melanoma

A recent study appearing in the current JAMA Dermatology explores whether having a partner help a melanoma survivor with his or her skin self-examination (SSE) improves lesion detection and what effect the quality of the two-person relationship has on this same parameter.

Melanoma remains a significant public health concern with an estimated 73,000 new cases of invasive melanoma and more than 9,900 deaths expected this year. Melanoma is a treatable cancer with a high survival rate if it is detected early. Individuals previously diagnosed with melanoma are 10 times more likely to develop additional melanomas, which makes them an important population on which to focus early detection. Melanomas detected during SSE are more likely to have favorable outcomes. However, many areas on the body are difficult to examine by oneself, so a skin-check partner is beneficial.

The study comprised 494 dyads: one melanoma survivor and his/her "skin-check partner." Led by Dr. June K. Robinson at the Northwestern University/Feinberg School of Medicine in Chicago (she is also an editor of the journal), the authors assessed the success of the training in SSE worked as a function of relationship quality, quantitated by objective criteria.

Study subjects were divided into active group (395 patients, plus partners) and 99 control. The partners were a cohabitating spouse or committed partner, a noncohabitating friend, child, parent, sibling or other relative. Both patients and their partners were an average age of 55.

In the intervention, patients and their skin-check partners received skills training to assess moles. They were also given a ruler; a lighted magnifying lens; a laminated card with the ABCDE (Assess Border, Color, Diameter and Evolution of pigmented lesions) rules; and a map of the body. During a clinical visit, the dermatologist also invited the partner to join in looking at the patient's back as part of the intervention. Patients and their partners in the control group received no such skills training and were not invited by the dermatologist to review the patient's back during a clinic visit.

The authors report the intervention increased patient SSE self-efficacy scores, which gauge confidence in performing SSE. Partner motivation did not affect patient SSE, as measured by the patients' own self-efficacy scores. However, there was an effect from relationship variables (happiness and activities performed with the partner) on how the intervention affected patient SSE self-efficacy, with the greatest benefit of SSE education identified in those pairs who spend the least time together and have the least happiness, according to the study.

Why this is so evinced this speculation from the authors:

"While dermatologists are most likely not going to be able to change the relationship quality, pairs who were given an activity partner-assisted SSE to perform together did so; thus, pairs with low relationship quality increased their activities performed with their partner. Since these individuals showed the largest increase in patient SSE self-efficacy after they received the SSE training, pairs who have low relationship quality, as determined by activities performed with the partner, and happiness, may have received the greatest benefits from the training intervention because they were given an activity to perform together."

I found this study intriguing from both the perspective of a former clinician, who dealt with melanoma patients frequently, and from the perspective of someone interested in the ebb and flow of human relationships.

I found it astounding that the lower the initial quality of the couple's relationship, the more they gained from the instructional SSE and its actual performance. Talk about a win-win. Such couples got the added benefit of better (i.e. earlier) skin lesion detection, as well as a shortcut to an improved relationship without the time and expense of professional counseling!