title: Exploring patterns of recurrent melanoma in Northeast Scotland to inform the introduction a digital self-examination intervention.
abstract: BACKGROUND
  Melanoma incidence is growing and more people require follow-up to detect recurrent melanoma quickly. Those detecting their own recurrent melanoma appear to have the best prognosis, so total skin self examination (TSSE) is advocated, but practice is suboptimal. A digital intervention to support TSSE has potential but it is not clear which patient groups could benefit most. The aim of this study was to explore cutaneous melanoma recurrence patterns between 1991 and 2012 in Northeast Scotland. The objectives were to: determine how recurrent melanomas were detected during the period; explore factors potentially predictive of mode of recurrence detection; identify groups least likely to detect their own recurrent melanoma and with most potential to benefit from digital TSSE support.
  
  
  METHODS
  Pathology records were used to identify those with a potential recurrent melanoma of any type (local, regional and distant). Following screening of potential cases available secondary care-held records were subsequently scrutinised. Data was collected on demographics and clinical characteristics of the initial and recurrent melanoma. Data were handled in Microsoft Excel and transported into SPSS 20.0 for statistical analysis. Factors predicting detection at interval or scheduled follow-up were explored using univariate techniques, with potentially influential factors combined in a multivariate binary logistic model to adjust for confounding.
  
  
  RESULTS
  149 potential recurrences were identified from the pathology database held at Aberdeen Royal Infirmary. Reliable data could be obtained on 94 cases of recurrent melanoma of all types. 30 recurrences (31.9%) were found by doctors at follow-up, and 64 (68.1%) in the interval between visits, usually by the patient themselves. Melanoma recurrences of all types occurring within one-year were significantly more likely to be found at follow-up visits, and this remained so following adjustment for other factors that could be used to target digital TSSE support.
  
  
  CONCLUSIONS
  A digital intervention should be offered to all newly diagnosed patients. This group could benefit most from optimal TSSE practice.
authors.forename: Rhona
authors.initials: R
authors.lastname: Auckland
authors.forename: Patrick
authors.initials: P
authors.lastname: Wassell
authors.affiliation: Centre of Academic Primary Care - Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. s.hall@abdn.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Hall
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Nicolson
authors.forename: Peter
authors.initials: P
authors.lastname: Murchie
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012606:Scotland; D016353:Self-Examination / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis*; D012959:Socioeconomic Factors