Caring for Melanoma Survivors with Self-detected Concerning Moles During COVID-19 Restricted Physician Access: A Cohort Study

Self-management of melanoma detection with skin self-examination (SSE) by melanoma survivors and other patients atrisk to develop melanoma depends on ready access to dermatologists when a concerning mole is detected. With the March 2020 Illinois stay at home order (COVID-19) inperson physician appointments for nonessential care ceased. Additionally, there is uncertainty about when regularly scheduled health care would resume. Dermatologists currently provide care under expanded telehealth benefits using electronic health record (EHR) portals for synchronous evisits. Despite the limited quality of storeforward images, physicians attempted to interpret patient’s photographs and videos of concerning moles; however, improvements and objective assessments beyond image interpretation appear highly desirable.

Self-management of melanoma detection with skin self-examination (SSE) by melanoma survivors and other patients atrisk to develop melanoma depends on ready access to dermatologists when a concerning mole is detected. 1 With the March 2020 Illinois stay at home order  inperson physician appointments for nonessential care ceased. Additionally, there is uncertainty about when regularly scheduled health care would resume. Dermatologists currently provide care under expanded telehealth benefits using electronic health record (EHR) portals for synchronous evisits. 2 Despite the limited quality of storeforward images, 3 physicians attempted to interpret patient's photographs and videos of concerning moles; however, improvements and objective assessments beyond image interpretation appear highly desirable.
The cohort study of melanoma survivors presented here assessed SSE anxiety prior to and during restricted physician access. It furthermore evaluated a telehealth support solution that enables patients to rule out melanomas and the need for surgical INTRODUCTION Background: Physician appointments for non-essential care ceased during COVID-19.
Objective: To pilot test a telehealth solution for patients to rule out melanomas and need for surgical biopsies based on genomic analyses of pigmented lesion samples obtained via adhesive patches.

Methods:
Surveys assessed SSE anxiety. Under remote clinician guidance, patients or partners obtained samples using adhesive patches (DermTech, La Jolla, CA).
Conclusions: Adhesive patch self-sampling under remote physician guidance is a viable specimen collection option.
ABSTRACT biopsies based on genomic analyses of pigmented lesion samples obtained noninvasively via adhesive patches. Patients applied adhesive patches to confirmed skin lesions suspicious for melanoma under remote guidance by their dermatologist (JKR). 4 (DermTech, Inc. La Jolla, CA.) Melanoma survivors were trained to perform partner assisted SSE and completed periodic online surveys assessing SSE performance, identification of concerning moles, physician visits for moles, and biopsies of moles. 5 SSE anxiety and benefit were assessed (Table 1).
In March 2020, melanoma survivors submitted photographs of concerning moles that had changed or had moles reviewed via FaceTime by their dermatologist, who determined if the mole was clinically suspicious for melanoma. For confirmed concerning moles, the dermatologist ordered adhesive patch skin sample collection kits (DermTech, La Jolla, CA) to be couriered to patients. Patients or their skin check partners obtained the samples under remote clinician guidance. Samples were returned by courier to DermTech for LINC00518 and PRAME genomic risk factor analyses via DermTech's Pigmented Lesion Assay (PLA). 4 The dermatologist communicated test results and next steps to patients remotely. Subjects were interviewed about their mole selfsampling experience. The Institutional Review Board of Northwestern University approved the research. Melanoma survivors received $20 for each survey and those who submitted a specimen received $50.
There were 211 respondents among 258 eligible melanoma survivors (81.7%). In the   After COVID-19, five subjects noted change in a mole. Subjects related that lack of physician access influenced subjects' decision to do mole self-sampling. Guided self-sampling led to successful molecular risk factor analyses by PLA in 7/7 (100%) of cases compared to 9/10 (90%) randomly selected physician-sampled control cases received during the same timeframe (Table  2).

(1.5)*
In this study, increased SSE anxiety may be partially attributed to generalized health anxiety; however, lack of physician access to provide skin examinations for melanoma survivors with self-identified concerning moles was an important factor in patients' desire for high-quality alternatives. A limitation was lack of general anxiety assessment. This research demonstrates This proof-of-concept research demonstrates that patients are able to reliably perform selfsampling of concerning moles under remote physician supervision. Patient-obtained skin sample collection using adhesive patches was successful in 100% of cases enabling actionable molecular pathology PLA test reports to rule-out melanoma in all cases. The offered teledermatology solution provided pigmented lesion management with a negative predictive value of over 99% and reduced patient anxiety while avoiding office visits during a period when office visits are limited by COVID-19 to essential care. Adhesive patch self-sampling under remote clinician guidance is a viable specimen collection option.