Many melanoma survivors do not perform regular skin self-exams, trial shows

Even after treatment for early-stage melanoma, many patients worry about whether the cancer will return and feel uncertain about how to check their own skin for warning signs. A new analysis suggests both issues are common among melanoma survivors participating in a large clinical trial evaluating patient-led surveillance.

Baseline data from the Melanoma Self Surveillance (MEL-SELF) randomized clinical trial show that while most participants believe skin self-examination is important, many did not perform it regularly or lacked confidence in their ability to do so. Nearly half also reported significant fear that their melanoma might recur, according to a study published online March 11, 2026, in JAMA Dermatology. The research was led by Ellie Medcalf, Ph.D., of the School of Public Health at the University of Sydney, Australia.

Melanoma incidence continues to rise globally, with much of the increase driven by early-stage disease. After treatment, patients are typically monitored through routine clinic visits with clinicians, but there is little evidence that more frequent visits improve detection of recurrence or survival. Patient-led surveillance, including regular skin self-examination and use of digital tools to evaluate suspicious lesions, is being explored as a potential way to improve early detection while reducing healthcare use.

The new study examined baseline characteristics of patients screened and randomized into the MEL-SELF trial. The trial included adults previously treated for stage 0 to stage 2 melanoma from dermatology and primary care skin cancer clinics across Australia between December 2021 and June 2024.

Of 1,226 patients who were screened and considered potentially eligible, 504 were ultimately randomized to either patient-led surveillance (251 participants) or clinician-led surveillance (253 participants). Participants had a mean age of 56 years, and most had melanoma in situ or stage 1A disease.

The baseline analysis revealed wide variation in patients’ skin self-examination practices. About one in five participants had not performed a skin self-examination in the previous year, while nearly one-third reported examining their skin weekly or monthly. Although more than 90% of participants said checking for skin cancer is important, only about half expressed confidence in their ability to identify suspicious lesions.

Fear of melanoma recurrence was also common. Among randomized participants, 232 of 504 (46%) had fear-of-recurrence scores above the threshold considered clinically significant. This fear was more likely among women, younger participants, and those with higher levels of depression, anxiety or stress. Notably, fear of recurrence was associated with participants’ perceived risk of melanoma returning but not with their calculated clinical risk of developing another melanoma.

Participants generally reported high levels of comfort with digital technology, with 91% indicating confidence in using digital devices. This finding may be important because the patient-led surveillance model tested in the trial includes smartphone-based imaging tools, tele-dermatology assessments and reminders to perform self-examinations.

The investigators say the findings highlight gaps in patient education and support after treatment for early-stage melanoma. While many participants understood the importance of skin monitoring, large proportions either did not perform self-examinations at recommended intervals or lacked confidence in doing so.

Medcalf and her colleagues also observed that patients who performed skin self-examinations more frequently than recommended were more likely to report clinically significant fear of recurrence. In theory, they wrote, checking too often “could decrease its effectiveness by making it more difficult to distinguish the signal (suspicious long-term changes in lesions) from the noise (short-term random variations).” More frequent checks could also increase anxiety and potentially lead to greater healthcare utilization.

However, the authors cautioned that the direction of this relationship remains unclear. It is possible that higher fear of recurrence leads patients to check their skin more frequently, or that frequent checking may itself contribute to anxiety. Because the analysis was cross-sectional, the study cannot determine cause and effect, and further analyses during trial follow-up are planned.

Tools such as clearer explanations of melanoma risk and educational interventions may help patients better understand their prognosis and manage anxiety. The MEL-SELF trial will continue to evaluate whether patient-led surveillance, including digital tools and structured self-examination guidance, can improve detection of new or recurrent melanoma while also addressing psychological outcomes such as fear of recurrence. Researchers say follow-up results will help determine whether empowering patients to take a more active role in monitoring their skin can improve both clinical outcomes and patient well-being.