Experiences of patient-led melanoma surveillance and teledermatology in underserved groups in the Melanoma Self-Surveillance Trial: A qualitative sub-study

BackgroundPatient-led melanoma surveillance using mobile dermoscopy and teledermatology may support earlier detection and improve access to dermatology care for underserved populations.MethodsWe conducted semi-structured interviews with Melanoma Self Surveillance (MEL-SELF) Trial participants (control, intervention and run-in participants) to explore ways to support mobile teledermatology uptake among underserved populations. Participants had 1+ underserved population characteristics: age ≥70 years, residence outside major cities, low income, and Aboriginal and/or Torres Strait Islander (First Nations Australians) identity. We used thematic analysis to code data and report findings.ResultsOf the 22 participants (55% women; mean age 64.7 years), nine were ≥70 years, 13 lived outside major cities, four had low income and two identified as First Nations Australians (six had ≥2 characteristics). Participants valued the convenience of home-based skin checks, reassurance from expert feedback delivered via teledermatology and increased access to dermatology care. Family or partner support helped participants use the technology and examine hard-to-see areas, which increased confidence and adherence to the intervention. Barriers to skin self-examination included physical limitations, low confidence, and difficulties using the app or dermatoscope. Regional participants noted that teledermatology could potentially help reduce travel costs, provided additional clinic visits were not prompted by the teledermatology. Participants suggested that clear instructions and face-to-face training would facilitate uptake in practice, and that help from health professionals may also be beneficial.ConclusionTailored instructions, training, and technical assistance may help underserved groups use patient-led melanoma surveillance and improve their access to dermatological care.