| Description |
Background: Melanoma, the deadliest form of skin cancer, presents a significant and growing public health challenge. Early detection is crucial, yet many primary care clinics lack standardized protocols for assessing melanoma risk, leading to missed opportunities for early detection and education. Local Problem: Utah leads the nation in both melanoma incidence and mortality rates due to high elevation, year-round outdoor activities, and a predominantly fair-skinned population. At a primary care clinic in Orem, Utah, the absence of standardized screening practices with a validated risk assessment tool resulted in missed opportunities for early detection and initiation of follow-up actions. Multiple barriers compounded this problem, including time constraints, lack of confidence in skin assessments, and competing priorities. Methods: This quality improvement initiative implemented a validated risk screening tool in a primary care clinic for six weeks to improve early melanoma screening and standardize follow-up actions for high-risk patients. Pre-implementation interviews and surveys established baseline practices, while post-implementation surveys assessed usability, feasibility, satisfaction, and sustainability. Weekly site visits incorporated Plan-Do-Study-Act cycles for continuous improvement. Interventions The project occurred in two phases. Phase one included a 30-minute staff training session with a PowerPoint presentation, creating a laminated workflow diagram, and assembling of melanoma prevention education packets using American Academy of Dermatology materials. Phase two involved integrating the Self-Assessment of Melanoma Risk Score (SAMScore) questionnaire into clinical workflow for six weeks, with medical assistants administering it to the first five eligible patients per provider daily. The SAMScore form included a structured checkbox system for documenting patient consent, risk level determination, follow-up actions, and confirmation of education packet distribution. Results: The clinic transitioned from performing no melanoma risk screening to 140 completed screenings during the six-week implementation. The patient population screened was predominantly female (59.3%), with ages ranging from 18 to 86 years (mean: 49.3 years). Of those screened, 45.2% were identified as high-risk. Follow-up actions were documented for all high-risk patients, with 96.4% receiving dermatology referrals and 3.6% receiving full-body examinations. Education packets were distributed to over 91% of all screened patients. Staff surveys reported high levels of usability (83.3%), feasibility (83.3%), satisfaction (100%), and sustainability (100%), with time constraints identified as the primary implementation barrier. Conclusion: Implementing the SAMScore questionnaire proved valuable for standardizing melanoma risk assessment and initiating follow-up actions in primary care settings. With its paper-based structure, minimal costs, and straightforward design, the project could readily adapt to other primary care settings, particularly in regions with high melanoma rates and limited dermatologist access. Future improvements could include expanding to more clinics, integrating with electronic health records, and creating outcome-tracking systems. |
