目前大多数国家不建议进行全民皮肤癌筛查。相反，大多数临床指南都纳入了基于风险的皮肤检查建议，尽管实践中实施和遵守建议的证据有限。我们的目的是确定对个人风险定制的黑色素瘤皮肤检查计划的遵守情况，并探讨影响遵守情况的原因。在澳大利亚悉尼黑色素瘤研究所三级皮肤科诊所就诊的患者（有/没有既往黑色素瘤）被邀请通过 iPad 填写黑色素瘤风险评估问卷，并获得个人风险信息以及针对风险的皮肤检查时间表。数据是从风险工具、临床医生记录的时间表偏差数据和预约系统收集的。咨询后，我们对患者和诊所工作人员进行了半结构化访谈。我们使用收敛分离混合方法进行分析。访谈内容均进行录音、转录，并对数据进行专题分析。参与者数据通过临床记录 (n = 247) 和访谈 (n = 29 名患者，11 名工作人员) 进行分析。总体而言，62% 的人遵守了针对风险的皮肤检查计划。如果不遵守规定，皮肤检查的频率往往会高于建议的频率。偏离的决定同样受到患者 (44%) 和临床医生 (56%) 的影响。导致患者不依从的主题包括焦虑和想要决策自主权，而临床医生则包括对特定病变和风险评估准确性的担忧。适度遵守个人风险定制皮肤检查建议的临床服务计划。通过纳入识别和帮助高度焦虑患者的策略以及支持临床医生与患者沟通基于风险的建议，可以进一步提高患者的依从性。© 2024 作者。约翰·威利出版的《国际癌症杂志》

Population-wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk-based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk-tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk-tailored skin check schedule. Data were collected from the risk tool, clinician-recorded data on schedule deviations, and appointment booking system. Post-consultation, we conducted semi-structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk-tailored skin check schedules. In cases of non-adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non-adherence among patients included anxiety and wanting autonomy around decision-making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk-tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk-based recommendations with patients.© 2024 The Author(s). International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.