Efficacy of a mobile app in improving adherence to total body photography and sequential digital dermatoscopic imaging in high-risk patients: a randomized controlled trial.

Introduction: Patients with multiple atypical nevi are at increased risk of developing melanoma. Total body photography (TBP) combined with sequential digital dermatoscopic imaging (SDDI) is an established strategy for early melanoma detection, but its success depends critically on patient adherence to scheduled follow-up visits. Despite their proven diagnostic value, adherence rates to medium- and long-term surveillance remain suboptimal. Objectives: To evaluate whether a dedicated mobile application (FollowUpp) could improve patient adherence to TBP and SDDI follow-up visits in high-risk individuals. Methods: A single-center, randomized controlled study was conducted at the Dermatology Unit of the University of Campania, Naples. Patients undergoing TBP and SDDI for the first time were randomly assigned to the intervention group (using the FollowUpp app with automated SMS reminders) or the control group (standard scheduling only). The primary endpoint was the proportion of unattended follow-up visits after six months; the secondary endpoint was the mean time lost per outpatient session due to no-shows. Results: A total of 208 patients were enrolled. Attendance at the six-month follow-up was significantly higher in the intervention group (96.2%) compared with the control group (74.0%), corresponding to a 21.1% absolute reduction in unattended visits (p < 0.001). The mean time lost per clinic day due to unannounced no-shows decreased from 7.2 ± 13.6 minutes in the control group to 0.3 ± 3.0 minutes in the intervention group (p < 0.0001). Conclusions: The use of an automated mobile reminder system significantly improved adherence to dermatologic follow-up and reduced organizational inefficiencies. The FollowUpp app represents a low-cost, easily implementable digital solution to enhance patient compliance and optimize resource utilization in melanoma surveillance programs.