Objective:To determine factors associated with physician discovery of early melanoma in middle-aged and older men. Design: Survey.Setting: Three institutional melanoma clinics.Participants: A total of 227 male participants (aged Ն40 years) with invasive melanoma who completed surveys within 3 months of diagnosis.Intervention: Survey. Main Outcome Measures: Factors associated with physician-detected thin melanoma.Results: Patients with physician-detected melanoma were older, 57% were 65 years or older compared with 34% for other-detected (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.19-5.55) and 42% for patient-detected mela-

dents with diabetes had a history of a lower-extremity ulcer. Respondents with diabetes demonstrated a high rate of correct knowledge and attitudes regarding lower extremity skin care. Correct response rates exceeded 70% for all questions in these categories except for 2 items: twothirds of Latinos with diabetes felt they should soak their feet, and one-third agreed or strongly agreed that "It is too difficult to check my own feet" (Table 1). Correct practices did not fare as well as correct knowledge and attitudes. Only half of Latino respondents with diabetes reported that they inspected their feet every day for the last 7 days. Fewer than half reported daily inspection of their shoes. Only 60% stated that they washed their feet and dried between their toes daily during the previous week (Table 2). The number of years since diagnosis of diabetes was not correlated with any knowledge, attitude, or practice. Weak correlations existed between respondent characteristics, knowledge, attitudes, and lower-extremity skin-care practices. The Cronbach ␣ for the survey as a whole was 0.74 (knowledge, 0.73; attitudes, 0.75; and practices, 0.80). Intraclass correlation coefficients ranged from 0.60 to 0.81. The survey took 5 to 10 minutes to complete. Comment. Latinoswithdiabetesmeritfocusedattentionwith respect to lower-extremity skin care, but busy clinicians do not have an easy-to-use tool to rapidly assess gaps in practices. Although knowledge and attitudes were found to be highly favorable in this study, the true clinical benefit can only be derived from consistent practices such as coupling daily foot inspections with ingrained daily habits. To our knowledge, this study was the first to survey the knowledge, attitudes, and practices regarding lower-extremity skin care of Latinos with diabetes. It will hopefully serve as a basis to further explore effective strategies to improve skin ulcer preventioninthisandothergroupsathighriskoflower-extremity skin ulceration. The survey developed in this study is a fast, reliablemethodtoassesspatientpractices,highlightingwhere deficits exist and prompting discussion of ways to resolve barriers to good lower-extremity skin care.

No abstract

Objectives: To identify factors related to the detection of melanoma and to determine those that differ between thinner vs thicker tumors in middle-aged and older men. Design: Survey. Setting: Three institutional melanoma clinics. Participants: Men 40 years or older who had newly diagnosed invasive melanoma. Main Outcome Measures: Differences in melanoma awareness, skin examination practices, discovery patterns, and social/medical care factors relative to tumor thickness. Results: Two hundred twenty-seven men completed surveys within 3 months of melanoma diagnosis; 57 (25.1%) had thicker tumors (Ͼ2.00 mm). Thicker tumors were associated with nodular histologic features (43.9%), a lack of atypical nevi, having less than a high school education, and patient vs physician (dermatologist or nonder-Author Affiliations are listed at the end of this article.