Dermatologist Detection and Skin Self-examination Are Associated With Thinner Melanomas

Abstract

To investigate patterns of detection and variables associated with early diagnosis of melanoma in a population at intermediate melanoma risk.Design: Survey.Setting: Hospital and university centers belonging to the Italian Multidisciplinary Group on Melanoma.Patients: Eight hundred sixteen patients who were consecutively diagnosed as having melanoma and treated at 11 participating centers.Main Outcome Measure: Relationship between patterns of detection and patient's and physician's delay with melanoma thickness, assessed by multivariate analysis.Results: A statistically significant association with early diagnosis was found for female sex (odds ratio [OR] for a lesion Ͼ1 mm in thickness, 0.70; 95% confidence interval [CI], 0.50-0.97), higher educational level (OR, 0.44; 95% CI, 0.24-0.79), residence in northern and central Italy (compared with southern Italy) (OR, 0.44; 95% CI, 0.30-0.65 and OR, 0.24; 95% CI, 0.15-0.37, respectively), and the habit of performing a skin self-examination (OR, 0.65; 95% CI, 0.45-0.93). When adjusted for all the previously mentioned variables, only melanoma detection made by a dermatologist, maybe incidentally, was associated with a statistically significant additional effect on early diagnosis (OR, 0.45; 95% CI, 0.28-0.73). No significant effect of anatomical site (trunk compared with other sites: OR, 0.83; 95% CI, 0.59-1.17), presence of atypical nevi (OR, 0.78; 95% CI, 0.52-1.17), and patient's delay (Ͼ3 months compared with Յ3 months: OR, 1.12; 95% CI, 0.78-1.60) was found. Conclusion:Future melanoma early diagnosis strategies should adequately stress the role of skin self-examination among the adult population, and should recommend that dermatologists perform a total skin examination to identify suspect lesions (such an examination should also be performed during consultations for other reasons).

Demographic, behavioural and physician‐related determinants of early melanoma detection in a low‐incidence population

“…24 Our analysis confirmed previously observed associations of thinner tumours with female sex, nonnodular histological subtypes (SSM, LMM and ALM), and absence of histological ulceration. 9,[25][26][27] In contrast to other reports showing a predilection of thick tumours on the head and neck area, we observed an increased frequency of thicker tumours on the trunk and lower extremities, suggesting possible differences in patient population and disease characteristics. Well-known risk factors such as higher education, prior history of skin cancer, skin type, sunburn frequency, number of melanocytic naevi, and presence of atypical naevi were not found to correlate with tumour thickness, implying a possible lower level of awareness of predisposing factors among patients with melanoma.…”

Comparing Melanoma Invasiveness in Dermatologist- versus Patient-Detected Lesions: A Retrospective Chart Review

“…These results are consistent with previous studies demonstrating that dermatologist-identified cutaneous melanomas were significantly less severe than those identified by patients [12, 15, 16]. They also add to the relative paucity of data indicating that board-certified dermatologists identify roughly half of the lesions found during routine private dermatology clinic visits [12].…”

“…Few studies have examined interactions among factors previously associated with tumor severity, and thus these results demonstrate that additional information is critical to understanding how these factors interact and eventually impact early detection. Most importantly, consistent with previous findings [12, 15, 16, 27], they suggest that board-certified dermatologists play a critical role in the early detection of malignant cutaneous melanomas.…”

Time to Diagnosis of Melanoma: Same Trend in Different Continents

“…This is well known in the literature, in which a lower self-detection rate and longer delay (PST) in men has been reported. 3–10,12–15 Lesions in men are detected more frequently by family members, as also shown in the present study. 4,13,14 The change to a dark color and the enlargement of the area of the lesion were the most important reasons for patients to seek treatment.…”

“…Nevertheless, continuing medical education concerning recognizing suspicious pigmented and nonpigmented lesions is essential for medical students, physicians of all specialties, and other health professionals. 5,6,11,13,14,16 There was a longer time period between first detection of the melanoma and the first consultation for males than for females, in agreement with the literature. 9,10,[13][14][15] A somewhat odd finding is that younger patients (exception Sydney) have a longer suspicion time (PST) than older patients, in contrast to the literature, where older patients have a longer time.…”