Factors Associated With Physician Discovery of Early Melanoma in Middle-aged and Older Men

Geller, Alan C.; Johnson, Timothy M.; Miller, Donald R.; Brooks, Katie R.; Layton, Christle J.; Swetter, Susan M.

doi:10.1001/archdermatol.2009.8

Cited by 42 publications

(40 citation statements)

References 17 publications

(20 reference statements)

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“…Another potential explanation is that patients who examine more body sites may not be focusing on areas where melanomas are more likely to occur, that is, back of the body. Physicians also play a role in examining body sites that are harder for patients to see (25).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

Pollitt

Geller

Brooks

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Although skin self-examination (SSE) may increase rates of early melanoma detection, the efficacy of different SSE practices has not been thoroughly studied. We examined associations between SSE practices and tumor thickness in patients with recently diagnosed melanoma. Methods: 321 melanoma patients at three hospitals completed questionnaires on demographics and SSE practices. Patient-reported SSE was measured by routine examination of 13 specific body areas, frequency of mole examination, and use of a melanoma picture aid to assist with SSE. Histologic diagnoses and Breslow depth were confirmed by dermatopathologists. Regression analyses were used to calculate ratios of geometric mean tumor thickness and odds ratios for having thicker versus thinner tumors for different SSE behaviors. Results: Rates of SSE varied considerably by SSE item. Patients routinely examining at least some of their skin had thinner melanomas [adjusted geometric mean tumor ratio, 0.73; 95% confidence interval (95% CI), 0.50-0.94]. Frequency of mole examination did not predict tumor thickness. Using a melanoma picture as a SSE aid was strongly associated with reduced tumor thickness (adjusted ratio, 0.75; 95% CI, 0.66-0.85 for ever versus never use). A composite measure of thoroughness of SSE was the best predictor of thickness (adjusted ratio, 0.58; 95% CI, 0.36-0.75) for high versus low thoroughness. Conclusions: SSE was associated with decreased tumor thickness by most measures. However, the diverse rates of SSE practices and the distinct associations between these practices and melanoma thickness suggest a complexity in SSE that should be addressed in future studies. SSE should be evaluated by more than one measure.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

Pollitt

Geller

Brooks

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Nearly all of the studies have found a favorable tumor thickness for melanoma diagnosed by primary care providers at least 0.5 to 1.00 mm thinner. 36,37 In a study of cases diagnosed in Michigan and California, 69% of physician-diagnosed melanomas were less than 1 mm compared with 33% of self-detected melanomas. 36 However, less than half of US physicians routinely examine the skin for cancer, and neither medical students nor primary care residents are adequately trained in skin cancer examination.…”

Section: Clinician Educationmentioning

confidence: 99%

“…36,37 In a study of cases diagnosed in Michigan and California, 69% of physician-diagnosed melanomas were less than 1 mm compared with 33% of self-detected melanomas. 36 However, less than half of US physicians routinely examine the skin for cancer, and neither medical students nor primary care residents are adequately trained in skin cancer examination. [38][39][40][41] Much remains unknown about melanoma discovery patterns and differences between dermatologist and primary care provider biopsy and referral practices.…”

Section: Clinician Educationmentioning

confidence: 99%

Reducing mortality in individuals at high risk for advanced melanoma through education and screening

Geller

Swetter

Oliveria

et al. 2011

Journal of the American Academy of Dermatology

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Incidence and mortality rates of melanoma throughout most of the developed world have increased in the past 25 years. We propose that reduction of deaths from melanoma can be best enhanced by strong collaborations between experts in dermatology, primary care, oncology, cancer education and health systems research, epidemiologists, and behavioral scientists, among others. Public and professional educational campaigns should be guided by an understanding of 3 underlying but overlapping roots: epidemiology and preventable mortality (an understanding of who is most likely to be given the diagnosis of thick or late-stage melanoma), biology (an investigation of tumor types that are relatively common but potentially most lethal), and sociology (an analysis of the changes needed in social structures to improve access to those most in need of early detection programs). We review these major concepts, concentrating on the key risk factors for advanced melanoma.

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“…Middle-aged and older men are recognized as a high-risk group 29 , probably due to low prediagnosis awareness of melanoma warning signs and poor skin self-examination practices 30 . In Latin America there are also elevated incidence rates of invasive melanoma among males in older age-groups (60 or more), perhaps associated with age-associated changes in the immune system, lower socioeconomic groups and late diagnosis due to a relative lack of access to medical care 29,30,31 .…”

Section: Discussionmentioning

confidence: 99%

“…In Latin America there are also elevated incidence rates of invasive melanoma among males in older age-groups (60 or more), perhaps associated with age-associated changes in the immune system, lower socioeconomic groups and late diagnosis due to a relative lack of access to medical care 29,30,31 .…”

Section: Discussionmentioning

confidence: 99%