Factors related to the presentation of patients with thick primary melanomas

Hersey, Peter; Sillar, Robert; Howe, C G; Burton, Robert C.; Darbar, Soumendra; Foster, Hamish McA.; Collins, Steve; Bradley, D E; Owens, D

doi:10.5694/j.1326-5377.1991.tb121217.x

Cited by 76 publications

(37 citation statements)

References 20 publications

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“…Breslow thickness was markedly affected by age, the proportion of thick lesions progressively increasing with age, and this finding concurs with previous studies 16–19 . However, Cohen et al 16 .…”

Section: Discussionsupporting

confidence: 92%

“…Given the major prognostic significance of tumour thickness, demographic and clinical correlates are of obvious importance. Direct relationships between Breslow thickness and advancing age, 16–19 male sex 2,18 , 20,21 and certain body sites 18,20 have been reported. However, there are only limited published data 21,22 on the relationship of tumour thickness with either the presenting clinical features or with the primary referral clinic.…”

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confidence: 99%

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Clinical correlates of Breslow thickness of malignant melanoma

Osborne

Hutchinson

2001

British Journal of Dermatology

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Results were similar for the two thickness groups, but more significant for the thick group. The previously described correlations of tumour thickness and increasing age (P < 0.00001) and location on head and neck (P = 0.0002), together with the independence of these variables, have been confirmed. The correlation with male gender was also confirmed but this was weak (P = 0.05). Novel findings were correlations of Breslow thickness with all features of the seven-point checklist (P varying from P = 0.01 to P < 0.00001) and tumour elevation (P < 0.00001). In general in the seven-point checklist, the absence of the major features (except variation in size) (P < 0.00001) and presence of minor features (except altered sensation) (P varying from P = 0.004 to P < 0.00001) were strongly associated with thick MMs. These results for tumour thickness are a further argument for retention of the minor features of the seven-point checklist. False negative diagnosis was found to be correlated with tumour thickness (P < 0.02) but this relationship was lost on multivariate analysis with inclusion of the clinical features. MM thickness was highly correlated with primary referral clinic (P < 0.00001). Only approximately 8% of MMs presenting to the Pigmented Lesion Clinic (PLC) were thick, while the proportion presenting to general dermatology was about three times greater and to plastic surgery about five times greater. This was maintained on multivariate analysis, including all other variables and, therefore, there must be other determining factors of referral not examined in the study. Conclusion MM thickness is associated with increasing age, male gender, location on the head and neck, all features of the seven-point checklist, tumour elevation and referral to the PLC. It is important to investigate further the reasons for general practitioner referral of different thickness MM to different types of clinic, as referral to clinics other than the PLC results in delay in the first hospital appointment, and it is now apparent that thicker lesions are disproportionately affected.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Clinical correlates of Breslow thickness of malignant melanoma

Osborne

Hutchinson

2001

British Journal of Dermatology

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“…Results from a large, population-based cancer registry (n = 3772) and treatment unit data sets (n = 1300) in Australia independently showed that the time from detection of a change in the skin (first noticing a suspicious spot) to diagnosis was not longer in those who had thick lesions compared with those who had thin melanomas [36,37]. These findings support the idea that the different melanoma subtypes represent different biological characteristics and etiologic pathways.…”

Section: Anatomic Locationmentioning

confidence: 76%

“…New epidemiologic data support the hypothesis that these melanomas are very different from thinner melanomas and their initiation through UV exposure is questionable. There are sparse scientific data on how human immunological factors influence these thick, possibly more genetically induced melanomas [35,36]. …”

Section: Epidemiology Of Melanomamentioning

confidence: 99%

A new understanding in the epidemiology of melanoma

Erdei

Torres

2010

Expert Review of Anticancer Therapy

283

249

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The incidence of melanoma is continuing to increase worldwide. UV exposure is a known risk factor for melanoma. Geographic location is known to influence UV exposure and the distribution of the incidence of melanoma. Furthermore, epidemiologic data suggest that gender and genetics may influence the distribution of melanoma on the body surface and histopathologic characteristics of the lesion. This article describes what is known about the impact of gender, ethnicity and geography on the progression of melanoma. Advanced-stage cutaneous melanoma has a median survival time of less than 1 year. Surgical removal, radiotherapy, chemotherapy, targeted therapies and a variety of immunotherapies have been utilized in the treatment of melanoma. Current treatment strategies and the results of recent clinical trials are also discussed in this article.

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“…1 Thus, it is important not only to determine who is at high risk of developing melanoma, but also who is at high risk of late-stage diagnosis. Studies that have examined predictors of later stage at diagnosis or poor prognosis generally have reported that patients who are male, 2-8 older age, 2,3,5,6,9-13 low socioeconomic status (SES), 2,3,8,13-16 nonwhite, 2,4,17 cigarette smokers, 8,18-22 living in areas with fewer dermatologists, 23 or uninsured or on Medicaid 24 are more likely to be diagnosed at late stage and to have correspondingly worse outcomes. In addition, physician discovery of melanoma (compared with self-discovery or discovery by a spouse or significant other) is more commonly associated with thinner lesions.…”

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confidence: 99%

Marital status and stage at diagnosis of cutaneous melanoma

McLaughlin

Fisher

Paskett

2010

Cancer

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Background We evaluated the effect of marital status on risk of late-stage cutaneous melanoma diagnosis. Methods Information about melanoma patients was obtained from Surveillance Epidemiology and End Results (SEER), 1973-2006. A multivariable logistic regression model was used to estimate relative risks of late-stage disease at diagnosis. Results After exclusion criteria, 192,014 adult melanoma patients remained for analyses. After adjustment for age, race, year of diagnosis, tumor histology, anatomic site, socioeconomic status, and SEER site, the relationship between estimated risk of late-stage melanoma diagnosis and marital status was dependent on sex (P < .0001 for interaction). Although unmarried patients had a higher risk of being diagnosed at a late stage among men and women, the magnitude of the effect varied by sex. Moreover, among married, single, and divorced or separated patients, men had more than a 50% increase in risk of late-stage diagnosis when compared with women. Widowed men and widowed women, however, were not statistically different in their stage at diagnosis. Conclusions Results from this study are important and may be used by clinicians and public health practitioners interested in increasing the proportion of melanoma patients diagnosed at an early stage through screening, perhaps by specifically targeting unmarried individuals in addition to having broad-based skin cancer prevention programs.

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Factors related to the presentation of patients with thick primary melanomas

Cited by 76 publications

References 20 publications

Clinical correlates of Breslow thickness of malignant melanoma

Clinical correlates of Breslow thickness of malignant melanoma

A new understanding in the epidemiology of melanoma

Marital status and stage at diagnosis of cutaneous melanoma

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