Melanoma and Tumor Thickness

Abstract

Objective: To test the basic assumption of campaigns for early diagnosis of melanoma, ie, prognosis is correlated with the delay in the diagnosis. Design: Prospective study of the correlation between delays to diagnosis, assessed using a questionnaire, and the Breslow thickness as a prognosis marker. Setting: Dermatology departments in France. Patients: Fivehundredninetyconsecutivepatients,referred within 12 weeks after resection of cutaneous melanoma. Main Outcome Measures: Assessment of 5 successive time intervals from the first time the patients realized that they had a lesion until the resection of the melanoma, and results of the correlation between each time interval and tumor thickness (Breslow). Results: There is a positive but weak correlation between tumor thickness and the delay to identify a lesion as suspicious (r = 0.17; P = .009). However, this delay tends to be short for the thickest tumors. There is a negative correlation between tumor thickness and the delay to seek medical attention (r = −0.20; PϽ.001). This delay was shorter for nodular melanoma. No correlation is found between melanoma thickness and physicians' delays. Conclusions: Poor prognosis can be accounted for by aggressive rapidly growing tumors rather than by delays. In well-informed populations, campaigns for early diagnosis of melanoma may thus no longer have a major impact on prognosis, unless they are focused on subgroups less accessible to information and medical care.

Nodular Type and Older Age as the Most Significant Associations of Thick Melanoma in Victoria, Australia

“…17 Multiple factors seem to contribute to the development of thick melanoma, including factors intrinsic to NM and those intrinsic to the elderly. There is now evidence 25 to suggest that NM grows more rapidly, possessing greater biological "aggressivity" than other tumor types. It is established that NM has a poorer prognosis than SSM, but in a large study of prognostic factors, 26 this was attributed to thickness alone.…”

Which symptoms are linked to a delayed presentation among melanoma patients? A retrospective study

“…Nodular melanoma tends to follow a more aggressive clinical course than the superficial spreading subtype [24], lacking a precancerous or “ in situ ” phase, whilst desmoplastic melanomas generally carry a better prognosis, tending to present with localized disease [25, 26]. The biology of all melanomas may not be the same: nodular melanomas are also believed to progress rapidly [27]. This means that a similar interval between symptom onset and presentation could result in differences in tumour thickness related to the biological behaviour of the tumour [27].…”

“…The biology of all melanomas may not be the same: nodular melanomas are also believed to progress rapidly [27]. This means that a similar interval between symptom onset and presentation could result in differences in tumour thickness related to the biological behaviour of the tumour [27]. It was not possible to determine whether or not delay was influenced by melanoma-specific features, e.g.…”

Nodular Melanoma: Controversies and Considerations for Containment

“…In these studies exploring the earliest clinical manifestation of nodular melanomas, which are more often small in diameter, regular in shape and even in color, and frequently amelanotic, a strict histologic definition is observed. Although it may prove nearly impossible to detect rapidly growing nodular melanoma, invasive from the outset and biologically aggressive nodular melanomas at thicknesses that pose minimal risk to the patient, early detection will be achieved only with greater awareness of this clinically distinct subtype 6 . Certainly, we previously indicated that nodular melanomas may be detected at an early point, 7 albeit rarely.…”