Thickness and Delay in Diagnosis of Melanoma

MacKie, Rona M.

doi:10.1001/archderm.135.3.339

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…The institution of a primary prevention program in West Scotland in 1985 lead to an increase in the number of thin melanomas excised, with a reduction in mortality observed after 1990. The subsequent decade confirmed a durable benefit among females, but older male mortality rates rose between 1990 and 2000 39–41. Those findings are corroborated by reports from Swedish prevention programs with initial education of physicians and nurses followed by public education, showing a decreased mortality rate among females 45.…”

Section: Discussionsupporting

confidence: 61%

“…Skin cancer screening by physicians commonly occurs opportunistically rather than at regular intervals; however, screening with coincidental detection by a physician resulted in the detection of thinner melanomas compared with the melanomas that were self‐ detected 37. During a visit, physicians may provide skin cancer prevention counseling or education, although this occurs in fewer than half of the visits for high‐risk patients 38–42. In one study, 63% of patients with melanoma were seen by a physician in the year prior to diagnosis, but only 20% of patients were given a cutaneous examination by the physician 43…”

Section: Discussionmentioning

confidence: 99%

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Predictors of skin self‐examination performance

Robinson

Fisher

Turrisi

2002

Cancer

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BACKGROUND Skin self‐examination (SSE) may reduce the death rate from melanoma by as much as 63%. Enhancing SSE performance may reduce mortality and morbidity. This study determined predictors of SSE performance in a population of individuals who were at risk of developing melanoma or nonmelanoma skin carcinoma (NMSC). METHODS Patients (n = 200) were asked about their knowledge of the warning signs, their sense of the importance of SSE to them, their attitude about and confidence in their ability to perform SSE, and their impression of their partner's comfort and ability with assisting in the skin examination. The interval since last skin examination, the number of physician visits (nondermatologist and dermatologist), the number and type of skin malignancies, the time since initial diagnosis, the number of skin biopsies, and health insurance status were determined from the medical records for the prior 3 years. RESULTS Seventy percent of participants performed SSE. The three strongest predictors of SSE performance were attitude, having dermatology visits with skin biopsies and at least one skin carcinoma in the previous 3 years, and confidence in performance (P = 0.0001). Other predictors of SSE performance were perceived risk (P = 0.0001), knowledge (P = 0.004), and younger age (P = 0.045). CONCLUSIONS Annual skin examination by physicians and monthly SSE by patients reinforce one another in promoting early detection. In this high‐risk population, the dermatologist reinforced SSE performance by biopsy of skin lesions that were skin malignancies. People have intimate knowledge of their own skin and bear the consequences for failure to detect and treat skin carcinoma early; thus, monthly SSE becomes relevant as a personal health‐promotion habit. Cancer 2002;95:135–46. © 2002 American Cancer Society. DOI 10.1002/cncr.10637

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Predictors of skin self‐examination performance

Robinson

Fisher

Turrisi

2002

Cancer

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“…Besides the number of prior removals, we note several aspects of the initial provider evaluation that relate to this delay, including the initial diagnostic impression and type of procedures performed at this evaluation. Some have speculated about the role of medical providers in prolonged delay (Cassileth et al, 1988;Dunkley and Morris, 1991;Blum et al, 1999;MacKie, 1999;Richard et al, 1999). Many of the clinicians that treat BCC and SCC in their practices have little formal training in dermatology (only 60% of skin cancer treatments are provided by dermatologists) (Joseph et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Relationship of Treatment Delay with Surgical Defect Size from Keratinocyte Carcinoma (Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin)

Eide

Weinstock

Dufresne

et al. 2005

Journal of Investigative Dermatology

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Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R(2) = 0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p = 0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7-8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5-18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5-83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5-15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.

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“…These data suggest that the inherent biologic aggressiveness of a tumor could determine prognosis. 29 In contrast to SSMs, NMs are most often symmetric and can have a diameter less than 5 mm. 22 Bergenmar et al 22 observed that NMs smaller than 2 mm thick were smaller in diameter compared with SSMs smaller than 2 mm thick (P Ͻ.05) and that NMs were more frequently new lesions (P Ͻ .05) compared with SSMs of similar thickness that more often had developed from preexisting nevi.…”

Section: Commentmentioning

confidence: 99%