Delays in diagnosis and melanoma prognosis (I): The role of patients

Authors

  • Marie A. Richard,

    1. Service de Dermatologie, Hôpital Sainte Marguerite, Marseille, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Jean J. Grob,

    Corresponding author
    1. Service de Dermatologie, Hôpital Sainte Marguerite, Marseille, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    • Service de Dermatologie, Hôpital Sainte Marguerite, 270 Bd de Sainte Marguerite, 13009 Marseille, France. Fax: 00 33 4 91 74 47 81
    Search for more papers by this author
  • Marie F. Avril,

    1. Service de Dermatologie, Institut Gustave Roussy, Villejuif, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Michèle Delaunay,

    1. Service de Dermatologie, Hôpital Pellegrin, Bordeaux, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Johany Gouvernet,

    1. Service d'Informatique Médicale, Hôpital Timone, Marseille, France
    Search for more papers by this author
  • Pierre Wolkenstein,

    1. Service de Dermatologie, Hôpital Henri-Mondor, Créteil, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Pierre Souteyrand,

    1. Service de Dermatologie, Hôpital Hôtel-Dieu, Clermont-Ferrand, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Brigitte Dreno,

    1. Service de Dermatologie, Hôpital Hôtel-Dieu, Nantes, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Jean J. Bonerandi,

    1. Service de Dermatologie, Hôpital Timone, Marseille, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Sophie Dalac,

    1. Service de Dermatologie, Hôpital du Bocage, Dijon, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Laurent Machet,

    1. Service de Dermatologie, Hôpital Trousseau, Tours, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Jean C. Guillaume,

    1. Service de Dermatologie, Hôpital Louis Pasteur, Colmar, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Jacqueline Chevrant-Breton,

    1. Service de Dermatologie, Hôpital Hôtel-Dieu, Rennes, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Catherine Vilmer,

    1. Service de Dermatologie, Centre René Huguenin, Saint-Cloud, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • François Aubin,

    1. Service de Dermatologie, Hôpital Saint-Jacques, Besançon, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Bernard Guillot,

    1. Service de Dermatologie, Hôpital Caremeau, Nîmes, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Marie Beylot-Barry,

    1. Service de Dermatologie, Hôpital du Haut-Lévèque, Pessac, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Catherine Lok,

    1. Service de Dermatologie, Hôpital Sud, Amiens, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author
  • Nadia Raison-Peyron,

    1. Service de Dermatologie, Hôpital Saint-Charles, Montpellier, France
    Search for more papers by this author
  • Philippe Chemaly

    1. Service d'Anatomie et Cytologie Pathologiques, Hôpital Saint-Louis, Paris, France
    2. Club de Cancérologie Cutanée, Société Francaise de Dermatologie, France
    Search for more papers by this author

  • Presented at 4th World Conference on Melanoma. Sydney, 1997: 10–14 June; Journées Dermatologiques de Paris. Paris, 1997: 3–6 December; EDEN Congress. 2nd International Meeting on Epidemiology and Prevention of Skin diseases. Bamberg, 1998: 2–4 May.

Abstract

A prospective survey was conducted to assess the role of patients in the melanoma prognosis. Consecutive patients with primary melanoma were interviewed and examined using a comprehensive questionnaire including a psychological instrument. Main outcome measures were the delay before medical intervention and the tumor thickness. Of 590 melanomas, 70.8% were detected by patients and this proportion was higher in females. Relatives were involved in the detection of half of the cases. Median delays before the patient realized he had a suspicious lesion, before this lesion was seen by a doctor, and before the melanoma was removed were 4 months, 2 months, and 1 week, respectively. Delays up to several years were observed in some cases. The rate of self-detection tended to be lower, the delays before seeking medical advice to be longer, and the tumor thickness to be higher in old people, in males, in lower-educated individuals, in those living out of towns, and in people with a low awareness about melanocytic tumors than in other cases. Conversely, individuals with a high number of atypical nevi, those who were aware to be at risk, and those who regularly visited a dermatologist tended to detect their melanoma more rapidly. No specific psychological traits were associated with a late reaction, although negligence and anxiety tended to prolong the delays. Knowledge about melanoma was poor in many patients, especially in males, and wrong beliefs were widespread. This study provides the targets of future education programs. Int. J. Cancer 89:271–279, 2000. © 2000 Wiley-Liss, Inc.

Ancillary