Behavioral determinants of successful early melanoma detection

Role of self and physician skin examination

Authors

  • Susan M. Swetter MD,

    Corresponding author
    1. Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
    2. Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
    • Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 900 Blake Wilbur Drive, W1013, Stanford, CA 94305-5356

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    • Fax: (650) 496-2573

  • Ricardo A. Pollitt MD, PhD,

    1. Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California
    Current affiliation:
    1. Ricardo A. Pollitt's current address: Department of Dermatology, University of California, San Francisco, San Francisco, California
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  • Timothy M. Johnson MD,

    1. Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
    2. Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan
    3. Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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  • Daniel R. Brooks DSc, MPH,

    1. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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  • Alan C. Geller RN, MPH

    1. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts
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  • We acknowledge Mitzi C. Rabe, RN, BSN, OCN for her role as study coordinator at the University of Michigan. We also thank the Melanoma Prevention Working Group for its valuable contributions to the initial study design and analysis.

  • The sponsor had no role in the design or conduct of the study; in the collection, analysis, or interpretation of data; or in the preparation, review, or approval of the article.

Abstract

BACKGROUND.

Reduced melanoma mortality should result from an improved understanding of modifiable factors related to early detection. The authors of this report surveyed newly diagnosed patients to identify differences in prediagnosis behavioral and medical care factors associated with thinner versus thicker melanoma.

METHODS.

In total, 566 adults with invasive melanoma completed questionnaires within 3 months of diagnosis on demographics, health care access, skin self-examination (SSE), and physician skin examination (PSE) practices in the year before diagnosis. SSE was measured by us e of a melanoma picture aid and routine examination of some/all body sites versus none. Patient-reported partial or full-body PSE also was assessed. Melanoma thickness was dichotomized at 1 mm.

RESULTS.

Patient ranged in age from 18 years to 99 years, and 61% were men. The median tumor thickness was 1.25 mm, and 321 tumors (57%) were >1 mm thick. Thinner tumors (≤1 mm) were associated with age ≤60 years (P = .0002), women (P = .0127), higher education level (P = .0122), and physician discovery (P ≤ .0001). Patients who used a melanoma picture aid and performed routine SSE were more likely to have thinner tumors than those who did not (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.48-4.80). Full-body PSE was associated with thinner tumors (OR, 2.51; 95% CI, 1.62-3.87), largely because of the effect of PSE in men aged >60 years (OR, 4.09 95% CI, 1.88-8.89).

CONCLUSIONS.

SSE and PSE were identified as complementary early detection strategies, particularly in men aged >60 years, in whom both partial and full-body PSE were associated with thinner tumors. Given the high rates of physician access, PSE may be a more practical approach for successful early detection in this subgroup with highest mortality. Cancer 2012. © 2011 American Cancer Society.

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