Abstract

The incidence of and death rate from cutaneous melanoma (CMM) continue to increase. Prior data suggests that more than half of CMM are detected by patients or their close contacts and that these patient-detected melanomas (PDM) present at higher stage than those found by physicians. As outcome is directly related to stage at presentation we undertook this study to identify strategies to improve timely patient detection of early CMM. Methods We reviewed prospective questionnaire data obtained at surgical oncology consultation along with demographic and pathology information on 488 CMMs in 435 patients. Data analysis with performed with SAS statistical software. Results 248 CMM (51%) were PDM, 34% were diagnosed by non-dermatologists and 15% by dermatologists. Factors associated with patient detection included female sex, younger age, non-Caucasian race, no prior skin cancer, non-truncal site, anterior location and nodular or acral lentiginous histology, but not family history or CMM diameter. The main symptoms prompting patients to seek care were change in size (32%), color (31%) and bleeding (10%). PDM was associated with higher tumor level and thickness (p < 0.005). Median tumor thickness was 1.07 mm for PDM versus 0.61 mm for physician-detected melanoma (MDM), p < 0.0001. Two-thirds of CMM > 2 mm in thickness and 85% of T4 melanomas were PDM. Patient-detected disease was more frequently ulcerated and lymph node-positive (p < 0.05). Nodular, acral lentiginous and amelanotic lesions were more often PDM. Of MDM, most were identified by non-dermatologists. Conclusions We identified several modifiable barriers that hinder early detection of melanoma. Our data suggest that public health efforts such as targeted screening programs, along with skin examinations during routine primary care visits and novel educational tools might improve awareness among high-risk patients who are unlikely to detect their own CMM, resulting in a meaningful improvement in melanoma outcomes.

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