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Faldetta C, Kaleci S, Chester J, Ruini C, Ciardo S, Manfredini M, Guida S, Chello C, Cantisani C, Young JN, Cabral P, Gulati N, Guttman-Yassky E, Pellacani G, Farnetani F. Melanoma clinicopathological groups characterized and compared with dermoscopy and reflectance confocal microscopy. J Am Acad Dermatol 2024; 90:309-318. [PMID: 37988042 DOI: 10.1016/j.jaad.2023.09.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Dermoscopic and reflectance confocal microscopy (RCM) correlations between morphologic groups of melanoma have not yet been described. OBJECTIVE Describe and compare dermoscopic and RCM features of cutaneous melanomas with histopathological confirmation. METHODS Single center, retrospective analysis of consecutive melanomas evaluated with RCM (2015-2019). Lesions were clinically classified as typical, nevus-like, amelanotic/nonmelanoma skin cancer (NMSC)-like, seborrheic keratosis (SK)-like and lentigo/lentigo maligna (LM)-like. Presence or absence of common facial and nonfacial melanoma dermoscopic and RCM patterns were recorded. Clusters were compared with typical lesions by multivariate logistic regression. RESULTS Among 583 melanoma lesions, significant differences between clusters were evident (compared to typical lesions). Observation of dermoscopic features (>50% of lesions) in amelanotic/NMSC-like lesions consistently displayed 3 patterns (atypical network, atypical vascular pattern + regression structures), and nevus-like and SK-like lesions and lentigo/LM-like lesions consistently displayed 2 patterns (atypical network + regression structures, and nonevident follicles + heavy pigmentation intensity). Differences were less evident with RCM, as almost all lesions were consistent with melanoma diagnosis. LIMITATIONS Small SK-like lesions sample, single RCM analyses (no reproduction of outcome). CONCLUSION RCM has the potential to augment our ability to consistently and accurately diagnose melanoma independently of clinical and dermoscopic features.
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Affiliation(s)
- Cristina Faldetta
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany; Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvana Ciardo
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Manfredini
- Dermatology Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- School of Medicine Vita Salute San Raffaele University, Milan, Italy; Dermatologic Clinic, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Chello
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carmen Cantisani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Jade N Young
- Department of Dermatology, Mount Sinai, New York, New York
| | | | | | | | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Wu Q, Pan J, Lin W, Zhao S, Chen M, Lu L, Chen X, Su J. Clinicopathologic features, delayed diagnosis, and survival in amelanotic acral melanoma: A comparative study with pigmented melanoma. J Am Acad Dermatol 2024; 90:369-372. [PMID: 37690705 DOI: 10.1016/j.jaad.2023.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Qingrong Wu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Jie Pan
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Wenrui Lin
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Shuang Zhao
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Mingliang Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Lixia Lu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Xiang Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China
| | - Juan Su
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China; Furong Laboratory, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China; Xiangya Clinical Research Center for Cancer Immunotherapy, Central South University, Changsha, Hunan, China.
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3
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Wu T, Wang X, Zhao S, Xiao Y, Shen M, Han X, Chen X, Su J. Socioeconomic Determinants of Melanoma-Related Health Literacy and Attitudes Among College Students in China: A Population-Based Cross-Sectional Study. Front Public Health 2021; 9:743368. [PMID: 34858925 PMCID: PMC8632051 DOI: 10.3389/fpubh.2021.743368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the association of gender, ethnicity, living region, and socioeconomic status (SES) with health literacy and attitudes toward nevi and melanoma in Chinese adolescents and to examine whether health literacy mediates the association of SES with attitudes. Study Design: A multicenter cross-sectional study was conducted among newly enrolled college students. First-year students were recruited from five universities in different regions of China in 2018 using the cluster sampling method. The observers were blinded to the participants. Methods: Health literacy and attitudes were measured using a previously validated tool (Nevus and Melanoma Health Literacy and attitudes Test). SES was measured by annual family income and parental highest educational level. Nonparametric test was used to examine the association of participants' characteristics with health literacy and attitudes. Two-level generalized linear model with logarithm link function and Gamma distribution was used individually for SES. The mediation effect model was used to examine the mediation effect of health literacy. Results: A total of 21,086 questionnaires were completed by college students with a mean age of 18.0 ± 0.8 years. The mean scores of health literacy and attitudes were 9.83 ± 7.46 (maximum score: 28) and 16.98 ± 2.92 (maximum score: 20), respectively. Female, Han nationality, annual family income, and parental educational levels were positively associated with health literacy and attitudes. Regional differences showed different effects on health literacy and attitudes. A mediation model showed that literacy mediated the association of SES with attitudes toward nevi and melanoma. Health literacy mediated ~30-50% of the association of SES with attitudes. Conclusions: Melanoma-related health literacy among Chinese college students is generally insufficient and needs to be improved. Targeted and personalized health education for improving health literacy related to nevi and melanoma may improve the general population's attitudes and further promote health-related behavior to prevent and identify early-stage melanoma.
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Affiliation(s)
- Tianhao Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Xianggui Wang
- Eye Center of Xiangya Hospital, Central South University, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Xi Han
- ULink College Guangzhou, Guangzhou, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China.,Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
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4
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Investigation of skin self-examination and sunscreen use in adolescents in northern Cyprus. Postepy Dermatol Alergol 2021; 38:505-509. [PMID: 34377135 PMCID: PMC8330876 DOI: 10.5114/ada.2021.107937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/17/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction Regular skin self-examination (SSE) is very important for the early diagnosis of malignant melanoma (MM). Since sun exposure is the most important trigger factor for the development of skin cancers, effective and regular sun protection is the main preventive method. Aim To investigate the awareness of SSE, risky nevus and sun protection of the adolescents in the Turkish Republic of Northern Cyprus (TRNC). Material and methods The data used within this research were obtained from questionnaires administered to volunteer high school students in the TRNC. Results 39.8% of the participants included in the study stated that they conducted SSE. All the participants who said they conducted SSE reported that they performed a face exam. The body regions that the participants did not examine were the scalp (47.7%), foot (36.9%), back (35.4%) and genital area (35.4%). The features of the nevus perceived by the participants as risk factors included rapid growth, bleeding and itching. While 74% of respondents said they used sunscreen products, only 9% of users reported using them every day. Conclusions In the TRNC where the exposure to the sun is high, young people perform skin examinations at high rates in order to monitor their nevi. Nevertheless, the results of this research show that hard-to-reach areas are neglected.
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5
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Is Basal Cell Carcinoma an Itchy Tumor? Clinical Characteristics of Itch in Basal Cell Carcinoma. J Clin Med 2020; 9:jcm9082386. [PMID: 32722592 PMCID: PMC7465681 DOI: 10.3390/jcm9082386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022] Open
Abstract
In common knowledge, basal cell carcinoma (BCC) is known to be asymptomatic, but in clinical practice, at least some patients complain of itching. The present study group comprised of 180 patients with histologically confirmed BCC. Detailed information on demographics, clinical history, and physical findings was recorded. Moreover, various clinical features of itch (including intensity, localization, quality, descriptors) and the most common factors responsible for its aggravation or alleviation were examined. The itch was present in 21.1% of patients with BCC and was limited to the tumor. The mean intensity of the itch was 3.1 ± 1.2 points (Numerical Rating Scale), indicating moderate itch intensity. Among the patients, 22.4% reported that itching occurred constantly, every day. BCC-associated itch seems to be moderately frequent, although being a seemingly underestimated problem among patients with BCC.
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6
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Melanoma diagnosis: predictive value of macroscopic changes observed by the patient. Melanoma Res 2018; 28:611-617. [DOI: 10.1097/cmr.0000000000000496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Klebanov N, Gunasekera NS, Lin WM, Hawryluk EB, Miller DM, Reddy BY, Christman MP, Beaulieu D, Rajadurai S, Duncan LM, Sober AJ, Tsao H. Clinical spectrum of cutaneous melanoma morphology. J Am Acad Dermatol 2018; 80:178-188.e3. [PMID: 30165162 DOI: 10.1016/j.jaad.2018.08.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/10/2018] [Accepted: 08/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Melanoma can mimic other cutaneous lesions, but the full spectrum and prevalence of these morphologic variants remain largely unknown. OBJECTIVE To classify nonacral cutaneous melanomas into distinct morphologic clusters and characterize clusters' clinicopathologic features. METHODS All pathologic melanoma diagnoses (occurring during 2011-2016) were reviewed for routine prebiopsy digital photographs (n = 400). Six dermatologists independently assigned lesions into 1 of 14 diagnostic classes on the basis of morphology. Image consensus clusters were generated by K-means; clinicopathologic features were compared with analysis of variance and χ2. RESULTS Five morphologic clusters were identified: typical (n = 136), nevus-like (n = 81), amelanotic/nonmelanoma skin cancer (NMSC)-like (n = 70), seborrheic keratosis (SK)-like (n = 68), and lentigo/lentigo maligna (LM)-like (n = 45) melanomas. Nevus-like melanomas were found in younger patients. Nevus-like and lentigo/LM-like melanomas tended to be thinner and more likely identified on routine dermatologic examinations. NMSC-like melanomas were tender, thicker, more mitotically active, and associated with prior NMSC. Typical and SK-like melanomas had similar clinicopathologic features. LIMITATIONS Cluster subdivision yielded diminished sample sizes. Visual assignment was performed without clinical context. CONCLUSION When primary cutaneous melanomas were assigned into diagnostic groups and subjected to novel consensus clustering, recurrent morphologic patterns emerged. The spectrum of these morphologies was unexpectedly diverse, which might have implications for visual training and possibly clinical diagnosis.
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Affiliation(s)
- Nikolai Klebanov
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole S Gunasekera
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William M Lin
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - David M Miller
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Bobby Y Reddy
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mitalee P Christman
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Derek Beaulieu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Suvithan Rajadurai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Boston, Massachusetts
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hensin Tsao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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Herath HMMTB, Keragala BSDP, Udeshika WAE, Samarawickrama SSM, Pahalagamage SP, Kulatunga A, Rodrigo C. Knowledge, attitudes and skills in melanoma diagnosis among doctors: a cross sectional study from Sri Lanka. BMC Res Notes 2018; 11:389. [PMID: 29898775 PMCID: PMC6001064 DOI: 10.1186/s13104-018-3499-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to assess the knowledge, attitudes and skills of non-specialist doctors on timely referral of suspicious lesions for melanoma diagnosis. RESULTS One hundred and twenty-three doctors (mean age; 30.4 years, SD ± 8.015) were enrolled. Very few (3.3%) correctly stated all four types of melanoma. Only 8.1% of the total sample had been trained to perform a total body examination for skin cancer detection and a majority (110/123) had never performed one. Almost all (95.2%) were not confident in using a dermatoscope for examination of a skin lesion. Only 17.9% of participants had discussed skin cancer/melanoma risk reduction with patients. Only 13.8% had educated at least one patient regarding skin self-examination for suspicious skin lesions. Knowledge and clinical skills regarding melanoma recognition was unsatisfactory in our sample. Urgent attention is needed to bridge the gap in knowledge and clinical skills on this topic.
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Affiliation(s)
| | | | - W A E Udeshika
- National Hospital of Sri Lanka, Colombo, 01000, Sri Lanka
| | | | | | | | - Chaturaka Rodrigo
- National Hospital of Sri Lanka, Colombo, 01000, Sri Lanka.,School of Medical Sciences, University of New South Wales, Sydney, 2052, Australia
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Helsper CCW, van Erp NNF, Peeters PPHM, de Wit NNJ. Time to diagnosis and treatment for cancer patients in the Netherlands: Room for improvement? Eur J Cancer 2017; 87:113-121. [PMID: 29145037 DOI: 10.1016/j.ejca.2017.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIM Reducing the duration of the diagnostic cancer care pathway is intensively pursued. The aim of this study was to chart the diagnostic pathway for the five most common cancers in the Netherlands. METHODS A retrospective cohort study using cancer patients' anonymised primary care data (free text and coded) linked to the Netherlands Cancer Registry. We determined the median duration of the following: 1. Primary care intervals (IPCs): the first cancer-related general practitioner consultation to referral, 2. Referral intervals (IRs): referral to diagnosis, 3. Treatment intervals (ITs): diagnosis to treatment and the overarching intervals, 4. Diagnostic intervals (IDs): IPC and IR combined and 5. Health care intervals (IHCs): IPC, IR and IT combined. RESULTS For 465, 309, 197, 237 and 149 patients diagnosed with breast-, colorectal-, lung-, prostate cancer and melanoma, respectively; median IPC, IR and ID durations were shortest for breast cancer and melanoma (ID duration 7 and 21 days, respectively), intermediate for lung- and colon cancer (ID duration 49 and 54 days) and the longest for prostate cancer (ID duration 137 days). For all cancers, the duration of intervals increased steeply for the 10-25% with longest durations. For colorectal cancer, increasing ID durations showed increasing proportions of time attributable to primary care (IPC). CONCLUSION Approximately 10-25% of cancer patients show substantially long duration of diagnostic intervals. Reducing primary care delay seems particularly relevant for colorectal cancer.
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Affiliation(s)
- Charles C W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Nicole N F van Erp
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Petra P H M Peeters
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Niek N J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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10
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Xavier MH, Drummond-Lage AP, Baeta C, Rocha L, Almeida AM, Wainstein AJ. Delay in cutaneous melanoma diagnosis: Sequence analyses from suspicion to diagnosis in 211 patients. Medicine (Baltimore) 2016; 95:e4396. [PMID: 27495055 PMCID: PMC4979809 DOI: 10.1097/md.0000000000004396] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 11/26/2022] Open
Abstract
Advanced melanoma is an incurable disease with complex and expensive treatments. The best approach to prevent melanoma at advanced stages is an early diagnosis. A knowledge of factors associated with the process of detecting cutaneous melanomas and the reasons for delays in diagnosis is essential for the improvement of the secondary prevention of the disease.Identify sociodemographic, individual, and medical aspects related to cutaneous melanoma diagnosis delay.Interviews evaluated the knowledge of melanoma, signals, symptoms, persons who were suspected, delays in seeking medical attention, physician's deferrals, and related factors of 211 patients.Melanomas were self-discovered in 41.7% of the patients; healthcare providers detected 29.9% of patients and others detected 27%. The main component in delay was patient-related. Only 31.3% of the patients knew that melanoma was a serious skin cancer, and most thought that the pigmented lesion was not important, causing a delay in seeking medical assistance. Patients (36.4%) reported a wait interval of more than 6 months from the onset of an observed change in a pigmented lesion to the first visit to a physician. The delay interval from the first physician visit to a histopathological diagnosis was shorter (<1 month) in 55.5% of patients. Improper treatments without a histopathological confirmation occurred in 14.7% of patients. A professional delay was related to both inappropriate treatments performed without histopathological confirmation (P = 0.003) and long requirements for medical referrals (P < 0.001).A deficient knowledge in the population regarding melanoma and physicians' misdiagnoses regarding suspicious lesions contributed to delays in diagnosis.
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Affiliation(s)
| | | | - Cyntia Baeta
- Faculty of Medical Sciences, Belo Horizonte, MG, Brazil
| | - Lorena Rocha
- Faculty of Medical Sciences, Belo Horizonte, MG, Brazil
| | | | - Alberto J.A. Wainstein
- Faculty of Medical Sciences, Belo Horizonte, MG, Brazil
- Oncad, Surgical Oncology, Belo Horizonte, Brazil
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Blum A, Ingvar C, Avramidis M, von Kannen A, Menzies SW, Olsson H, Rezze GG, Wennberg AM, Westerhoff K. Time to Diagnosis of Melanoma: Same Trend in Different Continents. J Cutan Med Surg 2016; 11:137-44. [PMID: 17601421 DOI: 10.2310/7750.2007.00023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Patients and physicians both play an important role in the diagnosis of malignant melanoma. Objective: The purpose of this study was to assess important factors of delay in diagnosis at different centers and on three continents. Methods: Between October 2001 and October 2002, patients with histologically confirmed invasive melanoma were included in the study and given an established questionnaire. Recorded patients and tumor characteristics included age, sex, anatomic location, Breslow thickness, patients' awareness of the lesion and time with suspicion, and physicians' time (delay) before the operation. Results: The study included 985 patients (486 males, 499 females): 253 from Germany, 464 from Sweden, 58 from Brazil, and 210 from Australia. More females detected their lesions by themselves. The change to a darker color (21 %) and enlargement of the area of the lesion (19%) were the major signs. The highest knowledge among patients that early detection may improve the outcome was found in Sweden and Australia. At each center, the media (newspaper, magazine, radio, and television) provided the best sources of information about melanoma. Twenty to 33% of all physicians initially consulted missed the melanoma diagnosis, independent of their specialty. Conclusions: There are still factors for the delay in melanoma diagnosis in different countries and continents, but the differences are rather small. The results should be included in planning prevention campaigns in this specific field and in the education of medical students, physicians of all specialties, and other health professionals.
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Affiliation(s)
- Andreas Blum
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany.
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12
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Denying the Obvious: Four Extreme Cases of Neglected Tumors. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e571. [PMID: 26893996 PMCID: PMC4727723 DOI: 10.1097/gox.0000000000000541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/17/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known about the relatively common phenomenon of patients neglecting tumors as part of a denial mechanism to presumably cope with the obvious, outward and clearly visible signs of cancer. As a result of this tumor neglect, disease progression continues unchecked, resulting in excessive tumor growth, invasion of nearby structures, (often) metastatic spread, and significant disfigurement. METHODS In this case series, we present 4 extreme cases of neglected tumors that posed significant reconstructive challenges and explore the biopsychosocial components of tumor neglect. RESULTS In this series, we present 4 cases representing various cases of extreme tumor neglect. These 4 cases required multidisciplinary efforts involved in tumor resection, adjuvant treatments and the complex reconstructive efforts after tumor extirpation. CONCLUSIONS The tumor neglect phenomenon is of broad interest to the field of plastic and reconstructive surgery. Given the complex patient factors that contribute to the extreme state of disease progress upon presentation, all cases required extensive extirpative efforts with complex and challenging reconstructive solutions. Cases of extreme tumor neglect provide insight into the biopsychosocial underpinnings of this specific patient population and have implications for a further understanding of the potential immunoprotective effect of these large, longstanding, and often nonmetastatic tumors.
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Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol 2015; 72:717-23. [PMID: 25698455 DOI: 10.1016/j.jaad.2015.01.025] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/11/2022]
Abstract
Over the course of their nearly 30-year history, the ABCD(E) criteria have been used globally in medical education and in the lay press to provide simple parameters for assessment of pigmented lesions that need to be further evaluated by a dermatologist. In this article, the efficacy and limitations of the ABCDE criteria as both a clinical tool and a public message will be reviewed.
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Affiliation(s)
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeannette M Olazagasti
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Susan C Taylor
- Society Hill Dermatology and Cosmetic Center, Philadelphia, Pennsylvania
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mary-Margaret Chren
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Reva Bhushan
- American Academy of Dermatology, Schaumburg, Illinois
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Haenssle HA, Hoffmann S, Holzkamp R, Samhaber K, Lockmann A, Fliesser M, Emmert S, Schön MP, Rosenberger A, Buhl T. Melanoma thickness: the role of patients' characteristics, risk indicators and patterns of diagnosis. J Eur Acad Dermatol Venereol 2014; 29:102-8. [PMID: 24646029 DOI: 10.1111/jdv.12471] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/17/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Factors associated with early vs. late diagnosis of cutaneous melanoma remain poorly understood. OBJECTIVE To identify factors with a significant impact on melanoma thickness. METHODS Patients with previous melanoma (n = 347, median age at diagnosis: 56.5 years, 44.7% female, 55.3% male) were recruited for this monocentre, non-randomized, observational study between April 2012 and March 2013. All patients were assessed by means of a structured interview and systematic clinical and dermoscopic full-body examination. Melanoma thickness in association with patients' characteristics, risk indicators and patterns of diagnosis was submitted to statistical analyses. RESULTS Univariate analyses revealed associations between a statistically significant lower Breslow thickness and participation in specialized dermoscopic screening programs, personal history of more than one previous melanoma, diagnostic examination with a dermatoscope, diagnostic examination by board certified dermatologist, high number of common and/or atypical nevi, younger age at time of diagnosis, higher level of education, or superficial spreading or lentigo maligna melanoma subtype (all P ≤ 0.01). In a multivariate regression analysis only three of these criteria: (i) participation in specialized screening programs (P < 0.0001); (ii) melanoma subtype (P < 0.0001); and (iii) diagnostic examination with a dermatoscope (P = 0.040) and one interaction term ('younger age' x 'female sex', P < 0.0001) showed an independent influence on a significantly lower melanoma thickness. CONCLUSIONS The screening of patients in specialized surveillance programs resulted in melanoma detection at significantly earlier stages. The use of dermoscopy, SSM or LMM histotype and younger age in connection with female sex were also characteristics that were independently associated with significantly thinner melanomas in multivariate analyses.
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Affiliation(s)
- H A Haenssle
- Department of Dermatology, Venerology, and Allergology, University Medical Center, Georg-August-University Göttingen, Göttingen, Germany
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Titus L. Skin self-examination and the ABCDE rule in the early diagnosis of melanoma: is the game over? Reply from author. Br J Dermatol 2013; 168:1371-2. [DOI: 10.1111/bjd.12251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Titus LJ, Clough-Gorr K, Mackenzie TA, Perry A, Spencer SK, Weiss J, Abrahams-Gessel S, Ernstoff MS. Recent skin self-examination and doctor visits in relation to melanoma risk and tumour depth. Br J Dermatol 2013; 168:571-6. [PMID: 22897437 PMCID: PMC3579004 DOI: 10.1111/bjd.12003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the potential benefit of skin self-examination for melanoma prevention and early detection. OBJECTIVES To determine whether skin self-examination is associated with reduced melanoma risk, self-detection of tumours, and reduced risk of deeper melanomas. METHODS We used data from a population-based case-control study (423 cases, 678 controls) to assess recent skin self-examination in relation to self-detection, melanoma risk and tumour depth ( ≤1 mm; > 1 mm). Logistic regression was used to estimate odds ratios (ORs) and confidence intervals (CIs) for associations of interest. RESULTS Skin self-examination conducted 1-11 times during a recent year was associated with a possible decrease in melanoma risk (OR 0·74; 95% CI 0·54-1·02). Melanoma risk was decreased for those who conducted skin self-examination and saw a doctor (OR 0·52; 95% CI 0·30-0·90). Among cases, those who examined their skin were twice as likely to self-detect the melanoma (OR 2·23; 95% CI 1·47-3·38), but self-detection was not associated with shallower tumours. Tumour depth was reduced for those who conducted skin self-examination 1-11 times during a recent year (OR 0·39; 95% CI 0·18-0·81), but was not influenced by seeing a doctor, or by conducting skin self-examination and seeing a doctor. CONCLUSIONS Risk of a deeper tumour and possibly risk of melanoma were reduced by skin self-examination 1-11 times annually. Melanoma risk was markedly reduced by skin self-examination coupled with a doctor visit. We cannot, however, exclude the possibility that our findings reflect bias or confounding. Additional studies are needed to elucidate the potential benefits of skin self-examination for melanoma prevention and early detection.
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Affiliation(s)
- L J Titus
- Department of Community and Family Medicine, Dartmouth Medical School, Norris Cotton Cancer Center, Lebanon, NH 03756, USA.
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Körner A, Drapeau M, Thombs BD, Rosberger Z, Wang B, Khanna M, Spatz A, Coroiu A, Garland R, Batist G. Barriers and facilitators of adherence to medical advice on skin self-examination during melanoma follow-up care. BMC DERMATOLOGY 2013; 13:3. [PMID: 23448249 PMCID: PMC3600035 DOI: 10.1186/1471-5945-13-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/18/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger and middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early diagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination results in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing subsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a minority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient education. However, dermatological education is effective only in about 50% of the cases and little is known about those who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well as partner and physician support are widely neglected in relation to the practice of skin self-examination, despite the fact that they have been shown to be essential for other health behaviors and for adherence to medical advice. Moreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main objective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous and clinically sound methodology. METHODS/DESIGN The longitudinal, mixed-method study examines key psychosocial variables related to the acquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of self-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on best-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam efficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured interviews will complement and enlighten the quantitative findings. DISCUSSION The identification of short and long-term predictors of skin self-examination and an increased understanding of barriers will allow health care professionals to better address patient difficulties in adhering to this life-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidence-based, comprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach programs and secondary prevention initiatives for other populations with increased melanoma risk.
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Affiliation(s)
- Annett Körner
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Martin Drapeau
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, 4333, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Zeev Rosberger
- Louise-Granofsky-Psychosocial Oncology Program, Jewish General Hospital, 4333, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Beatrice Wang
- Melanoma Clinic, Royal Victoria Hospital, MGill University Health Centre, 687 Pine Avenue West, Montréal, QC, H3A 1A1, Canada
| | - Manish Khanna
- Department of Dermatology, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
| | - Alan Spatz
- Department of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
| | - Adina Coroiu
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Rosalind Garland
- Department of Educational and Counselling Psychology, McGill University, 3700, rue McTavish, Montréal, QC, H3A 1Y2, Canada
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, 3755, Chemin de la Côte-Ste-Catherine, Montréal, QC, H3S 1X2, Canada
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Husein-ElAhmed H, Gutierrez-Salmeron MT, Naranjo-Sintes R, Aneiros-Cachaza J. Factors Related to Delay in the Diagnosis of Basal Cell Carcinoma. J Cutan Med Surg 2013; 17:27-32. [DOI: 10.2310/7750.2012.12030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: There is often a delay between the clinical emergence of a basal cell carcinoma (BCC) and the point in time at which the patient presents for definitive diagnosis and treatment. Previously published studies on delays regarding skin cancer have focused on melanoma rather than Bcc. We conducted a study aimed at identifying factors associated with the detection of Bcc and reasons for the delay in diagnosis. Method: A monocentric study was performed. Patients with a primary BCC diagnosed in 2010 were included in the study. They were asked about factors concerning BCC awareness and detection, tumor characteristics, previous history of nonmelanoma cutaneous cancer, family history of nonmelanoma cutaneous cancer, and the presence of comorbidities. Data were analyzed using SPSS software. Results: The mean diagnostic delay for BCC in our hospital setting was estimated at 19.79 ± 14.71 months. Delayed diagnosis was significantly associated with patients over 65 years, those without a previous history of BCC, those without a family history of BCC, those with BCC located elsewhere than the head or neck, and those with lesions not associated with itching or bleeding. Conclusion: This study revealed considerable delay in the diagnosis of BCC. The main reason for delay in the diagnosis seems to be the initial decision of the patient to seek medical advice. These data suggest a need for greater information for the general public on the symptoms and signs that should prompt suspicion of a BCC.
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Affiliation(s)
- Husein Husein-ElAhmed
- From the Departments of Dermatology and Pathology, San Cecilio University Hospital, Granada, Spain
| | | | - Ramon Naranjo-Sintes
- From the Departments of Dermatology and Pathology, San Cecilio University Hospital, Granada, Spain
| | - Jose Aneiros-Cachaza
- From the Departments of Dermatology and Pathology, San Cecilio University Hospital, Granada, Spain
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Hajdarevic S, Schmitt-Egenolf M, Brulin C, Sundbom E, Hörnsten A. Malignant melanoma: gender patterns in care seeking for suspect marks. J Clin Nurs 2011; 20:2676-84. [PMID: 21777314 DOI: 10.1111/j.1365-2702.2011.03788.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS AND OBJECTIVES Gender patterns in self-detection of melanoma are not sufficiently highlighted in the literature. The aim of the study was to identify specific patterns in the decision-making process to seek care for suspect melanoma, as narrated by women and men. BACKGROUND Females have a more favourable prognosis than males and also a higher level of perceived susceptibility and a higher level of knowledge about melanoma. Women are, furthermore, more prone to participate in screening. METHOD Thirty patients (15 women and 15 men) with a mean age of 55.5 years and diagnosed with malignant melanoma were interviewed about their decisions to seek care for suspect skin marks. The interviews were transcribed and analysed with qualitative content analysis. RESULTS Care-seeking behaviour for suspect melanoma was influenced by gender constructions. Men seldom or never acknowledged interest in attention to bodily changes, but when they became aware of changes, they often took a quick decision and sought an expert's assessment. Men were compliant with wives' and relatives' advice about seeking care. All women reported that they paid attention to bodily changes, but they often delayed care seeking, due to family responsibilities and emotional struggles. The women also attempted self-care remedies, such as applying ointment, before seeking professional care. CONCLUSIONS There are gender-specific patterns that may influence decision making in the care-seeking process. Such patterns are important to identify, since health care professionals must take these factors into account in communicating with men and women. RELEVANCE TO CLINICAL PRACTICE Nurses and in particular those working in telephone counselling, are often at the frontlines, deciding who can have access to health services. They are ideally placed to tackle the issue of gender constructions in the development of effective health care services.
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Affiliation(s)
- Senada Hajdarevic
- Department of Nursing, Umeå University and Department of Public Health and Clinical Medicine, Division of Dermatology and Venereology, Umeå, Sweden
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Rosina P, Tessari G, Giordano M, Girolomoni G. Clinical and diagnostic features of in situ melanoma and superficial spreading melanoma: a hospital based study. J Eur Acad Dermatol Venereol 2011; 26:153-8. [DOI: 10.1111/j.1468-3083.2011.04015.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neglected Basal cell carcinomas in the 21st century. J Skin Cancer 2010; 2011:392151. [PMID: 21151693 PMCID: PMC2993023 DOI: 10.1155/2011/392151] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 10/21/2010] [Indexed: 11/17/2022] Open
Abstract
Although tumors on the surface of the skin are considered to be easily recognizable, neglected advanced skin neoplasms are encountered even in the 21st century. There can be numerous causes of the delay in the diagnosis: fear of the diagnosis and the treatment, becoming accustomed to a slowly growing tumor, old age, a low social milieu, and an inadequate hygienic culture are among the factors leading some people not to seek medical advice. The treatment of such advanced neoplasms is usually challenging. The therapy of neglected cases demands an individual multidisciplinary approach and teamwork. Basal cell carcinoma (BCC), the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential; these factors are suggesting that BCCs might well be the “ideal candidates” for neglected tumors. Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009. The clinical characteristics and treatment modalities of these neoplasms are discussed, together with the possible causes of the neglect.
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Alam M, Goldberg LH, Silapunt S, Gardner ES, Strom SS, Rademaker AW, Margolis DJ. Delayed treatment and continued growth of nonmelanoma skin cancer. J Am Acad Dermatol 2010; 64:839-48. [PMID: 21055843 DOI: 10.1016/j.jaad.2010.06.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 05/26/2010] [Accepted: 06/06/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients may delay treatment for skin cancer for various reasons. Prior research on treatment delay has focused on melanoma rather than nonmelanoma skin cancer (NMSC), which is much more common. OBJECTIVE We sought to clarify the reasons for delay in the presentation for diagnosis and treatment of NMSC. METHODS This was a prospective cohort study in a Mohs micrographic surgery private practice in an urban setting. Eligible subjects were 982 consecutive patients presenting for Mohs micrographic surgery for NMSC between March and December 2005. No enrolled subjects were withdrawn for adverse effects. The survey was a 4-page written self-administered questionnaire, eliciting patient medical history, skin cancer history, demographic information, initial and subsequent lesion size, and reasons for delay in presentation for evaluation and management. Outcome analyses addressed the: (1) frequency of specific reasons for delayed presentation, as provided by self-report; (2) association between reasons for delay with demographic or other patient-specific factors; and (3) change in lesion diameter from the time of detection by the patient to the time of presentation to the doctor. RESULTS Among the reasons for waiting, denial (including: thought it would go away, thought it wasn't important, too busy, thought they could self-treat, afraid it might be something dangerous) was the most frequent, accounting for 71% of cases; difficulty scheduling was associated with 10% of the instances of delay. Older patients (age >64 years) were more likely to wait to seek care than younger patients (odd ratio [OR] = 0.5; 95% confidence interval [CI] 0.4-0.7). Patients with a prior skin cancer were more likely to wait (OR = 1.4; 95% CI 1.1-2.0), as were patients with major life problems (OR = 2.6; 95% CI 1.6-4.3) and patients with a history of any cancer (OR = 1.8; 95% CI 1.3-2.4). Weighted kappa analysis comparing tumor size at the two time points yielded a kappa of 0.72 (SE = .02; 95% CI 0.68-0.77). When the data were separated into two groups, one including those tumors that had decreased in size or remained the same (698 patients), and those that had increased in size (120 patients), the median delay-to-presentation intervals associated with these two groups (2.5 vs 6.0 months, respectively) were found to be significantly different (P < .0001). LIMITATIONS This study may have limited generalizability to the extent that it reflects the characteristics only of the subpopulation of patients with skin cancer who eventually received treatment at a referral-based, urban, dermatology private practice. Overall, these patients may have been better insured and be more affluent than the general population. CONCLUSIONS Denial is the most common patient-specific factor accounting for delayed presentation for NMSC diagnosis and treatment. Patients younger than 65 years, with a skin cancer history, with major life problems, and with a history of any cancer were most likely to wait to see a doctor. There was a significant increase in tumor size from the time when tumors were noticed by patients to the time when patients presented to a physician. Increased delay was associated with increased tumor growth.
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Affiliation(s)
- Murad Alam
- Section of Cutaneous and Aesthetic Surgery, Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA.
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Walter FM, Humphrys E, Tso S, Johnson M, Cohn S. Patient understanding of moles and skin cancer, and factors influencing presentation in primary care: a qualitative study. BMC FAMILY PRACTICE 2010; 11:62. [PMID: 20807441 PMCID: PMC2939514 DOI: 10.1186/1471-2296-11-62] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 08/31/2010] [Indexed: 11/10/2022]
Abstract
Background Melanoma incidence in the UK has doubled over two decades, yet there is conflicting evidence about factors which prompt or delay patients seeking advice. Aim: To explore patient understanding of pigmented skin lesions (moles) and skin cancer, and factors which influence seeking help in primary care. Method Semi-structured interviews with forty MoleMate Trial participants, analysed using the theoretical framework of the Safer-Andersen model of Total Patient Delay. Results Patient understanding and awareness was influenced by personal, family and friends' experiences of moles, skin cancer and other cancers, knowledge of risk factors, and the lay media. The route to consulting was complex and often iterative. For lesions that people could see, detecting and appraising change was influenced by comparisons with a normal mole on themselves, a family member, friend or image. Inferring illness came about with recognition of changes (particularly size) as serious, and associated 'internal' symptoms such as pain. For lesions that people could not see, family, friends and health professionals detected and appraised changes. Deciding to seek help was often prompted by another person or triggered by rapid or multiple changes in a mole. Three of four people subsequently diagnosed with melanoma did not seek help; instead, their GP opportunistically noticed the lesion. Conclusions Changing moles are often perceived as trivial and not signifying possible skin cancer. This study contributes to current national strategies to improve patient awareness and earlier diagnosis of cancer by highlighting factors that can trigger or act as barriers to seeking help. (ISRCTN79932379)
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Affiliation(s)
- Fiona M Walter
- General Practice & Primary Care Research Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK.
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Renzi C, Mastroeni S, Passarelli F, Mannooranparampil TJ, Caggiati A, Potenza C, Pasquini P. Factors associated with large cutaneous squamous cell carcinomas. J Am Acad Dermatol 2010; 63:404-11. [PMID: 20598396 DOI: 10.1016/j.jaad.2009.09.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 09/24/2009] [Accepted: 09/26/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large cutaneous squamous cell carcinoma (SCC) is associated with a higher risk of disfigurement, local recurrence, and metastasis; however, little is known about factors associated with tumor size at diagnosis. OBJECTIVES We sought to evaluate factors associated with SCC size, including diagnostic/treatment delay and patient and tumor characteristics. METHODS We studied a stratified sample of 308 patients with SCC recently treated at a dermatologic referral center in Italy. Medical records were reviewed and telephone interviews conducted. Multiple logistic regression was used to examine factors associated with SCC size. RESULTS With univariate analyses, among both invasive and in situ cases, SCC greater than 2 cm was significantly associated with male gender, tumors arising in chronic lesions, and tumors located on not easily visible sites. Long delay before surgical removal was significantly associated with large SCC size only for invasive SCC (P < .001). Among patients with invasive SCC, when controlling for age and gender, multivariate analysis showed a significantly higher likelihood of SCC greater than 2 cm with a total delay longer than 18 months before surgical removal (odds ratio=4.18; 95% confidence interval 2.45-7.13) and for tumors arising in chronic lesions (odds ratio=6.42; 95% confidence interval 3.13-13.2). LIMITATIONS The study was cross-sectional and based on a single center. CONCLUSIONS Long total delay in removal significantly increased the likelihood of invasive SCC greater than 2 cm. Our findings highlight the importance of early detection and treatment to prevent large invasive SCCs, which are associated with a higher risk of disfigurement, recurrence, and metastasis. Particular attention should be paid to chronic skin lesions and not easily visible body sites during physician- and patient-performed examinations.
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Affiliation(s)
- Cristina Renzi
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy.
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25
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Hajdarevic S, Hörnsten Å, Sundbom E, Brulin C, Schmitt-Egenolf M. Patients’ decision making in seeking care for suspected malignant melanoma. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01057.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND The United Kingdom has poorer cancer outcomes than many other countries due partly to delays in diagnosing symptomatic cancer, leading to more advanced stage at diagnosis. Delays can occur at the level of patients, primary care, systems and secondary care. There is considerable potential for interventions to minimise delays and lead to earlier-stage diagnosis. METHODS Scoping review of the published studies, with a focus on methodological issues. RESULTS Trial data in this area are lacking and observational studies often show no association or negative ones. This review offers methodological explanations for these counter-intuitive findings. CONCLUSION While diagnostic delays do matter, their importance is uncertain and must be determined through more sophisticated methods.
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Affiliation(s)
- R D Neal
- Department of Primary Care and Public Health, North Wales Clinical School, Cardiff University, Gwenfro 5, Wrexham Technology Park, Wrexham, UK.
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Time trends in tumour thickness vary in subgroups: analysis of 6475 patients by age, tumour site and melanoma subtype. Melanoma Res 2009; 19:24-30. [PMID: 19430403 DOI: 10.1097/cmr.0b013e32831c6fe7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An elevated tumour thickness is strongly associated with an increased risk of mortality in melanoma patients. In the last few decades, an overall decrease of the tumour thickness to prognostically more favourable levels has been observed in several countries. Nevertheless, it is not clear whether this positive time trend occurred uniformly in specific subgroups of melanoma patients. Therefore, we aimed to assess time trends of tumour thickness by age group, tumour site and melanoma subtype. The study population consisted of 6475 patients with histologically proven primary invasive cutaneous melanomas seen at the Department of Dermatology and Allergology at the Ludwig-Maximilian-University Munich between 1977 and 2000. Age-adjusted time trends were assessed using linear and logistic regression analysis. Overall, a positive time trend with a decreasing tumour thickness was observed during the observation period in most subgroups. However, no significant time trend was observed in patients with a melanoma on the feet or with a nodular or acrolentiginous melanoma. The almost constant high tumour thickness of these patients might be caused by underaddressing the specific traits of these melanomas in earlier prevention campaigns. An important goal for the upcoming years should consist of a positive time trend with a decreasing tumour thickness in these subgroups.
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Bristow IR, Bowling J. Dermoscopy as a technique for the early identification of foot melanoma. J Foot Ankle Res 2009; 2:14. [PMID: 19435498 PMCID: PMC2694773 DOI: 10.1186/1757-1146-2-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 05/12/2009] [Indexed: 01/03/2023] Open
Abstract
Malignant melanoma is the most common primary malignant tumour arising on the foot. Where improvements in the prognosis have been observed for patients with melanoma elsewhere on the skin, pedal lesions are still frequently delayed in presentation through neglect or misdiagnosis. Detection of foot melanoma relies on the health care practitioner's skills and observations in recognising early changes. Recent publications have documented the use a dermoscopy as a tool to improve recognition of such suspicious lesions. This paper reviews current literature with a special emphasis of its potential applications on plantar and nail unit melanoma. Data from these studies suggest that the technique is a useful and significant adjunct to clinical examination, which ultimately may lead to earlier recognition of this aggressive tumour.
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Affiliation(s)
- Ivan R Bristow
- School of Health Sciences, University of Southampton, UK.
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Shin S, Palis BE, Phillips JL, Stewart AK, Perry RR. Cutaneous melanoma in Asian-Americans. J Surg Oncol 2009; 99:114-8. [PMID: 19034932 DOI: 10.1002/jso.21195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is little information available on melanoma in non-white populations. Our objective was to characterize melanoma in Asian-Americans (AsA) and compare patient demographics and tumor characteristics with the non-Hispanic White (NHW) population. METHODS 483,050 cutaneous melanoma patients diagnosed between 1986 and 2005 were identified using the National Cancer Data Base (NCDB); 1,237 were AsA, and 409,564 were NHW. Age, gender, site, histologic type, tumor thickness, AJCC stage, and survival were compared. RESULTS AsA were more likely to be diagnosed with acral lentiginous tumors (6.7%) than NHW (0.8%, P < 0.001). A greater proportion of AsA were diagnosed with T4 tumors (15.6%) than NHW (8.5%, P < 0.001). AsA presented with fewer early stage I-II tumors and more late stage III-IV tumors than NHW (P < 0.001). Survival was similar for AsA and NHW. CONCLUSIONS This is the largest study to date on melanoma in AsA. Compared to NHW, AsA are more likely to have acral lentinginous tumors, thick tumors, and higher stage. Despite this, their survival is similar to the NHW population.
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Affiliation(s)
- Susanna Shin
- Department of Surgery, Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, VA, USA
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BETTI R, MARTINO P, VERGANI R, GUALANDRI L, CROSTI C. Nodular melanomas: Analysis of the casistic and relationship with thick melanomas and diagnostic delay. J Dermatol 2008; 35:643-50. [DOI: 10.1111/j.1346-8138.2008.00536.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Neal RD, Cannings-John R, Hood K, Sowden J, Lawrence H, Jones C, Jones J. Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision. Fam Pract 2008; 25:221-7. [PMID: 18573803 DOI: 10.1093/fampra/cmn036] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The epidemiology of melanoma is changing and its current management is variable, with some lesions being removed in general practice. We aimed to determine the quality of excision and time to diagnosis relating to the excising surgeon and the place of excision. METHOD Analysis of data from the North Wales Melanoma Database. RESULTS In total, 578 cases were diagnosed 1993-2001. There was a gender difference with anatomical location, with 107 (65%) males with lesions on their trunk compared to 57 (35%) females. Median Breslow thickness was 1.10 mm (range 0.05-16.0 mm). Ninety-five (16%) lesions were removed in general practice, of which 49 (52%) were referred on to hospital. In total, 266 (61%) lesions were excised with 'adequate' margins and 170 (39%) excised with margins narrower than the guidelines. General practice excisions were from a younger group than hospital excisions. There were no differences in quality of excision between general practice and hospital excisions. Time to diagnosis was shorter overall for general practice excisions than hospital excisions (median 12 versus 41 days, P < 0.001). CONCLUSION These findings are of policy importance in that there is no evidence from this study that general practice excisions are managed poorly or have a worse prognosis.
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Affiliation(s)
- Richard D Neal
- Department of Primary Care and Public Health, North Wales Clinical School/School of Medicine, Cardiff University, Wrexham Technology Park, Wrexham LL137YP, UK.
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Francken AB, Shaw HM, Thompson JF. Detection of second primary cutaneous melanomas. Eur J Surg Oncol 2008; 34:587-92. [PMID: 17681449 DOI: 10.1016/j.ejso.2007.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 06/18/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS There have been few studies investigating the value of follow-up in the detection of second primary melanomas (SPMs) and there is scant information on the role of self-surveillance by the patient. The aim of this study was to assess the frequency of patient detection of both first primary melanomas (FPMs) and SPMs. PATIENTS AND METHODS Patients were interviewed to determine who detected their FPM and SPM (in situ or invasive). The associations between clinical and pathological factors and the person who identified the FPM and SPM were examined using multivariate analysis. RESULTS One hundred and twelve patients with a recently diagnosed SPM were treated at the Sydney Melanoma Unit (July 2001 to March 2003). Patients detected 59% of the FPMs as compared with 46% of the SPMs. Female gender, greater Breslow tumour thickness and younger age were significant predictors for a patient-detected FPM (Odds Ratio: 4.9 (Confidence Interval 1.5-16.0), 3.2 (1.65-6.04), and 0.9 (0.9-1.0), respectively). Greater tumour thickness and ready visibility of the lesion to the patient were predicting factors for patient detection of a SPM (Odds Ratio: 1.9 (Confidence Interval 1.1-3.3) and 3.6 (1.4-9.1), respectively). CONCLUSIONS A history of melanoma does not increase the ability of patients to detect new or thinner primary melanomas themselves. Therefore, patients may benefit from regular clinical review by clinicians, who play an important role in the detection of new melanomas.
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Affiliation(s)
- A B Francken
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales Australia
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Renzi C, Mastroeni S, Mannooranparampil TJ, Passarelli F, Caggiati A, Pasquini P. Skin Cancer Knowledge and Preventive Behaviors among Patients with a Recent History of Cutaneous Squamous Cell Carcinoma. Dermatology 2008; 217:74-80. [DOI: 10.1159/000127389] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 11/27/2007] [Indexed: 11/19/2022] Open
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Goldsmith SM, Solomon AR. A series of melanomas smaller than 4 mm and implications for the ABCDE rule. J Eur Acad Dermatol Venereol 2007; 21:929-34. [PMID: 17659002 DOI: 10.1111/j.1468-3083.2006.02115.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although multiple studies have reported that a significant number of melanomas have diameters of less than or equal to 6 mm at the time of diagnosis, there has been only one series evaluating the proportion of melanomas less than 4 mm in diameter. OBJECTIVE The objective of this study was to determine the proportion of melanomas, in a single-practitioner, general dermatology practice, with clinical diameters less than 4 mm. METHODS Information regarding each new diagnosis of melanoma had been recorded during the study period of 2000-2004. Patient records and pathology reports were examined from these patients. RESULTS Thirteen (13.7%) of the 95 melanomas had diameters less than 4 mm at the time of presentation, including five invasive and eight in situ melanomas. The defining clinical characteristic of these lesions was intensity of pigment. Three of these 13 melanomas, including one invasive and two in situ lesions, showed features of regression. CONCLUSIONS The findings of this study support those authors who have suggested elimination of the 6-mm diameter criterion in the ABCDE rule. In addition, this study provides further evidence that dark colour as a diagnostic criterion for melanoma should be given more emphasis. The substitution of 'D' to represent dark instead of diameter is worthy of consideration to enhance the value of the ABCDE mnemonic.
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Affiliation(s)
- S M Goldsmith
- Southwest Georgia Dermatology, 2401 Osler Court, Albany, GA 31707, USA.
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Abstract
Skin cancer is the most common type of cancer in the United States. US incidence of malignant melanoma is increasing faster than any other type of cancer. To minimize increasing morbidity and mortality rates, it is imperative that appropriate screening and early detection of skin cancer become more widespread. All physicians who see patients clinically have the potential for detecting skin cancers. The scope of skin cancer as a health-care problem is discussed. Evidence for the effectiveness and necessity of skin cancer screening and early detection is presented. Costs of screening and detection are discussed in relation to impact on treatment costs and overall costs of skin cancer burden. Current methods and recommendations for skin cancer screening and detection are reviewed, especially with regard to individuals and populations that may require more specialized or intensive screening and follow-up. Newer approaches involving instrument-assisted screening and detection of skin cancer are under intense development, and these exciting emerging technologies are reviewed.
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Affiliation(s)
- Kenneth G Linden
- Department of Dermatology and the Chao Family Comprehensive Cancer Center, University of California at Irvine, 101 The City Drive, Orange, CA 92868, USA.
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Baade PD, Youl PH, English DR, Mark Elwood J, Aitken JF. Clinical pathways to diagnose melanoma: a population-based study. Melanoma Res 2007; 17:243-9. [PMID: 17625455 DOI: 10.1097/cmr.0b013e328194f265] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To better understand the clinical diagnostic process for invasive melanoma in Queensland. Descriptive population-based study of Queensland residents (n=3772) aged 20-75 years diagnosed with invasive melanoma between January 2000 and December 2003. Information was obtained via telephone interview combined with pathology data from the Queensland Cancer Registry. About 85% of melanoma patients diagnosed in Queensland saw a general practitioner at least once during the process, most of these for the initial consultation. Almost one-fifth of patients (18.1%) saw a skin clinic doctor sometime through the diagnosis pathway; this proportion increased significantly over the study period (P<0.001). The most common pathway for diagnosing melanoma was an initial consultation by a general practitioner followed by referral to a surgeon for a definitive diagnosis. People living in southeast Queensland were more likely to see a dermatologist compared with those living in more rural or remote areas (14.7 versus 6.8%), more likely to see a skin clinic doctor (21.8 versus 7.2%), or a surgeon (54.9 versus 49.3%) at least once during the diagnostic process, and less likely to see a general practitioner (76.8 versus 90.2%). This descriptive study has demonstrated the complexity and diversity of clinical diagnostic pathways for melanoma in Queensland, highlighting the important role of general practitioners and the emerging role of primary care skin clinics. Although this system has resulted in a very favourable thickness distribution for diagnosed melanomas, access issues for people living in rural and remote areas of Queensland need to be addressed.
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Affiliation(s)
- Peter D Baade
- The Cancer Council Queensland, Fortitude Valley, Queensland, Australia.
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Askari SK, Schram SE, Wenner RA, Bowers S, Liu A, Bangerter AK, Warshaw EM. Evaluation of prospectively collected presenting signs/symptoms of biopsy-proven melanoma, basal cell carcinoma, squamous cell carcinoma, and seborrheic keratosis in an elderly male population. J Am Acad Dermatol 2007; 56:739-47. [PMID: 17258839 DOI: 10.1016/j.jaad.2006.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 11/09/2006] [Accepted: 11/29/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Presenting signs/symptoms of skin cancer may aid in earlier detection and diagnosis. OBJECTIVE We sought to compare prospectively collected, presenting signs/symptoms of malignant melanoma (MM), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and seborrheic keratosis (SK). METHODS This analysis was part of a larger study on teledermatology involving 3039 skin neoplasms in 2152 patients at a Department of Veterans Affairs medical center. At presentation, participants were asked about signs/symptoms of specific skin lesions. In all, 912 biopsy-proven MM (39), BCC (411), SCC (238), and SK (224) were included in this analysis. Pearson chi(2) analyses were used to test associations of lesion type and specific signs/symptoms in pairwise comparisons. RESULTS "No symptoms" was reported more often with MM (82%) as compared with BCC (relative risk [RR] 2.26, confidence interval [CI] 1.86, 2.75), SCC (RR 3.31, CI 2.54, 4.32), or SK (RR 2.0, CI 1.61, 2.48; all P < .0001). Tenderness was more commonly reported with SCC (40%) as compared with MM (RR 15.9, CI 2.28, 110.69), SK (RR 3.0, CI 2.11, 4.39), or BCC (RR 2.6, CI 1.97, 3.38; all P < .0001). Bleeding was more commonly reported with BCC (37%) as compared with SK (RR 2.3, CI 1.67, 3.20), SCC (RR 1.6, CI 1.22, 2.05), or MM (RR 29.8, CI 1.89, 469.65; all P <or= .007). LIMITATIONS The small number of MM and study population characteristics (elderly, Caucasian, male) limit generalizability. CONCLUSION This study describes common signs/symptoms of BCC, SCC, and SK. Our findings suggest that MM may be asymptomatic more often than previously recognized.
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Affiliation(s)
- Sharone K Askari
- Department of Dermatology at Minneapolis Veterans Affairs Medical Center, MN 55417, USA
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Baumert J, Plewig G, Volkenandt M, Schmid-Wendtner MH. Factors associated with a high tumour thickness in patients with melanoma. Br J Dermatol 2007; 156:938-44. [PMID: 17381454 DOI: 10.1111/j.1365-2133.2007.07805.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prognosis of patients with melanoma is strongly associated with tumour thickness at time of diagnosis. Therefore, knowledge of patient characteristics and behaviour associated with a high tumour thickness is essential for the development and improvement of melanoma prevention campaigns. OBJECTIVES The present study aimed to identify sociodemographic, clinical and behavioural factors associated with high tumour thickness according to Breslow. METHODS The study population consisted of 217 patients with histologically proven primary invasive cutaneous melanomas seen at the Department of Dermatology and Allergology at the Ludwig-Maximilian-University Munich, Germany, between January 1999 and January 2001. Personal interviews were conducted by two physicians to obtain information on sociodemographic characteristics and on patients' knowledge of melanoma symptoms, sun behaviour, delay in diagnosis and related factors. Multivariate linear and logistic regression analysis with stepwise variable selection was used to identify risk groups with a high tumour thickness. To assess possible effect modifications, interaction terms were included in the regression analysis. RESULTS The median tumour thickness was 0.8 mm (interquartile range 0.5-1.6). Fifty-seven patients (26%) had tumour thickness >1.5 mm. In a multivariate linear regression analysis, patients living alone and patients with a low educational level showed a significantly greater tumour thickness. The relation of melanoma knowledge to tumour thickness was modified by the melanoma subtype: whereas lack of melanoma knowledge led to an increased tumour thickness for the subtypes superficial spreading melanoma, lentigo maligna melanoma and unspecified malignant melanoma, no significant effect was estimated for the subtypes nodular melanoma (NM) and acrolentiginous melanoma (ALM). Sex, age, self-detection of melanoma, patient delay and professional delay were not significantly associated with the tumour thickness in multivariate linear regression. Similar results were found in multivariate logistic regression. CONCLUSIONS An increased tumour thickness was found in subjects living alone and having a low educational level. These subjects should be targeted in future prevention campaigns in a more focused way. Further efforts are necessary to improve knowledge and earlier detection of melanoma subtypes NM and ALM.
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Affiliation(s)
- J Baumert
- Department of Dermatology and Allergology, Ludwig-Maximilian-University, Munich, Germany
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Francken AB, Shaw HM, Accortt NA, Soong SJ, Hoekstra HJ, Thompson JF. Detection of First Relapse in Cutaneous Melanoma Patients: Implications for the Formulation of Evidence-Based Follow-up Guidelines. Ann Surg Oncol 2007; 14:1924-33. [PMID: 17357855 DOI: 10.1245/s10434-007-9347-2] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 10/20/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The value of follow-up surveillance for patients with cutaneous melanoma remains uncertain. In this prospective study the frequency of detection of first melanoma recurrence (FMR) by patient or doctor was analyzed to assist in the future design of evidence-based follow-up guidelines. METHODS Patients who had a recurrence of a previously treated American Joint Committee on Cancer (AJCC) stage I-III primary melanoma (PM) were interviewed to ascertain how their PM and FMR were detected. Factors predicting the detection of PM and FMR were analyzed. RESULTS The study group comprised 211 patients. In 168 patients, information on detection of their PM was available; 102 PMs (61%) were detected by the patient and 18 (11%) by their partner. Higher AJCC stage, visible location for the patient, and female sex were independent predictive factors for patient-detected PM (P = .03, .002, and .02 respectively). The FMR type was local in 28 (13%), in transit in 35 (17%), in regional lymph nodes in 97 (46%), and distant in 51 (24%). Seventy-three percent of all FMRs were detected by the patient. The presence of a symptom was the only independent predictor of a patient-detected FMR (P < .0001). There was no statistically significant survival difference between the patient-detected and doctor-detected FMRs. CONCLUSIONS Three-quarters of FMRs were detected by patients or their partners, and it should be possible to improve this rate even further by better education. More frequent follow-up visits are thus unlikely to be valuable. Reductions in follow-up frequency may therefore be safe and economically responsible.
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Affiliation(s)
- Anne Brecht Francken
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, 1A Eden Street, North Sydney, New South Wales, 2050, Australia
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Fisher NM, Schaffer JV, Berwick M, Bolognia JL. Breslow depth of cutaneous melanoma: impact of factors related to surveillance of the skin, including prior skin biopsies and family history of melanoma. J Am Acad Dermatol 2006; 53:393-406. [PMID: 16112344 DOI: 10.1016/j.jaad.2005.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Revised: 02/27/2005] [Accepted: 03/04/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND Because the early detection of cutaneous melanoma can dramatically improve survival, identification and surveillance of persons at risk have received much attention. OBJECTIVE Our purpose was to examine the influences of personal or family history, patterns of detection, and prior skin biopsies (considered to be a measurement of surveillance by medical personnel) on the Breslow depth of cutaneous melanomas. METHODS A retrospective cohort analysis of 218 patients with a history of at least one invasive cutaneous melanoma who visited the Yale Pigmented Lesion Clinic between January 1995 and January 1996 was performed. Data on patterns of detection, melanocytic nevi, and skin biopsies before and after the initial diagnosis of melanoma were collected, and patients with a family history of melanoma were compared with sporadic patients. RESULTS Initial melanomas discovered by dermatologists were more likely to be 0.75 mm or less in depth than those found by other physicians (P = .03). Although patients detected 45% of the initial primary melanomas (98/218), dermatologists discovered 80% of the second primary tumors (33/41; P = .001). A personal history of melanoma was predictive of a thinner Breslow depth (P = .01), but a family history of melanoma was not. Having a biopsy of any type or combination of types of skin lesion(s) performed in the 5 years, 2 years, or 1 year before the first diagnosis of melanoma did not predict a melanoma of thinner Breslow depth among either familial or sporadic patients. The mean number of skin biopsies performed per patient was 8 times higher in the 5-year period after (5.6) versus the 5-year period before (0.7) the initial diagnosis of melanoma, with a peak in the first year after the diagnosis (2.3 vs 0.25 in the prior year). In 27 patients, one or more skin biopsies were performed in the year before the initial diagnosis of melanoma; 41% of these biopsies (23/56) were of lesions in normally exposed sites (eg, the face, neck, and forearms) compared with 22% of the melanomas (6/27). LIMITATIONS Since an invasive melanoma (with the possible exception of a nodular melanoma) would likely have been present for at least a year, plausible explanations for why evidence of previous dermatologic care did not appear to result in earlier detection include performance of a limited rather than a total body skin examination as well as subtle clinical features of early melanomas. However, this study cannot give weight to these explanations because at the time new Pigmented Lesion Clinic patients were not routinely asked about previous total body skin examinations. CONCLUSIONS The disappointing trends seen in this study, with neither the well-established risk factor of a family history of melanoma nor previously having a skin biopsy predicting thinner melanomas, highlight the need to establish criteria defining the subset of patients for whom appropriate management requires periodic total body skin examination.
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Affiliation(s)
- Nina M Fisher
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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McPherson M, Elwood M, English DR, Baade PD, Youl PH, Aitken JF. Presentation and detection of invasive melanoma in a high-risk population. J Am Acad Dermatol 2006; 54:783-92. [PMID: 16635658 DOI: 10.1016/j.jaad.2005.08.065] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 07/26/2005] [Accepted: 08/04/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early detection of melanoma has been encouraged in Queensland for many years, yet little is known about the patterns of detection and the way in which they relate to tumor thickness. OBJECTIVE Our purpose was to describe current patterns of melanoma detection in Queensland. METHODS This was a population-based study, comprising 3772 Queensland residents diagnosed with a histologically confirmed melanoma between 2000 and 2003. RESULTS Almost half (44.0%) of the melanomas were detected by the patients themselves, with physicians detecting one fourth (25.3%) and partners one fifth (18.6%). Melanomas detected by doctors were more likely to be thin (<0.75 mm) than those detected by the patient or other layperson. Melanomas detected during a deliberate skin examination were thinner than those detected incidentally. LIMITATIONS Although a participation rate of 78% was achieved, as in any survey, nonresponse bias cannot be completely excluded, and the ability of the results to be generalized to other geographical areas is unknown. CONCLUSION There are clear differences in the depth distribution of melanoma in terms of method of detection and who detects the lesions that are consistent with, but do not automatically lead to, the conclusion that promoting active methods of detection may be beneficial.
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Nyawata ID, Topping AE. Symptom interpretation as a source of delay in malignant melanoma presentation — A literature review. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cein.2006.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Liu W, Hill D, Gibbs AF, Tempany M, Howe C, Borland R, Morand M, Kelly JW. What features do patients notice that help to distinguish between benign pigmented lesions and melanomas?: the ABCD(E) rule versus the seven-point checklist. Melanoma Res 2005; 15:549-54. [PMID: 16314742 DOI: 10.1097/00008390-200512000-00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ABCD(E) rule and the seven-point checklist are diagnostic aids that have proven to be useful in the hands of physicians; however, little is known of their value to patients with respect to aiding self-detection. The objective of this study was to investigate features that patients notice when identifying melanomas and to explore how well these features correspond to the ABCD(E) rule and the seven-point checklist. A retrospective, modified, case-control study involving patient interviews was performed. All interviews were conducted through the private consulting rooms of a Melbourne dermatologist (JWK) and a Newcastle plastic surgeon (CH) prior to the result of pathology being known to the patients and the interviewers. Sixty-seven patients with benign pigmented skin lesions and 46 patients with melanomas were included. Using a logistic regression model, the change in size/new lesion and change in colour (major criteria, seven-point checklist) were most useful in differentiating between melanomas and benign pigmented lesions in the hands of patients [odds ratio (OR), 4.74; 95% confidence interval (CI), 1.85-12.19; P=0.001; OR, 4.27; 95% CI, 1.62-11.26; P=0.003, respectively). The ABCD(E) rule failed to discriminate between melanoma and other benign pigmented skin lesions. It can be concluded that, of the patients' observations, changes in size or colour were most important in distinguishing between benign pigmented lesions and melanomas. Such features therefore deserve emphasis in public education campaigns. Medical professionals should also remember to seek a history of change in assessing pigmented skin lesions.
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Affiliation(s)
- Wendy Liu
- Victorian Melanoma Service, The Alfred Hospital, Prahran, Victoria, Australia.
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Abstract
BACKGROUND In several studies, delays in malignant melanoma (MM) diagnosis have been correlated with increased tumor thickness, increased morbidity, and increased mortality. OBJECTIVE We sought to assess how MM is detected in British Columbia, Canada, and to understand the role of patient education and other factors on diagnostic delays. METHODS A self-administered questionnaire was distributed to 176 consecutive patients with histologically confirmed MM. RESULTS The total median delay was 4 months. There was no correlation between tumor thickness and delay times. Lesions found incidentally by physicians were less invasive (median Breslow thickness 0.59 vs 1.0 mm, P=.006) than those found by patients. The majority of patients had some knowledge of MM and recognized the importance of early detection. Nearly one fourth of respondents were unaware MM could develop from a melanocytic nevus. In general, MM knowledge did not affect total delay. CONCLUSION Patients in British Columbia, Canada, report relatively short delays in diagnosis of MM. Delays were not correlated with increased tumor thickness or with patient knowledge regarding melanoma before diagnosis.
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Evans RE, Brotherstone H, Miles A, Wardle J. Gender differences in early detection of cancer. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.jmhg.2004.12.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Eide MJ, Weinstock MA, Dufresne RG, Neelagaru S, Risica P, Burkholder GJ, Upegui D, Phillips KA, Armstrong BK, Robinson-Bostom L. Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin). J Invest Dermatol 2005; 124:308-14. [PMID: 15675948 PMCID: PMC1613794 DOI: 10.1111/j.0022-202x.2004.23546.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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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Affiliation(s)
- Melody J. Eide
- Department of Community Health and
- Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, USA
- Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Address correspondence to: Melody J. Eide, MD, MPH, and Martin A. Weinstock, MD PhD, VA Medical Center Providence, 830 Chalkstone Avenue (111D), Providence, Rhode Island 02908, USA.
| | - Martin A. Weinstock
- Department of Community Health and
- Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Department of Dermatology, Brown Medical School, Providence, Rhode Island, USA
| | - Raymond G. Dufresne
- Department of Dermatology, Brown Medical School, Providence, Rhode Island, USA
| | - Suleka Neelagaru
- Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Patricia Risica
- Department of Community Health and
- Institute for Community Health Promotion, Brown University, Providence, Rhode Island, USA
| | - Gary J. Burkholder
- Institute for Community Health Promotion, Brown University, Providence, Rhode Island, USA
| | - David Upegui
- Institute for Community Health Promotion, Brown University, Providence, Rhode Island, USA
| | - Katharine A. Phillips
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
| | | | - Leslie Robinson-Bostom
- Department of Dermatology, Brown Medical School, Providence, Rhode Island, USA
- Department of Pathology, Brown Medical School, Providence, Rhode Island, USA
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47
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Bauer J, Blum A, Strohhäcker U, Garbe C. Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol 2005; 152:87-92. [PMID: 15656806 DOI: 10.1111/j.1365-2133.2005.06370.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermoscopy has improved the sensitivity and specificity of clinical diagnosis of melanoma from 60% to over 90%. However, in order not to miss melanoma a certain percentage of suspicious but benign lesions has to be excised. OBJECTIVES To evaluate the dermoscopic changes and the rates of excision in benign melanocytic naevi and cutaneous malignant melanoma in long-term follow-up of high-risk patients using digital dermoscopy. METHODS Digital dermoscopic images of 2015 atypical melanocytic naevi in 196 high-risk patients were analysed retrospectively. Among others, the following data were collected for each naevus: changes in surface area, overall architecture, dermoscopic patterns and distribution of pigmentation. All tumours suspicious for melanoma or showing asymmetrical changes were excised. RESULTS During a median follow-up time of 25 months 128 (6.4%) of all naevi showed changes in size or architecture. Eighty-six per cent of all changes in patients who attended more than one visit were observed at the first follow-up visit. Thirty-three lesions showing changes were excised and two melanomas in situ and 31 melanocytic naevi were diagnosed. CONCLUSIONS Follow-up examinations using digital dermoscopy revealed unchanged morphology in the large majority of melanocytic naevi. Excisions were only performed in cases of asymmetrical growth, asymmetrical changes of pigmentation, or development of dermoscopic features indicative of melanoma. The ratio of 33 lesions excised in order to identify two melanomas in situ seems reasonable and may be further reduced in future.
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Affiliation(s)
- J Bauer
- Department of Dermatology, Eberhard-Karls-University, Liebermeisterstr. 25, 72076 Tübingen, Germany.
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48
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Blum A, Metzler G, Stroebel W. [Red circumscribed tumor on the foot]. Hautarzt 2004; 56:170-2. [PMID: 15592908 DOI: 10.1007/s00105-004-0803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A Blum
- Universitäts-Hautklinik Tübingen.
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49
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Carli P, De Giorgi V, Palli D, Maurichi A, Mulas P, Orlandi C, Imberti G, Stanganelli I, Soma P, Dioguardi D, Catricala C, Betti R, Paoli S, Bottoni U, Lo Scocco G, Scalvenzi M, Giannotti B. Self-detected cutaneous melanomas in Italian patients. Clin Exp Dermatol 2004; 29:593-6. [PMID: 15550129 DOI: 10.1111/j.1365-2230.2004.01628.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Self-detection of suspicious pigmented skin lesion combined with rapid referral to dermatologic centres is the key strategy in the fight against melanoma. The investigation of factors associated with pattern of detection of melanoma (self- vs. nonself-detection) may be useful to refine educational strategies for the future. We investigated the frequency of melanoma self-detection in a Mediterranean population at intermediate melanoma risk. A multicentric survey identified 816 consecutive cases of cutaneous melanoma in the period January to December 2001 in 11 Italian clinical centres belonging to the Italian Multidisciplinary Group on Melanoma. All patients filled a standardized questionnaire and were clinically examined by expert dermatologists. Self-detected melanomas were 40.6%, while the remaining lesions were detected by a dermatologist (18.5%), the family physician (15.2%), other specialists (5%), the spouse (12.5%), a friend or someone else (8.2%). Variables associated with self-detected melanomas were female sex, young age, absence of atypical nevi, knowledge of the ABCD rule, habit of performing skin self-examination. Self-detected melanomas did not differ from nonself-detected tumours in term of lesion thickness; however, patients with self-detected melanomas waited a longer period before having a diagnostic confirmation (patient's delay) (> 3 months: odds ratio, 3.89; 95% confidence interval, 2.74-5.53). In order to reduce the patients' delays, educational messages should adequately stress the need for a prompt referral to a physician once a suspicious pigmented lesion is self-detected.
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Affiliation(s)
- P Carli
- Department of Dermatology, University of Florence, Italy.
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50
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Marckmann G, Möhrle M, Blum A. [Taking responsibility for one's own health. Possibilities and limits using the example of malignant melanoma]. Hautarzt 2004; 55:715-20. [PMID: 15241517 DOI: 10.1007/s00105-004-0766-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Because of the persistent shortage of health care resources, scientists and politicians are discussing ways to increase the patients' personal responsibility for their own health. Based on a philosophical analysis of the concept of responsibility, this article tries to assess strengths and limits of a personal responsibility for health, illustrated by the prevention of cutaneous melanoma. On the one hand, individuals bear prospective responsibility for their health status by adopting a healthy lifestyle and participating in prevention programs. On the other hand, individuals can--retrospectively--be held responsible for those conditions that result from the voluntary choice of health risks. Considering the tremendous practical and ethical problems associated with retrospective responsibility, prevention and public health policies should emphasize prospective personal responsibility for health.
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Affiliation(s)
- G Marckmann
- Institut für Ethik und Geschichte der Medizin, Universität Tübingen.
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