Comparing Melanoma Invasiveness in Dermatologist- versus Patient-Detected Lesions: A Retrospective Chart Review

University of Nevada School of Medicine, Reno, NV 89557, USA.
Journal of skin cancer 07/2012; 2012(3):187963. DOI: 10.1155/2012/187963
Source: PubMed


This study examined whether patient-identified melanomas were more advanced than dermatologist-identified tumors at routine clinic visits, and whether a personal or family history of skin cancer was associated with patterns of detection. A retrospective chart review was performed on melanoma patients (N = 201) in a private dermatology clinic. Variables included age, gender, pattern of detection (i.e., patient or a board certified dermatologist), personal or family history of skin cancer, skin type, and previous sun exposure, as well as tumor location and severity. Dermatologist-diagnosed melanomas were less invasive (P < 0.0005), and more likely present on the chest, back, and legs (P < 0.01). Conversely, patient-identified lesions were more likely to occur on the face, neck and scalp, be associated with younger patients, and a family history of melanoma, but not other types of skin cancer (P < 0.01). In a post-hoc analysis examining these factors as predictors of tumor invasiveness, only diagnostic source was significant. Specifically, dermatologist-identified tumors were significantly less invasive than patient-identified tumors. Although age, family history, and tumor location played roles in the early detection of melanomas, the most important factor was diagnostic source. Thus, board-certified dermatologists play a key role in the early detection of malignant melanoma.

Download full-text


Available from: Mohammed Kashani-Sabet
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients from ethnoracial minority groups have lower incidence rates of melanoma compared with whites, but are more likely to have advanced melanomas at diagnosis and lower survival. Infrequent skin cancer screening and poor melanoma awareness may contribute to these disparities. The purpose of this survey study was to evaluate skin cancer surveillance behaviors and awareness among patients attending a dermatology clinic at a public hospital in New York City. Surveys were administered to 152 patients from April to June 2012. In all, 16% of patients previously had a total body skin examination for cancer, 11% were taught by a health care practitioner how to perform skin self-examinations, and 15% perform skin self-examinations. More whites had a total body skin examination compared with minorities (49% vs 5%). Only 33% of patients previously given a diagnosis of skin cancer performed skin self-examinations. Patients possessed a poor ability to recognize features suspicious for melanoma, with minorities (especially Hispanics) performing worse than whites. Small sample size is a limitation. Few patients engage in skin cancer screening behaviors and their knowledge about melanoma is poor, with minorities demonstrating lower understanding than whites. Our findings emphasize the need for improved patient education about characteristics of melanoma, regardless of race.
    No preview · Article · Dec 2013 · Journal of the American Academy of Dermatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Early detection is critical to successful treatment of melanoma, and at-risk individuals often are educated about melanoma by showing them examples of symptom-free and highly symptomatic lesions. We explain why, according to principles of stimulus control, this common practice could discourage the detection of newly developed symptoms and present an experiment modeling the predicted effects. Using images depicting a continuum of melanoma symptom severity, we familiarized participants with a symptomatic lesion (S+), and then conducted generalization tests to determine how often they would label other degrees of symptom severity as the same as (unchanged from) S+. During training for a group that was modeled after typical melanoma education efforts, S- was an asymptomatic lesion. For passive and active control groups, respectively, S- was either absent or a more severely symptomatic lesion. In generalization tests, gradient shift occurred such that stimuli similar to S- were especially unlikely to be called “same.” For the target group, this resulted in reduced labeling of mildly symptomatic lesions as symptomatic. We discuss the implications of these findings for melanoma education efforts.
    Full-text · Article · Apr 2015 · The Psychological record