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Melanoma Detection by Patients and Physicians

The incidence of melanoma continues to rise, with an estimated 41,600 new cases diagnosed in 1998. Early detection is key for improved survival. In this retrospective study, investigators at a university center interviewed all 102 patients newly diagnosed with primary localized melanoma during a two-year period and reviewed their medical records.

The majority of melanomas (55%) were self-detected, 24% were detected by a physician, 12% by a spouse, and 10% by others. The lesions detected by physicians were thinner than those detected by nonphysicians (mean thickness, 0.23 vs. 0.9 mm). Younger patients and those with a higher educational level had thinner melanomas. Among physician-detected melanomas, 83% were biopsied within one month, while only 16% of nonphysician-detected melanomas were biopsied within one month. Women were more likely to detect melanomas on themselves or their spouses than men.

Comment: This study suggests that routine skin examinations by physicians are more effective at detecting early melanoma than patient self-examination. However, routine skin examination of all adults may not be cost-effective. Educational efforts to teach self-examination of the skin directed especially toward men may lead to the detection of thinner melanomas by the lay public.

— GJ Hruza

Published in Journal Watch Dermatology March 1, 1999

Citation(s):

Epstein DS et al. Is physician detection associated with thinner melanomas? JAMA 1999 Feb 17 281 640-643.

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