Physician-based screening leads to detection of thinner melanomas that were less likely to have negative prognostic attributes such as ulceration and dermal mitosis, according to a retrospective review of patient records and biopsy logs from 394 patients diagnosed with cutaneous melanoma. The results were reported in the Archives of Dermatology.
The study participants were 269 men and 125 women who were either established or new patients of a pigmented lesion clinic at Memorial Sloan-Kettering Cancer Center in New York. The mean age was 61.8 years, with a range of 17 to 91 years. Established patients were defined as those who have received professional services at the clinic for at least 3 months.
Findings at 10 Years
Over a period of 10 years, 527 melanomas were identified in the 394 patients, 323 (61.3%) in situ, 171 (32.4%) invasive, and 33 (6.3%) metastatic. “Importantly, the detection of early melanoma was not the result of the increase in the biopsy of benign lesions,” the authors noted.
“Established patients had more in situ disease (70% vs 57%; P < .001) and thinner invasive melanomas (0.45 mm vs 0.82 mm; P = .002) and were less likely to present with negative prognostic attributes such as ulceration and dermal mitoses compared with new patients,” the researchers wrote. “In new patients, 63% of melanomas were physician detected vs 82% in established patients; 18% of all melanomas were patient detected. Dermatologist-detected melanomas were thinner compared with self-detected melanomas. The majority of self-detected melanomas were noted by patients because of change (64%).”
“Our results suggest that physician screening leads to detection of thinner melanoma,” the authors commented and “have implications for promoting physician and self-screening and for emphasizing the important role that a specialized [pigmented lesion clinic] setting may play in the early diagnosis of melanoma.” They also noted the importance of educating patients to recognize melanoma signs and symptoms and perform skin self-examination.
“It is crucial,” the authors concluded, “to emphasize that a combined strategy of physician detection and patient participation must continue to be implemented to ensure early melanoma diagnosis.” ■
Kovalyshyn J, et al: Arch Dermatol 147:1269-1275, 2011.
