SOCIOECONOMIC-STATUS AND ATTITUDES OF 51 PATIENTS WITH GIANT BASAL AND SQUAMOUS-CELL CARCINOMA AND PAIRED CONTROLS

Background: Giant nonmelanoma skin cancers are disfiguring and clearly visible. This prospective study examined tumor characteristics, ie, l ocation, tumor type, duration, and the socioeconomic status and attitu dinal characteristics of these patients and their interactions with th e medical community. Design: From 1979 through 1993, preoperative ques tionnaires about age, sex, tumor duration, prior treatment, socioecono mic status, and attitudinal concerns were completed by 51 patients wit h giant tumors and randomly matched controls. Additional data complete d by the physician included tumor type, location, and preoperative cli nically apparent diameter of the tumor. Results: Giant tumors were mor e frequent on the scalp in men. Lower socioeconomic status and infrequ ent physician visits were characteristic of those with giant lesions. Those with giant lesions were less concerned about their general healt h, had a greater sense of shame about their appearance, had greater be lief that since prior treatment did not help the problem then nothing else would, and had an increased frequency of perceived prior reassura nce. Women and those younger than 65 years of both sexes were more con cerned about economic costs and/or the time lost from work or caring f or others. Conclusions: Health promotion by early detection and treatm ent of these nonmelanoma skin cancers in elderly men could prevent ext ensive surgical efforts later in the course of the disease. Skin scree ning examinations by all physicians and better public awareness of the signs of skin cancer, especially among elderly men, would enhance ear ly detection; however, it is not clear that early detection by physici ans enables treatment. Strategies to assist individuals in overcoming their barriers to accessing care need to be provided.