Melanoma and tumor thickness - Challenges of early diagnosis

Objective: To test the basic assumption of campaigns for early diagnosis of melanoma, ie, prognosis is correlated with the delay in the diagnosis. Design: Prospective study of the correlation between delays to diagnosis, a ssessed using a questionnaire, and the Breslow thickness as a prognosis mar ker. Setting: Dermatology departments in France. Patients: Five hundred ninety consecutive patients, referred within 12 week s after resection of cutaneous melanoma. Main Outcome Measures: Assessment of 5 successive time intervals from the f irst time the patients realized that they had a lesion until the resection of the melanoma, and results of the correlation between each time interval and tumor thickness (Breslow). Results: There is a positive but weak correlation between tumor thickness a nd the delay to identify a lesion as suspicious (r = 0.17; P = .009). Howev er, this delay tends to be short for the thickest tumors. There is a negati ve correlation between tumor thickness and the delay to seek medical attent ion (r = -0.20, P < .001). This delay was shorter for nodular melanoma. No correlation is found between melanoma thickness and physicians' delays. Conclusions: Poor prognosis can be accounted for by aggressive rapidly grow ing tumors rather than by delays. In well-informed populations, campaigns f or early diagnosis of melanoma may thus no longer have a major impact on pr ognosis, unless they are focused on subgroups less accessible to informatio n and medical care.