Delays in diagnosis and melanoma prognosis (I): The role of patients

A prospective survey was conducted to assess the role of patients in the me lanoma prognosis. Consecutive patients with primary melanoma were interview ed and examined using a comprehensive questionnaire including a psychologic al instrument. Main outcome measures were the delay before medical interven tion and the tumor thickness. Of 590 melanomas, 70.8% were detected by pati ents and this proportion was higher in females. Relatives were involved in the detection of half of the cases, Median delays before the patient realiz ed he had a suspicious lesion, before this lesion was seen by a doctor, and before the melanoma was removed were 4 months, 2 months, and 1 week, respe ctively. Delays up to several years were observed in some cases. The rate o f self-detection tended to be lower, the delays before seeking medical advi ce to be longer, and the tumor thickness to be higher in old people, in mal es, in lower-educated individuals, in those living out of towns, and in peo ple with a low awareness about melanocytic tumors than in other cases, Conv ersely, individuals with a high number of atypical nevi, those who were awa re to be at risk, and those who regularly visited a dermatologist tended to detect their melanoma more rapidly. No specific psychological traits were associated with a late reaction, although negligence and anxiety tended to prolong the delays. Knowledge about melanoma was poor in many patients, esp ecially in males, and wrong beliefs were widespread. This study provides th e targets of future education programs. (C) 2000 Wiley-Liss, Inc.