Patterns of detection in patients with cutaneous melanoma - Implications for secondary prevention

BACKGROUND, Despite the importance of early detection in preventing mortali ty from melanoma, little is known regarding how patients with the disease c ome to diagnosis. METHODS. The authors prospectively evaluated 471 newly diagnosed melanoma p atients between 1995 and 1998. Patients completed a questionnaire that incl uded 1) identification of the person who detected the lesion, 2) the anatom ic location of the lesion, and 3) family history of melanoma. Logistic regr ession analysis was performed to examine the relation between detection pat terns and lesion thickness, adjusting for age, gender, anatomic site of the primary lesion, and family history of melanoma. RESULTS, The majority of patients detected their own melanoma in = 270; 57% ). Females were more likely to self-detect than males (69% vs. 47%; P < 0.0 001). Physicians detected die melanoma in 16% of patients (n = 74), followe d by "spouse" in 11% of patients (n = 51). Within this group, detection by wives was 7.5 times more common than detection by husbands (P < 0.0001). Lo gistic regression analysis revealed that physicians were 3.6 times more lik ely to detect thin lesions (less than or equal to 0.75 mm) compared with no nphysician detectors (95% confidence interval [95%, CI], 2.1, 6.5; P = 0.00 01). In addition, patients who reported a family history of melanoma had a 2.7-fold increased likelihood of presenting with a thin lesion (95% CI, 1.6 , 4.7; P = 0.0003). CONCLUSIONS. Physician detection and a report of a family history of melano ma are associated with die presentation of patients with early melanoma, su ggesting that awareness of the disease among physicians and the public is c ritical for preventing mortality from melanoma. Increasing melanoma awarene ss in males may be a particularly effective means of secondary prevention. (C) 2000 American Cancer Society.