Is Physician Detection Associated With Thinner Melanomas?
Epstein, Darin S. MD; Lange, Julie R. MD; Gruber, Stephen B. MD, PhD; Mofid, Mona MD; Koch, Susan E. MD
[Article] JAMA. 281(7):640-643, February 17, 1999.

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Context: In cutaneous melanoma, tumor depth remains the best biologic predictor of patient survival. Detection of prognostically favorable lesions may be associated with improved survival in patients with melanoma.

Objective: To determine melanoma detection patterns and relate them to tumor thickness.

Design: Interview survey.

Setting and Patients: All patients with newly detected primary cutaneous melanoma at the Melanoma Center, Johns Hopkins Medical Institutions, between June 1995 and June 1997.

Main Outcome Measure: Tumor thickness grouped according to detection source.

Results: Of the 102 patients (47 men, 55 women) in the study, the majority of melanomas were self-detected (55%), followed by detection by physician (24%), spouse (12%), and others (10%). Physicians were more likely to detect thinner lesions than were patients who detected their own melanomas (median thickness, 0.23 mm vs 0.9 mm; P<.001). When grouped according to thickness, 11 (46%) of 24 physician-detected melanomas were in situ, vs only 8 (14%) of 56 patient-detected melanomas. Physician detection was associated with an increase in the probability of detecting thinner ( < or= to 0.75 mm) melanomas (relative risk, 4.2; 95% confidence interval, 1.4-11.1; P =.01).

Conclusions: Thinner melanomas are more likely to have been detected by physicians. Increased awareness by all physicians may result in greater detection of early melanomas.

JAMA.1999;281:640-643

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