Full-Body Screen More Likely to Find Melanoma
Reported May 02, 2009
HOUSTON — Routine screening for melanoma led to a 50% increase in detection of small back-of-body lesions in middle-age and older men, Boston investigators reported.
Back lesions accounted for almost half of the lesions detected by physicians, compared to less than 20% of patient-detected lesions, according to Alan C. Geller, of the Boston University School of Public Health, and colleagues.
However, 59% of patients in the study did not receive a full-body physical examination by a physician prior to diagnosis of melanoma, the authors said in the April issue of Archives of Dermatology.
“Skin screenings of at-risk middle-aged and older American men can be integrated into routine physical examination, with particular emphasis on hard-to-see areas, such as the back of the body,” the authors concluded.
” ‘Watch Your Back’ professional education campaigns should be promoted by skin cancer advocacy organizations,” they urged.
Physicians detect melanomas at an earlier stage than either a patient or a significant other. However, less than a third of melanomas are initially detected by physicians, the authors noted.
To identify factors associated with physician detection of melanomas, the authors surveyed 227 men =40 within three months of melanoma diagnosis.
The results showed that 57% of patients with physician-detected melanomas were = 65, compared with 34% of men whose melanomas were detected by others, and 42% of men with self-detected lesions.
Physician-detected melanomas in older patients had a thickness similar to that of self- or other-detected melanomas in younger men.
The authors found that 46% of physician-detected melanomas were back lesions compared with 16% of self-detected lesions (OR 4.25, 95% CI 1.96 to 9.23). Back lesions accounted for 57% of the other-detected melanomas.
Among all back lesions detected by physicians, 92% were <2 mm, compared with 63% of self-detected back lesions (P=0.004) and 76% of other-detected back lesions (P=0.07).
Few men sought educational materials prior to diagnosis, but the rate was higher among men with physician-detected compared with self-detected lesions (11% versus 3%, P=0.045).
More than half of men with physician- (59%) or self-detected (56%) melanoma reported having heard about melanoma from a physician. That compared with 39% of men with other-detected lesions (P=0.03 versus physician-detected melanoma).
Among melanomas discovered by physicians, the authors found no differences between dermatologists and other physicians with respect to tumor thickness, stage, histologic characteristics, or ulceration.
As reported by patients, dermatologists were more likely to give patients materials about how to examine the skin (P=0.002), talk about melanoma (P=0.001), and perform a full-body skin examination (P=0.04).
The proportion of patients reporting full-body examinations in the year prior to diagnosis did not differ among men with physician-detected (43%), self-detected (41%), or other-detected melanoma (52%).
The study was funded by the Harry J. Lloyd Charitable Trust for Melanoma Research.
The authors reported no competing interests.
Primary source: Archives of Dermatology
Source reference:
Geller AC, et al “Factors associated with physician discovery of early melanoma in middle-aged and older men” Arch Dermatol 145(4): 409-14.
