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Is Physician Detection Associated With Thinner Melanomas?
Darin S. Epstein, MD;
Julie R. Lange, MD;
Stephen B. Gruber, MD, PhD;
Mona Mofid, MD;
Susan E. Koch, MD
JAMA. 1999;281:640-643.
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 ( 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.
Author Affiliations: Departments of Dermatology (Drs Epstein and Mofid) and Surgery (Dr Lange), Johns Hopkins School of Medicine, Baltimore, Md; the Department of Molecular Medicine and Genetics, University of Michigan, Ann Arbor (Dr Gruber); and the Department of Dermatology, Oregon Health Sciences University, Portland (Dr Koch).
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