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Presentation and detection of invasive melanoma in a high-risk population

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Background

Early detection of melanoma has been encouraged in Queensland for many years, yet little is known about the patterns of detection and the way in which they relate to tumor thickness.

Objective

Our purpose was to describe current patterns of melanoma detection in Queensland.

Methods

This was a population-based study, comprising 3772 Queensland residents diagnosed with a histologically confirmed melanoma between 2000 and 2003.

Results

Almost half (44.0%) of the melanomas were detected by the patients themselves, with physicians detecting one fourth (25.3%) and partners one fifth (18.6%). Melanomas detected by doctors were more likely to be thin (<0.75 mm) than those detected by the patient or other layperson. Melanomas detected during a deliberate skin examination were thinner than those detected incidentally.

Limitations

Although a participation rate of 78% was achieved, as in any survey, nonresponse bias cannot be completely excluded, and the ability of the results to be generalized to other geographical areas is unknown.

Conclusion

There are clear differences in the depth distribution of melanoma in terms of method of detection and who detects the lesions that are consistent with, but do not automatically lead to, the conclusion that promoting active methods of detection may be beneficial.

Section snippets

Case ascertainment

Queensland residents between 20 and 75 years of age who were diagnosed with histologically confirmed first primary invasive cutaneous melanoma (not including acral lentiginous melanoma) between Jan 1, 2000 and Dec 31, 2003 were eligible for this study. During this period, 94.1% of all melanomas among Queensland residents were diagnosed within this age group. For sampling efficiency and cost, all patients with thick melanomas (≥0.75 mm) and a random 60% sample of those with thinner melanomas

Response

We identified 4854 eligible patients, but 15 were deceased and doctor's consent had not been obtained for 329. Of the remaining 4510 patients, 3887 consented to participate, 369 refused, 201 were contacted but never replied, and 53 were unable to be contacted (no current address or telephone number). Of the total, 80% of patients agreed to participate and 3772 (78%) completed an interview.

There were no significant differences between participants and nonparticipants in relation to age, site,

Discussion

The vast majority of melanomas were first detected by the patients themselves, their partners, and laypersons. However, melanomas detected by physicians were more likely to be thin at diagnosis than those detected by laypersons. Similarly, lesions detected by a doctor at a routine skin examination had a much more favorable thickness distribution than those detected by the patients themselves or another layperson as an incidental finding.

To our knowledge, this is the largest population-based

Conclusions

The message of this observational study is that there are clear differences in the thickness distribution of melanoma in terms of method of detection and who detects the lesions, and perhaps in symptomatology, which are consistent with, but do not automatically lead to, the conclusion that promoting active methods of detection may be beneficial. This study emphasizes the potential for earlier diagnosis and the need for definitive studies to address this issue.

References (49)

  • Australian Institute of Health and Welfare Australasian Association of Cancer Registries

    Cancer in Australia 2001

    (2003)
  • D.M. Parkin et al.

    Cancer incidence in five continents

    (2002)
  • Baade P, Coory M, Ring I. National Health Priority cancers in Queensland (1982-1997). Available at:...
  • A. Jemal et al.

    Cancer statistics, 2004

    CA Cancer J Clin

    (2004)
  • Hall L, Youden D, Coory M. Mortality and incidence trends for leading cancers in Queensland, 1982 to 2002. Available...
  • South Australian Cancer Registry

    Epidemiology of cancer in South Australia. Incidence, mortality and survival 1977 to 1997

    (1998)
  • A. Jemal et al.

    Recent trends in cutaneous melanoma incidence among whites in the United States

    J Natl Cancer Inst

    (2001)
  • D. Lipsker et al.

    Striking increase of thin melanomas contrasts with stable incidence of thick melanomas

    Arch Dermatol

    (1999)
  • D. Balzi et al.

    Cutaneous melanoma in the Florentine area, Italy: incidence, survival and mortality between 1985 and 1994

    Eur J Cancer Prev

    (2003)
  • L.D. Marrett et al.

    Trends in the incidence of cutaneous malignant melanoma in New South Wales, 1983-1996

    Int J Cancer

    (2001)
  • M.A. Richard et al.

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

    Int J Cancer

    (2000)
  • M.H. Schmid-Wendtner et al.

    Delay in the diagnosis of cutaneous melanoma: an analysis of 233 patients

    Melanoma Res

    (2002)
  • A. Blum et al.

    Awareness and early detection of cutaneous melanoma: an analysis of factors related to delay in treatment

    Br J Dermatol

    (1999)
  • D. Epstein et al.

    Is physician detection associated with thinner melanomas?

    JAMA

    (1999)
  • Cited by (0)

    Funding source: National Health and Medical Research Council, Australia.

    Conflicts of interest: None identified.

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