ReportPresentation and detection of invasive melanoma in a high-risk population
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.
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Funding source: National Health and Medical Research Council, Australia.
Conflicts of interest: None identified.