Betti Roberto, Vergani Raffaella, Tolomio Elena, Santambrogio Roberto, Crosti Carlo
Clinica Dermatologica IV, Università degli Studi di Milano, Ospedale San Paolo, Via A. di Rudinì n. 8, Italy.
Eur J Dermatol. 2003 Mar-Apr;13(2):183-8.
Delay in the diagnosis of melanoma was defined as the interval in months from the patient's report of first noticing a suspected lesion to the date of the removal of a histologically confirmed melanoma. 216 patients were included in our study. Total delay was subdivided in three components: patient, medical and referral delay. The major component of delay is due to the patient and the most important cause of it was lack of concern. Lesions in men were detected more frequently by family members, while in women melanomas tended to be self-detected. Nodular melanoma had lower delay but higher thickness. Amelanotic melanomas had a higher delay principally due to the physicians. A significative positive correlation between Breslow thickness and patient delay was observed. The visibility of the tumor and the educational or socio-economic status did not seem to improve early diagnosis. The observation about the shorter delays in thicker tumors lead us to think that educational campaigns should be more focused on recognition of changing or growing lesions than other signs of the ABCD rule and that nodular melanomas are quite different from superficial spreading melanomas.
黑色素瘤诊断延迟定义为从患者首次报告注意到疑似病变至组织学确诊的黑色素瘤切除日期之间的间隔时间（以月为单位）。我们的研究纳入了216例患者。总延迟分为三个部分：患者延迟、医疗延迟和转诊延迟。延迟的主要部分归因于患者，其最重要的原因是缺乏关注。男性的病变更常由家庭成员发现，而女性的黑色素瘤往往是自我发现的。结节性黑色素瘤的延迟时间较短，但厚度较大。无色素性黑色素瘤的延迟时间较长，主要原因在于医生。观察到Breslow厚度与患者延迟之间存在显著的正相关。肿瘤的可见性以及教育程度或社会经济地位似乎并未改善早期诊断。关于较厚肿瘤延迟时间较短的观察结果使我们认为，教育活动应更侧重于识别变化或生长的病变，而非ABCD法则的其他体征，并且结节性黑色素瘤与浅表扩散性黑色素瘤有很大不同。
