The impact of physician screening on melanoma detection.

OBJECTIVE

To compare melanoma characteristics and detection patterns in new vs established patients in a pigmented lesion clinic at Memorial Sloan-Kettering Cancer Center (MSKCC) during a 10-year period.

DESIGN

Single-center historical cohort study.

SETTING

Academic practice of 2 dermatologists with expertise in the management of pigmented skin lesions.

PATIENTS

The study included 394 patients diagnosed with cutaneous melanoma at MSKCC between 1998 and 2008. For the purposes of this study, we separated patients into 2 groups: established patients, defined as patients who have received professional services in a pigmented lesion clinic at MSKCC for at least 3 months, vs new patients, defined as patients new to our practice.

MAIN OUTCOME MEASURES

Melanoma histologic characteristics and patterns of melanoma detection in established vs new patients.

RESULTS

Established patients had more in situ disease (70% vs 57%; P < .001) and thinner invasive melanomas (0.45 mm vs 0.82 mm; P = .002) and were less likely to present with negative prognostic attributes such as ulceration and dermal mitoses compared with new patients. In new patients, 63% of melanomas were physician detected vs 82% in established patients; 18% of all melanomas were patient detected. Dermatologist-detected melanomas were thinner compared with self-detected melanomas. The majority of self-detected melanomas were noted by patients because of change (64%). The overall benign to malignant biopsy ratio over the 10-year period was 5.4:1.

CONCLUSION

Physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma.