First Department of Dermatology-Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece.
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
JAMA Dermatol. 2018 May 1;154(5):544-553. doi: 10.1001/jamadermatol.2018.0288.
Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer.
To investigate the association of SSE, PSE, and patient attitudes with the detection of thinner superficial spreading melanoma (SSM) and nodular melanoma (NM), the latter of which tends to elude early detection.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, questionnaire-based, multicenter study identified patients with newly diagnosed cutaneous melanoma at 4 referral hospital centers in the United States, Greece, and Hungary. Among 920 patients with a primary invasive melanoma, 685 patients with SSM or NM subtype were included.
A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis.
Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM.
Of 685 participants (mean [SD] age, 55.6 [15.1] years; 318 [46%] female), thinner melanoma was detected in 437 of 538 SSM (81%) and in 40 of 147 NM (27%). Patients who routinely performed SSE were more likely to be diagnosed with thinner SSM (odds ratio [OR], 2.61; 95% CI, 1.14-5.40) but not thinner NM (OR, 2.39; 95% CI, 0.84-6.80). Self-detected clinical warning signs (eg, elevation and onset of pain) were markers of thicker SSM and NM. Whole-body PSE was associated with a 2-fold increase in detection of thinner SSM (OR, 2.25; 95% CI, 1.16-4.35) and thinner NM (OR, 2.67; 95% CI, 1.05-6.82). Patient attitudes and perceptions focusing on increased interest in skin cancer were associated with the detection of thinner NM.
Our findings underscore the importance of complementary practices by patients and physicians for the early detection of melanoma, including regular whole-body PSE, SSE, and increased patient awareness.
早期黑素瘤检测策略包括皮肤自我检查（SSE）、医生皮肤检查（PSE）以及促进患者对皮肤癌的认识。
本研究旨在调查皮肤自我检查、医生皮肤检查和患者态度与检测更薄的浅表扩散性黑素瘤（SSM）和结节性黑素瘤（NM）之间的关系，后者往往难以早期发现。
设计、地点和参与者：这是一项横断面、基于问卷的多中心研究，在美国、希腊和匈牙利的 4 家转诊医院中心确定了新诊断为皮肤黑素瘤的患者。在 920 名原发性侵袭性黑素瘤患者中，纳入了 685 名 SSM 或 NM 亚型患者。
使用标准化问卷记录诊断前 1 年内的社会人口统计学信息、SSE 和 PSE 实践以及患者认知。
根据组织学厚度进行数据分析，以 2mm 为界将更薄的 SSM 和 NM 进行区分。
在 685 名参与者（平均[SD]年龄，55.6[15.1]岁；318[46%]为女性）中，538 名 SSM 患者（81%）和 147 名 NM 患者（27%）的肿瘤厚度更薄。常规进行 SSE 的患者更有可能被诊断为更薄的 SSM（比值比[OR]，2.61；95%CI，1.14-5.40），但不太可能被诊断为更薄的 NM（OR，2.39；95%CI，0.84-6.80）。自我发现的临床警示标志（如隆起和疼痛开始）是更厚的 SSM 和 NM 的标志物。全身 PSE 与更薄的 SSM（OR，2.25；95%CI，1.16-4.35）和更薄的 NM（OR，2.67；95%CI，1.05-6.82）的检测呈 2 倍相关。关注对皮肤癌兴趣增加的患者态度和认知与更薄 NM 的检出相关。
本研究结果强调了患者和医生互补实践的重要性，这些实践包括定期进行全身 PSE、SSE 和提高患者意识，以实现黑素瘤的早期发现。
