Temoshok L, DiClemente R J, Sweet D M, Blois M S, Sagebiel R W
Cancer. 1984 Dec 15;54(12):3048-53. doi: 10.1002/1097-0142(19841215)54:12<3048::aid-cncr2820541239>3.0.co;2-m.
This study investigated the relationship between patient delay in seeking medical attention and prognostic indicators, tumor characteristics, and demographic and behavioral factors in 106 patients with cutaneous malignant melanoma. Patients with less readily apparent lesions, particularly on the back, had longer delays in seeking treatment, as might be expected. The prognostically unfavorable nodular melanomas were detected more frequently by patients themselves than they were found during visits to physicians for unrelated problems. In terms of behavioral variables, patients with less knowledge of melanoma or its appropriate treatment had significantly longer delays. Patients who minimized the seriousness of their condition were more likely to seek treatment sooner, perhaps because this reduced fear and anxiety about the disease or its treatment. For superficial spreading melanoma, delay was significantly and positively correlated with Clark's level of invasion, and also with tumor thickness when only noncoincidentally diagnosed patients were included; whereas for the nodular type, delay was significantly and positively associated with tumor thickness, whether the patient was coincidentally diagnosed or not. The significance of these findings for early detection, and hence improved prognosis of malignant melanoma, is discussed.
本研究调查了106例皮肤恶性黑色素瘤患者就医延迟与预后指标、肿瘤特征以及人口统计学和行为因素之间的关系。正如预期的那样，病变不太明显的患者，尤其是背部有病变的患者，就医延迟时间更长。与因其他无关问题就诊时被医生发现相比，预后不良的结节性黑色素瘤更多是由患者自己发现的。在行为变量方面，对黑色素瘤或其适当治疗了解较少的患者延迟时间明显更长。将病情严重性降至最低的患者更有可能更快寻求治疗，这可能是因为这样减轻了对疾病或其治疗的恐惧和焦虑。对于浅表扩散型黑色素瘤，仅纳入非偶然诊断的患者时，延迟与克拉克侵袭分级显著正相关，也与肿瘤厚度显著正相关；而对于结节型，无论患者是否为偶然诊断，延迟均与肿瘤厚度显著正相关。本文讨论了这些发现对早期发现以及改善恶性黑色素瘤预后的意义。
