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Multicenter Study
. 2018 May 1;154(5):544-553.
doi: 10.1001/jamadermatol.2018.0288.

Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis

Clio Dessinioti  1 , Alan C Geller  2 , Aravella Stergiopoulou  1 , Susan M Swetter  3   4 , Eszter Baltas  5 , Jonathan E Mayer  6 , Timothy M Johnson  7 , John Talaganis  1 , Myrto Trakatelli  8 , Dimitrios Tsoutsos  9 , Gerasimos Tsourouflis  10 , Alexander J Stratigos  1
Affiliations
Multicenter Study

Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis

Clio Dessinioti et al. JAMA Dermatol. .

Abstract

Importance: Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer.

Objective: 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.

Interventions: A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis.

Main outcomes and measures: Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM.

Results: 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.

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Stratigos reports no conflicts relevant to this article. Outside the scope of this research, Dr Stratigos reports serving on advisory boards for Regeneron and Novartis; receiving honoraria from LeoPharma, Novartis, and Merck Sharp & Dohme; and receiving research support from Roche, Genesis Pharma, Janssen Cilag, and Abbvie. No other disclosures are reported.

Figures

Figure.
Figure.. Flowchart of Patients With Melanoma Included in the Study
Of 920 patients assessed for eligibility, 685 were included in the study. Participants were consecutive, newly diagnosed, predominantly Caucasian patients 18 years or older with primary invasive melanoma. As the study aimed to explore differences in tumor thickness at diagnosis between nodular melanoma (NM) and superficial spreading melanoma (SSM), only patients with these histopathological subtypes were included. Of 685 patients, 147 were diagnosed with NM, and 538 were diagnosed with SSM.
See this image and copyright information in PMC

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