Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma

Arch Dermatol. 2003 May;139(5):607-12. doi: 10.1001/archderm.139.5.607.


Objective: To investigate patterns of detection and variables associated with early diagnosis of melanoma in a population at intermediate melanoma risk.

Design: Survey.

Setting: Hospital and university centers belonging to the Italian Multidisciplinary Group on Melanoma.

Patients: Eight hundred sixteen patients who were consecutively diagnosed as having melanoma and treated at 11 participating centers.

Main outcome measure: Relationship between patterns of detection and patient's and physician's delay with melanoma thickness, assessed by multivariate analysis.

Results: A statistically significant association with early diagnosis was found for female sex (odds ratio [OR] for a lesion >1 mm in thickness, 0.70; 95% confidence interval [CI], 0.50-0.97), higher educational level (OR, 0.44; 95% CI, 0.24-0.79), residence in northern and central Italy (compared with southern Italy) (OR, 0.44; 95% CI, 0.30-0.65 and OR, 0.24; 95% CI, 0.15-0.37, respectively), and the habit of performing a skin self-examination (OR, 0.65; 95% CI, 0.45-0.93). When adjusted for all the previously mentioned variables, only melanoma detection made by a dermatologist, maybe incidentally, was associated with a statistically significant additional effect on early diagnosis (OR, 0.45; 95% CI, 0.28-0.73). No significant effect of anatomical site (trunk compared with other sites: OR, 0.83; 95% CI, 0.59-1.17), presence of atypical nevi (OR, 0.78; 95% CI, 0.52-1.17), and patient's delay (>3 months compared with < or =3 months: OR, 1.12; 95% CI, 0.78-1.60) was found.

Conclusion: Future melanoma early diagnosis strategies should adequately stress the role of skin self-examination among the adult population, and should recommend that dermatologists perform a total skin examination to identify suspect lesions (such an examination should also be performed during consultations for other reasons).

MeSH terms

  • Adult
  • Aged
  • Dermatology / statistics & numerical data*
  • Diagnosis, Differential
  • Female
  • Health Care Surveys / statistics & numerical data*
  • Humans
  • Italy
  • Male
  • Melanoma / diagnosis*
  • Melanoma / etiology
  • Melanoma / therapy
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data
  • Risk Factors
  • Self-Examination / statistics & numerical data*
  • Severity of Illness Index
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / etiology
  • Skin Neoplasms / therapy
  • Time Factors