Routine dermatologist-performed full-body skin examination and early melanoma detection

Arch Dermatol. 2009 Aug;145(8):873-6. doi: 10.1001/archdermatol.2009.137.

Abstract

Objective: To determine the proportion of patients in a private dermatology practice in whom melanoma was detected but was not the presenting complaint.

Design: Retrospective analytical case series.

Setting: Private dermatology practice in Florida, from July 2005 through October 2008. Patients Patients with 126 melanomas, of which 51 were invasive and 75 were melanomas in situ.

Main outcome measures: Proportion of melanomas detected as a result of patient complaint vs proportion determined by dermatologist-conducted full-body skin examination (FBSE). As a secondary analysis, we used logistic regression odds ratios (ORs) of association to examine whether dermatologist detection rather than patient complaint was associated with detecting thinner melanomas. A post hoc analysis was performed using a thickness cutoff of 1.0 mm to define a deep melanoma.

Results: Overall, 56.3% (95% confidence interval [CI], 47.6%-65.1%) of melanomas were found by the dermatologist and were not part of the presenting complaint. Of melanomas in situ, 60.0% (95% CI, 48.7%-71.3%) were dermatologist detected. Dermatologist detection was significantly associated with thinner melanomas, with an OR of 0.42 (P = .04). We found a significant association between thinner melanomas as a group (thickness <1 mm) and dermatologist detection, with a logistic regression OR of 5.0 (95% CI, 1.0-25.3).

Conclusions: Most melanomas detected in a general-practice dermatology setting were found as a result of dermatologist-initiated FBSE, not patient complaint. We found that dermatologist detection was associated with thinner melanomas and an increasing likelihood of the melanoma being in situ.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Melanoma / diagnosis*
  • Melanoma / pathology
  • Middle Aged
  • Physical Examination*
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / pathology
  • Young Adult