Melanoma depth in patients with an established dermatologist - 16/04/14

Doi : 10.1016/j.jaad.2013.10.060

Michelle Y. Cheng, BA ^a, Jacqueline F. Moreau, MS ^a, Sean T. McGuire, MD ^b, Jonhan Ho, MD ^c, Laura K. Ferris, MD, PhD ^c,^⁎
^a University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
^b Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
^c Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

^∗Reprint requests: Laura K. Ferris, MD, PhD, Department of Dermatology, University of Pittsburgh School of Medicine, 3601 Fifth Ave, Fifth Floor, Pittsburgh, PA 15213.

Abstract

Background

The impact of having an established dermatologist on melanoma depth at diagnosis is incompletely understood.

Objective

We sought to determine whether having had a previous dermatologic examination (an established dermatologist), the recency of the last examination, and the wait time for the dermatology appointment are associated with melanoma invasiveness and depth.

Methods

This was a retrospective cross-sectional study of 388 patients with primary melanoma at an academic dermatology department.

Results

Patients with an established dermatologist were more likely than patients without an established dermatologist to be given a diagnosis of melanoma in situ (103/162 [63.6%] vs 69/155 [44.5%], P = .001) and to have thinner invasive melanoma (0.48 [0.30-0.71] mm vs 0.61 [0.40-1.10] mm, respectively, P = .003). These trends were observed for patients with self-detected, but not dermatologist-detected, melanoma. Patient-detected melanomas made up 184/361 (51.0%) of all melanomas, 83/199 (41.7%) of in situ melanomas, and 101/162 (62.4%) invasive melanomas. Self-detected melanomas were in situ in 36 of 61 (59.0%) patients with an established dermatologist versus 40 of 108 (37.0%) patients without an established dermatologist, P = .006. Neither time from last dermatologic examination nor wait time for an appointment was associated with melanoma invasiveness or depth.

Limitations

Data are retrospective and from 1 large academic health care system.

Conclusion

Education obtained at the dermatology appointment may improve early self-detection of melanoma, and having an established dermatologist may facilitate earlier evaluation of concerning lesions.

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Key words : dermatology, education, melanoma, prevention, public health, skin cancer

Plan

Patient and melanoma characteristics

Relationship among having an established dermatologist, timing of last dermatologic examination, and melanoma invasiveness and depth

Relationship between appointment wait time for examination and melanoma invasiveness and depth

Discussion

	Supported in part by Clinical Research Fellowship funding from the Doris Duke Charitable Foundation (Ms Moreau) and by UL1 RR024153-04 (Dr Ferris). Statistics consultation funding from the National Institutes of Health (grant numbers UL1 RR024153 and UL1TR000005).
	Ms Cheng and Ms Moreau contributed equally to this work.
	Conflicts of interest: None declared.