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June K. Robinson, MD; Jeffrey S. Altman, MD; Alfred W. Rademaker, PhD

Arch Dermatol. 1995;131(4):428-431.

Abstract
Background
Giant nonmelanoma skin cancers are disfiguring and clearly visible. This prospective study examined tumor characteristics, ie, location, tumor type, duration, and the socioeconomic status and attitudinal characteristics of these patients and their interactions with the medical community.

Design
From 1979 through 1993, preoperative questionnaires about age, sex, tumor duration, prior treatment, socioeconomic status, and attitudinal concerns were completed by 51 patients with giant tumors and randomly matched controls. Additional data completed by the physician included tumor type, location, and preoperative clinically apparent diameter of the tumor.

Results
Giant tumors were more frequent on the scalp in men. Lower socioeconomic status and infrequent physician visits were characteristic of those with giant lesions. Those with giant lesions were less concerned about their general health, had a greater sense of shame about their appearance, had greater belief that since prior treatment did not help the problem then nothing else would, and had an increased frequency of perceived prior reassurance. Women and those younger than 65 years of both sexes were more concerned about economic costs and/or the time lost from work or caring for others.

Conclusions
Health promotion by early detection and treatment of these nonmelanoma skin cancers in elderly men could prevent extensive surgical efforts later in the course of the disease. Skin screening examinations by all physicians and better public awareness of the signs of skin cancer, especially among elderly men, would enhance early detection; however, it is not clear that early detection by physicians enables treatment. Strategies to assist individuals in overcoming their barriers to accessing care need to be provided.

(Arch Dermatol. 1995;131:428-431)

Author Affiliations
From the Departments of Dermatology, Rush-Presbyterian-St Luke's Medical Center (Dr Altman) and Northwestern University Medical School (Dr Robinson), and Lurie Cancer Center Biometry Section, Northwestern University Medical School (Dr Rademaker), Chicago, Ill.

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