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Dermatologist Detection and Skin Self-examination Are Associated With Thinner Melanomas
Results From a Survey of the Italian Multidisciplinary Group on Melanoma
Paolo Carli, MD;
Vincenzo De Giorgi, MD;
Domenico Palli, MD;
Andrea Maurichi, MD;
Patrizio Mulas, MD;
Catiuscia Orlandi, MD;
Gian Lorenzo Imberti, MD;
Ignazio Stanganelli, MD;
Pierfranco Soma, MD;
Domenico Dioguardi, MD;
Caterina Catricala', MD;
Roberto Betti, MD;
Roberto Cecchi, MD;
Ugo Bottoni, MD;
Angela Bonci, MD;
Massimiliano Scalvenzi, MD;
Benvenuto Giannotti, MD
Arch Dermatol. 2003;139:607-612.
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  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).
From the Department of Dermatology, University of Florence (Drs Carli, De Giorgi, and Giannotti), and the Molecular and Nutritional Epidemiology Unit, Centre for Cancer Prevention (Dr Palli), Florence; the National Cancer Institute, Milan (Dr Maurichi); the Dermatology Units, Businco Hospital, Cagliari (Dr Mulas), Bufalini Hospital, Cesena (Dr Orlandi), Ospedale S. Gallicano, Roma (Dr Catricala'), Ospedale S. Paolo, Milano (Dr Betti), Ospedale del Ceppo, Pistoia (Dr Cecchi), and Ospedale Civile, Reggio Emilia (Dr Bonci); the Dermatology Clinics, Ospedale Riuniti, Bergamo (Dr Imberti), and University La Sapienza, Roma (Dr Bottoni); the Center for Cancer Prevention, Ravenna (Dr Stanganelli); the Units of Plastic Surgery, Cannizaro Hospital, Catania (Dr Soma), and University of Bari, Bari (Dr Dioguardi); and the Department of Dermatology, Universita' Federico II, Napoli (Dr Scalvenzi), Italy. The authors have no relevant financial interest in this article.
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