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Jonathan Kantor, MD, MSCE; Deborah E. Kantor, MSN, CRNP

Arch Dermatol. 2009;145(8):873-876.

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.

Author Affiliations: North Florida Dermatology Associates, Jacksonville.

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