Delays in diagnosis and melanoma prognosis (I): The role of patients

A prospective survey was conducted to assess the role of patients in the melanoma prognosis. Consecutive patients with primary melanoma were interviewed and examined using a comprehensive questionnaire including a psychological instrument. Main outcome measures were the delay before medical interven...

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Published in:International journal of cancer 2000-05, Vol.89 (3), p.271-279
Main Authors: Richard, Marie A., Grob, Jean J., Avril, Marie F., Delaunay, Michèle, Gouvernet, Johany, Wolkenstein, Pierre, Souteyrand, Pierre, Dreno, Brigitte, Bonerandi, Jean J., Dalac, Sophie, Machet, Laurent, Guillaume, Jean C., Chevrant‐Breton, Jacqueline, Vilmer, Catherine, Aubin, François, Guillot, Bernard, Beylot‐Barry, Marie, Lok, Catherine, Raison‐Peyron, Nadia, Chemaly, Philippe
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Female
Humans
Male
Medical sciences
Melanoma - diagnosis
Melanoma - pathology
Melanoma - psychology
Melanoma - surgery
Middle Aged
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
Patient Education as Topic
Patient Participation
Patients
Prospective Studies
Skin Neoplasms - diagnosis
Skin Neoplasms - pathology
Skin Neoplasms - psychology
Skin Neoplasms - surgery
Time Factors
Tumors
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Summary:A prospective survey was conducted to assess the role of patients in the melanoma prognosis. Consecutive patients with primary melanoma were interviewed and examined using a comprehensive questionnaire including a psychological instrument. Main outcome measures were the delay before medical intervention and the tumor thickness. Of 590 melanomas, 70.8% were detected by patients and this proportion was higher in females. Relatives were involved in the detection of half of the cases. Median delays before the patient realized he had a suspicious lesion, before this lesion was seen by a doctor, and before the melanoma was removed were 4 months, 2 months, and 1 week, respectively. Delays up to several years were observed in some cases. The rate of self‐detection tended to be lower, the delays before seeking medical advice to be longer, and the tumor thickness to be higher in old people, in males, in lower‐educated individuals, in those living out of towns, and in people with a low awareness about melanocytic tumors than in other cases. Conversely, individuals with a high number of atypical nevi, those who were aware to be at risk, and those who regularly visited a dermatologist tended to detect their melanoma more rapidly. No specific psychological traits were associated with a late reaction, although negligence and anxiety tended to prolong the delays. Knowledge about melanoma was poor in many patients, especially in males, and wrong beliefs were widespread. This study provides the targets of future education programs. Int. J. Cancer 89:271–279, 2000. © 2000 Wiley‐Liss, Inc.
ISSN:0020-7136
1097-0215
DOI:10.1002/1097-0215(20000520)89:3<271::AID-IJC10>3.0.CO;2-7