[Observations on the "pretherapeutic phase" of malignant melanoma of the skin 1988-1990 and 1993-1995].
In a prospective trial patients were interviewed in two periods, from 1988 to 1990 and from 1993 to 1995. Ninety out of 189 patients (47.6%) with a histologically confirmed diagnosis of malignant melanoma who noted morphological changes in a pigmented lesion reported the mole had been present at least 10 years. 20.7% stated it was present since birth. 156 out of 189 patients (82.5%) noticed changes in the lesion over the time. Growth, discolouration and elevation were the most frequent changes but no significant early sign of disease was found. Bleeding and crusting were found with tumor thickness > 1.5 mm and thus be signs of an advanced stage. Almost 6 months passed until half of the patients visited a physician, either because of changes in the mole or in the lesion was detected during other medical examinations. In the second period of the survey from 1993 to 1995 the physician was frequently consulted earlier. The main reasons for the delay between identification by the patient and seeking medical cedure were lack of symptoms and the notion that the lesion was harmless. Only 72 out of 189 patients (38.1%) visited the physician on their own initiative. The primary evaluation of the "pigmental lesion" was done by a primary care physician in 57%, by a dermatologist in 32% and by others in 11% of our cases. A diagnosis of a non-melanoma was made and no further steps were initiated by 27% of the primary care physicians and 22.7% of the surgeons, gynecologists or internists. Only 5% of the dermatologists misdiagnosed the lesions. In the second trial period from 1993 to 1995 in all physician groups the rate of misdiagnosis increased due to changes in healthcare services in the context of privatisation in our health care system in East Germany. Whereas 83.2% of the patients first evaluated by dermatologists had a surgical removal of the mole within the first 2 months after consultation, the proportion for those diagnosed by non-dermatologists was only 58.5%. The rate of primary treatment by surgeons, often with a small safety margin, also increased.
Jage
G
G
Klinik und Poliklinik für Dermatologie und Venerologie der Otto-von-Guericke Universität Magdeburg.
Kühne
K H
KH
Gollnick
H
H
D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D005544:Forecasting; D005858:Germany; D006266:Health Education / Q000639:trends*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data / Q000639:trends; D011446:Prospective Studies; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery