title: Melanoma in middle-aged and older men: a multi-institutional survey study of factors related to tumor thickness.
abstract: OBJECTIVE
  To identify factors related to the detection of melanoma and to determine those that differ between thinner vs thicker tumors in middle-aged and older men.
  
  
  METHODS
  Survey.
  
  
  METHODS
  Three institutional melanoma clinics.
  
  
  METHODS
  Men 40 years or older who had newly diagnosed invasive melanoma.
  
  
  METHODS
  Differences in melanoma awareness, skin examination practices, discovery patterns, and social/medical care factors relative to tumor thickness.
  
  
  RESULTS
  Two hundred twenty-seven men completed surveys within 3 months of melanoma diagnosis; 57 (25.1%) had thicker tumors (>2.00 mm). Thicker tumors were associated with nodular histologic features (43.9%), a lack of atypical nevi, having less than a high school education, and patient vs physician (dermatologist or nondermatologist) detection. Knowledge of melanoma (P = .007), attention to skin cancer detection information (P = .02), an interest in health topics (P = .003), and knowing the importance of physician skin examination (P = .05) were more common in those with thin tumors. Tumor thickness did not correlate with age, anatomic location, marital/cohabitation status, prior skin cancer, or sun sensitivity. Overall patient awareness of melanoma warning signs, skin self-examination practices, and Internet use were poor (<20%, <50%, and <14%, respectively).
  
  
  CONCLUSIONS
  Physician discovery, the patient's higher level of education and detection-promoting awareness and attitudes, and the presence of clinically atypical nevi were related to thinner melanomas. Innovative outreach strategies and novel educational campaigns incorporating these factors, coupled with sharper messages regarding the importance of physician screening, are needed to improve early detection in middle-aged and older men.
authors.affiliation: Department of Dermatology, Stanford University Medical Center, 900 Blake Wilbur Dr, Room W0069, Stanford, CA 94305, USA. sswetter@stanford.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Christle J
authors.initials: CJ
authors.lastname: Layton
authors.forename: Katie R
authors.initials: KR
authors.lastname: Brooks
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D004522:Educational Status; D006266:Health Education; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology* / Q000523:psychology; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000523:psychology