title: The impact of physician screening on melanoma detection.
abstract: OBJECTIVE
  To compare melanoma characteristics and detection patterns in new vs established patients in a pigmented lesion clinic at Memorial Sloan-Kettering Cancer Center (MSKCC) during a 10-year period.
  
  
  METHODS
  Single-center historical cohort study.
  
  
  METHODS
  Academic practice of 2 dermatologists with expertise in the management of pigmented skin lesions.
  
  
  METHODS
  The study included 394 patients diagnosed with cutaneous melanoma at MSKCC between 1998 and 2008. For the purposes of this study, we separated patients into 2 groups: established patients, defined as patients who have received professional services in a pigmented lesion clinic at MSKCC for at least 3 months, vs new patients, defined as patients new to our practice.
  
  
  METHODS
  Melanoma histologic characteristics and patterns of melanoma detection in established vs new patients.
  
  
  RESULTS
  Established patients had more in situ disease (70% vs 57%; P < .001) and thinner invasive melanomas (0.45 mm vs 0.82 mm; P = .002) and were less likely to present with negative prognostic attributes such as ulceration and dermal mitoses compared with new patients. In new patients, 63% of melanomas were physician detected vs 82% in established patients; 18% of all melanomas were patient detected. Dermatologist-detected melanomas were thinner compared with self-detected melanomas. The majority of self-detected melanomas were noted by patients because of change (64%). The overall benign to malignant biopsy ratio over the 10-year period was 5.4:1.
  
  
  CONCLUSIONS
  Physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma.
authors.affiliation: Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA.
authors.forename: Ivanka
authors.initials: I
authors.lastname: Kovalyshyn
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Dusza
authors.forename: Katherine
authors.initials: K
authors.lastname: Siamas
authors.forename: Allan C
authors.initials: AC
authors.lastname: Halpern
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.forename: Ashfaq A
authors.initials: AA
authors.lastname: Marghoob
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D013997:Time Factors; D055815:Young Adult