title: Behavioral determinants of successful early melanoma detection: role of self and physician skin examination.
abstract: BACKGROUND
  Reduced melanoma mortality should result from an improved understanding of modifiable factors related to early detection. The authors of this report surveyed newly diagnosed patients to identify differences in prediagnosis behavioral and medical care factors associated with thinner versus thicker melanoma.
  
  
  METHODS
  In total, 566 adults with invasive melanoma completed questionnaires within 3 months of diagnosis on demographics, health care access, skin self-examination (SSE), and physician skin examination (PSE) practices in the year before diagnosis. SSE was measured by us e of a melanoma picture aid and routine examination of some/all body sites versus none. Patient-reported partial or full-body PSE also was assessed. Melanoma thickness was dichotomized at 1 mm.
  
  
  RESULTS
  Patient ranged in age from 18 years to 99 years, and 61% were men. The median tumor thickness was 1.25 mm, and 321 tumors (57%) were >1 mm thick. Thinner tumors (≤1 mm) were associated with age ≤60 years (P = .0002), women (P = .0127), higher education level (P = .0122), and physician discovery (P ≤ .0001). Patients who used a melanoma picture aid and performed routine SSE were more likely to have thinner tumors than those who did not (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.48-4.80). Full-body PSE was associated with thinner tumors (OR, 2.51; 95% CI, 1.62-3.87), largely because of the effect of PSE in men aged >60 years (OR, 4.09 95% CI, 1.88-8.89).
  
  
  CONCLUSIONS
  SSE and PSE were identified as complementary early detection strategies, particularly in men aged >60 years, in whom both partial and full-body PSE were associated with thinner tumors. Given the high rates of physician access, PSE may be a more practical approach for successful early detection in this subgroup with highest mortality.
authors.affiliation: Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center and Cancer Institute, 900 Blake Wilbur Drive, Stanford, CA 94305-5356, USA. sswetter@stanford.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Swetter
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Pollitt
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brooks
authors.forename: Alan C
authors.initials: AC
authors.lastname: Geller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D010781:Photography; D010808:Physical Examination; D016353:Self-Examination; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult