title: Patient-related delay in presentation for cutaneous squamous cell carcinoma. A cross-sectional clinical study.
abstract: BACKGROUND
  Delayed diagnosis of squamous cell carcinoma (SCC) increases recurrence, metastatic potential, and management costs. This study aims to identify risk factors of patient-related delayed presentation in cutaneous SCC.
  
  
  METHODS
  A total of 513 patients, who first sought care for cutaneous lesions that were subsequently removed and histologically confirmed as SCCs, were included. Attitude to symptoms, psychosocial profile, and reasons for delayed presentation were obtained via a structured questionnaire-based interview. First presentation > 3 months from the onset of symptoms was considered as delayed.
  
  
  RESULTS
  Mean presentation time was 3.90 ± 2.05 months, while 186 patients delayed presentation. Multivariate logistic regression analysis revealed that serious co-morbidity (p = 0.003), low education level (p < 0.001), non-recognition of the seriousness of symptoms (p < 0.001), a 'wait and see' attitude (p < 0.001), and fatalism (p = 0.005) were independent determinants of significantly higher risk for delayed presentation. In contrast, female sex (p = 0.006), new lesion (p = 0.012), accessible topography (p = 0.019), size increase (p = 0.002), color change (p = 0.017), non-healing wound (p = 0.048), and presence of social support/advice (p < 0.001) were independent determinants significantly associated with early presentation.
  
  
  CONCLUSIONS
  Recognition of symptom seriousness and elimination of factors hindering self-referral may increase awareness and promote early patient presentation and diagnosis of cutaneous SCC.
authors.affiliation: First Department of Surgery, Democritus University of Thrace, Dragana, Alexandroupolis, Greece.
authors.forename: Despoina
authors.initials: D
authors.lastname: Kakagia
authors.forename: Gregory
authors.initials: G
authors.lastname: Trypsiannis
authors.forename: Michael
authors.initials: M
authors.lastname: Karanikas
authors.forename: Alexandros
authors.initials: A
authors.lastname: Mitrakas
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Lyratzopoulos
authors.forename: Alexandros
authors.initials: A
authors.lastname: Polychronidis
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D012959:Socioeconomic Factors; D015996:Survival Rate