title: 'This isn't what mine looked like': a qualitative study of symptom appraisal and help seeking in people recently diagnosed with melanoma.
abstract: OBJECTIVE
  To explore symptom appraisal and help-seeking decisions among patients recently diagnosed with melanomas, and to compare experiences of people with 'thinner' (<1 mm) and 'thicker' (>2 mm) melanomas, as thickness at diagnosis is an important prognostic feature.
  
  
  METHODS
  In-depth interviews with patients within 10 weeks of melanoma diagnosis explored the factors impacting on their pathways to diagnosis. Framework analysis, underpinned by the Model of Pathways to Treatment, was used to explore the data with particular focus on patients' beliefs and experiences, disease factors, and healthcare professional (HCP) influences.
  
  
  RESULTS
  63 patients were interviewed (29-93 years, 31 women, 30 thicker melanomas). All described their skin changes using rich lay vocabulary. Many included unassuming features such as 'just a little spot' as well as common features of changes in size, colour and shape. There appeared to be subtly different patterns of symptoms: descriptions of vertical growth, bleeding, oozing and itch were features of thicker melanomas irrespective of pathological type. Appraisal was influenced by explanations such as normal life changes, prior beliefs and whether skin changes matched known melanoma descriptions. Most decisions to seek help were triggered by common factors such as advice from family and friends. 11 patients reported previous reassurance about their skin changes by a HCP, with little guidance on monitoring change or when it would be appropriate to re-consult.
  
  
  CONCLUSIONS
  Patients diagnosed with both thinner and thicker melanomas often did not initially recognise or interpret their skin changes as warning signs or prompts to seek timely medical attention. The findings provide guidance for melanoma awareness campaigns on more appropriate images, helpful descriptive language and the need to stress the often apparently innocuous nature of potentially serious skin changes. The importance of appropriate advice, monitoring and safety-netting procedures by HCPs for people presenting with skin changes is also highlighted.
authors: The Primary Care Unit, University of Cambridge, Cambridge, UK General Practice and Primary Care Academic Centre, University of Melbourne, Melbourne, Australia.
authors: Fiona M
authors: FM
authors: Walter
authors: The Primary Care Unit, University of Cambridge, Cambridge, UK.
authors: Linda
authors: L
authors: Birt
authors: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors: Debbie
authors: D
authors: Cavers
authors: Unit of Social & Behavioural Sciences, Kings College London Dental Institute, London, UK.
authors: Suzanne
authors: S
authors: Scott
authors: The Primary Care Unit, University of Cambridge, Cambridge, UK General Practice and Primary Care Academic Centre, University of Melbourne, Melbourne, Australia.
authors: Jon
authors: http://orcid.org/0000-0002-5274-6336
authors: J
authors: Emery
authors: Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors: Nigel
authors: N
authors: Burrows
authors: Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK.
authors: Gina
authors: G
authors: Cavanagh
authors: University of Glasgow, Glasgow, UK.
authors: Rona
authors: R
authors: MacKie
authors: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors: David
authors: D
authors: Weller
authors: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors: Christine
authors: C
authors: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D036301:Qualitative Research; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*; D063189:Symptom Assessment
keywords: PRIMARY CARE; QUALITATIVE RESEARCH