title: Incidental melanomas detected in veterans referred to dermatology.
abstract: BACKGROUND
  Early detection of melanoma is integral to preventing morbidity and mortality.
  
  
  OBJECTIVE
  We sought to characterize and compare incidental versus consult melanomas detected in veterans referred to the Minneapolis, MN, Department of Veterans Affairs Medical Center dermatology clinic.
  
  
  METHODS
  We retrospectively reviewed charts of all dermatology consults between January 2004 and March 2012.
  
  
  RESULTS
  Of the 28,405 consults sent during the study period, 17,174 met inclusion criteria. There were 231 melanomas identified in 221 patients. In all, 144 melanomas were identified on the consult and 87 melanomas were discovered incidentally. The incidental melanoma detection rate was 0.5% (84/17,174). Consult melanomas were more likely to be invasive than incidental melanomas (relative risk 1.51, 95% confidence interval 1.23-1.86, P < .0001) and less likely to have a Breslow depth of less than 1.00 mm (relative risk 0.73, 95% confidence interval 0.61-0.88, P = .0036). Incidental melanomas were smaller than consult melanomas (mean diameter 0.98 vs 1.3 cm, respectively) and thinner (mean Breslow depth 0.64 vs 1.74 mm). Consult melanomas were more likely to be detected on the head/neck (relative risk 1.25, 95% confidence interval 1.03-1.52, P = .0295).
  
  
  CONCLUSIONS
  Nondiverse patient population is a limitation.
  
  
  CONCLUSIONS
  Melanomas detected during an in-person skin examination by a dermatologist were more likely to be detected at an earlier stage of disease.
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota. Electronic address: richx077@umn.edu.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Hanson
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Kingsley-Loso
authors.affiliation: University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Grey
authors.affiliation: Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Srihari I
authors.initials: SI
authors.lastname: Raju
authors.affiliation: Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Parks
authors.affiliation: Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Bershow
authors.affiliation: Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Veterans Affairs Medical Center, Minneapolis, Minnesota.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Warshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D012306:Risk; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D058014:Veterans Health
keywords: cutaneous malignancy; dermatology consults; detection; incidental lesions; melanoma; skin cancer