title: Who detects melanoma? Impact of detection patterns on characteristics and prognosis of patients with melanoma.
abstract: BACKGROUND
  Despite the importance of early diagnosis, patients with cutaneous melanoma often seek consultation at advanced stages of the disease. The impact on prognosis according to who first detects the primary tumor has not been established.
  
  
  OBJECTIVE
  This study aims to determine who first detects melanoma, the reasons that patients with melanoma consult a doctor, and the impact of detection patterns on the characteristics and prognosis of melanoma.
  
  
  METHODS
  Seven hundred eighty-three patients with cutaneous melanoma who were diagnosed between 1996 and 2012 were included. Associations between who first noticed the melanoma (ie, self-detected, relatives, health care workers, or dermatologists), epidemiology, clinical presentation, histology, and patient outcomes were analyzed.
  
  
  RESULTS
  Most melanomas were self-detected (53%). Among these patients, 32% consulted because of bleeding, itching/pain, or nodule enlargement. There were more melanomas self-detected among women than among men, and these had a better prognosis. Men had significantly more melanomas on non-easily visible locations than women did. Among melanomas noticed by dermatologists, 80% were incidental findings. Self-detected melanomas were thicker and more frequently ulcerated, developed metastases more often, and were associated with more melanoma-related deaths.
  
  
  CONCLUSIONS
  Patients with melanomas detected by dermatologists had better prognoses than patients with self-detected melanomas. Patients with melanomas that were self-detected by women had better prognoses than those that were self-detected by men, especially for patients >70 years of age. This group might therefore be a logical target for melanoma detection education.
authors.affiliation: Department of Dermatology, Hospital General Universitario "Gregorio Marañón," Madrid, Spain. Electronic address: jaavilesizquierdo@gmail.com.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Avilés-Izquierdo
authors.affiliation: Department of Dermatology, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Molina-López
authors.affiliation: Department of Dermatology, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez-Lomba
authors.affiliation: Department of Medical Oncology, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Marquez-Rodas
authors.affiliation: Department of Dermatology, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Suarez-Fernandez
authors.affiliation: Department of Dermatology, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lazaro-Ochaita
mesh_terms: D000328:Adult; D003880:Dermatology; D055088:Early Detection of Cancer; D005260:Female; D006282:Health Personnel; D006801:Humans; D033162:Incidental Findings; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010820:Physicians; D011379:Prognosis; D012189:Retrospective Studies; D016353:Self-Examination; D012737:Sex Factors; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome; D000096142:Cutaneous Malignant Melanoma
keywords: cutaneous melanoma; diagnosis; epidemiology; gender; pattern detection; prognosis; skin cancer; tumor thickness