title: Which symptoms are linked to a delayed presentation among melanoma patients? A retrospective study.
abstract: The incidence of melanoma is rising. Early detection is associated with a more favourable outcome. The factors that influence the timing of a patient's presentation for medical assessment are not fully understood. The aims of the study were to measure the nature and duration of melanoma symptoms in a group of patients diagnosed with melanoma within the preceding 18 months and to identify the symptoms and barriers associated with a delay in presentation.
  
  
  
  A questionnaire was distributed to a random sample of 200 of the 963 melanoma patients who had participated in the Cancer Patient Experience Survey 2010 and were known to be alive 1 year later. Data were collected on symptoms, duration of symptoms prior to presentation and the reasons for not attending a doctor sooner.
  
  
  
  A total of 159 patients responded to the questionnaire; 74 (47%) were men; mean age was 62 (range 24-90) years. Of the 149 patients who reported a symptom, 40 (27%) had a delayed presentation (i.e. >3 months). A mole growing bigger was the most common symptom and reporting this symptom was significantly associated with a delayed presentation (odds ratio (OR) 2.04, 95% confidence interval (95% CI) 1.14-5.08). Patients aged ≥65 years were less likely to report a barrier to presentation and were less likely to delay than those under 40, although this was of borderline statistical significance (OR 0.28, 95% CI 0.08-1.00).
  
  
  
  This study highlights that an enlarging mole is a significant symptom influencing the timing of presentation. Increasing public awareness of the signs of melanoma and of the importance of early presentation is desirable. Health professionals should take advantage of the opportunity to educate patients on such symptoms and signs where feasible. Further exploration of the barriers to presentation in younger people should be considered.
authors.affiliation: Section of Epidemiology and Biostatistics, Cancer Genetics Building, Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK. S.J.O'Shea@leeds.ac.uk.
authors.forename: Sally Jane
authors.initials: SJ
authors.lastname: O'Shea
authors.affiliation: Section of Epidemiology and Biostatistics, Cancer Genetics Building, Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Rogers
authors.affiliation: Division of Cancer Studies, King's College London, Research Oncology, Guy's Hospital, Bermondsey Wing, 3rd Floor, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Warburton
authors.affiliation: Division of Cancer Studies, King's College London, Research Oncology, Guy's Hospital, Bermondsey Wing, 3rd Floor, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ramirez
authors.affiliation: Section of Epidemiology and Biostatistics, Cancer Genetics Building, Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Newton-Bishop
authors.affiliation: Division of Cancer Studies, King's College London, Research Oncology, Guy's Hospital, Bermondsey Wing, 3rd Floor, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Lindsay J L
authors.initials: LJ
authors.lastname: Forbes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Behavioural symptoms; Delayed diagnosis; Melanoma