title: Thick melanoma in Tuscany.
abstract: BACKGROUND
  The epidemiologic trends of cutaneous melanoma are similar in several countries with a Western-type lifestyle, where there is a progressively increasing incidence and a low but not decreasing mortality - even increasing in selected cases, especially in the older age groups. Also in Tuscany there is a steady rise in the incidence with prevalence of in situ and invasive thin melanomas, with also an increase of thick melanomas. It is necessary to reduce the frequency of thick melanomas to reduce specific mortality. The objective of the current survey has been to compare, in the Tuscany population, by a case-case study, thin and thick melanoma cases, trying to find out those personal and tumor characteristics which may help to customize preventive interventions.
  
  
  METHODS
  The study included nine centers involved in the melanoma diagnosis. A consecutive series of incident invasive melanomas diagnosed in a period of about 18 months (July 2010 to December 2011) was collected and matched according in a ratio of one thick melanoma (cutoff thickness: 1 mm) every two thin melanomas. The investigators filled in a questionnaire on patients' self-reported sun exposure, way of melanoma detection, awareness and performance of self-skin examination, as well as propensity to prevention in general.
  
  
  RESULTS
  The results of this survey confirm that older age and the lower education level are associated with a later detection. The habit of performing skin self-examination is crucial in the early diagnosis of thick melanoma. The results of this survey seem to suggest that population aged over 50 years, with few total and few atypical nevi, and limited sun exposure and burning are at higher risk of late diagnosis. It can be assumed that part of the population is not effectively reached by prevention campaigns because they do not recognize themselves as being at risk for skin cancers.
  
  
  CONCLUSIONS
  In order to achieve a higher rate of early diagnosis of skin melanoma, a new strategy must be implemented. It could be useful to rethink educational campaigns - which seem to unintentionally leave out subjects more at risk for melanoma - and to renew the active involvement of the general practitioners.
authors.affiliation: Unit of Secondary Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy - a.chiarugi@ispo.toscana.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Chiarugi
authors.affiliation: Unit of Secondary Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nardini
authors.affiliation: Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Borgognoni
authors.affiliation: Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Brandani
authors.affiliation: Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Gerlini
authors.affiliation: Section of Dermatology, Department of Medical, Surgical Sciences and Neurosciences, AUSL Toscana Sud-Est, Siena, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Rubegni
authors.affiliation: Section of Dermatology, Department of Medical, Surgical Sciences and Neurosciences, AUSL Toscana Sud-Est, Siena, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Lamberti
authors.affiliation: Department of Dermatology, AUSL Toscana Centro, Prato Hospital, Prato, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Salvini
authors.affiliation: Department of Dermatology, AUSL Toscana Centro, Prato Hospital, Prato, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lo Scocco
authors.affiliation: Unit of Dermatology, S. Jacopo Hospital, AUSL Toscana Centro, Pistoia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cecchi
authors.affiliation: Unit of Dermatology, Misericordia Hospital Grosseto, AUSL Toscana Sud-Est, Grosseto, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sirna
authors.affiliation: Unit of Dermatology, S. Luca Hospital, AUSL Toscana Nord-Ovest, Lucca, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Lorenzi
authors.affiliation: Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gattai
authors.affiliation: Unit of Dermatology, AUSL Toscana Nord-Ovest, Massa, Massa Carrara, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Battistini
authors.affiliation: Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì-Cesena, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Crocetti
mesh_terms: D000367:Age Factors; D057210:Delayed Diagnosis; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D008875:Middle Aged; D012307:Risk Factors; D016353:Self-Examination / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D013472:Sunlight / Q000009:adverse effects*