The impact of physician screening on melanoma detection Journal Article


Authors: Kovalyshyn, I.; Dusza, S. W.; Siamas, K.; Halpern, A. C.; Argenziano, G.; Marghoob, A. A.
Article Title: The impact of physician screening on melanoma detection
Abstract: Objective: To compare melanoma characteristics and detection patterns in new vs established patients in a pigmented lesion clinic at Memorial Sloan-Kettering Cancer Center (MSKCC) during a 10-year period. Design: Single-center historical cohort study. Setting: Academic practice of 2 dermatologists with expertise in the management of pigmented skin lesions. Patients: The study included 394 patients diagnosed with cutaneous melanoma at MSKCC between 1998 and 2008. For the purposes of this study, we separated patients into 2 groups: established patients, defined as patients who have received professional services in a pigmented lesion clinic at MSKCC for at least 3 months, vs new patients, defined as patients new to our practice. Main Outcome Measures: Melanoma histologic characteristics and patterns of melanoma detection in established vs new patients. Results: Established patients had more in situ disease (70% vs 57%; P < .001) and thinner invasive melanomas (0.45 mm vs 0.82 mm; P = .002) and were less likely to present with negative prognostic attributes such as ulceration and dermal mitoses compared with new patients. In new patients, 63% of melanomas were physician detected vs 82% in established patients; 18% of all melanomas were patient detected. Dermatologist-detected melanomas were thinner compared with self-detected melanomas. The majority of self-detected melanomas were noted by patients because of change (64%). The overall benign to malignant biopsy ratio over the 10-year period was 5.4:1. Conclusion: Physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma. ©2011 American Medical Association. All rights reserved.
Keywords: adolescent; adult; aged; major clinical study; united states; melanoma; skin biopsy; nevus; cohort analysis; cancer screening; cancer invasion; cancer center; physician; self evaluation; skin ulcer; dermatologist
Journal Title: Archives of Dermatology
Volume: 147
Issue: 11
ISSN: 0003-987X
Publisher: American Medical Association  
Date Published: 2011-11-01
Start Page: 1269
End Page: 1275
Language: English
DOI: 10.1001/archdermatol.2011.181
PROVIDER: scopus
PUBMED: 21768448
DOI/URL:
Notes: --- - "Export Date: 3 January 2012" - "CODEN: ARDEA" - "Source: Scopus"
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MSK Authors
  1. Allan C Halpern
    305 Halpern
  2. Stephen Dusza
    167 Dusza
  3. Ashfaq A Marghoob
    392 Marghoob
  4. Katherine Siamas
    2 Siamas