To investigate patterns of detection and variables associated with early diagnosis of melanoma in a population at intermediate melanoma risk.Design: Survey.Setting: Hospital and university centers belonging to the Italian Multidisciplinary Group on Melanoma.Patients: Eight hundred sixteen patients who were consecutively diagnosed as having melanoma and treated at 11 participating centers.Main Outcome Measure: Relationship between patterns of detection and patient's and physician's delay with melanoma thickness, assessed by multivariate analysis.Results: A statistically significant association with early diagnosis was found for female sex (odds ratio [OR] for a lesion Ͼ1 mm in thickness, 0.70; 95% confidence interval [CI], 0.50-0.97), higher educational level (OR, 0.44; 95% CI, 0.24-0.79), residence in northern and central Italy (compared with southern Italy) (OR, 0.44; 95% CI, 0.30-0.65 and OR, 0.24; 95% CI, 0.15-0.37, respectively), and the habit of performing a skin self-examination (OR, 0.65; 95% CI, 0.45-0.93). When adjusted for all the previously mentioned variables, only melanoma detection made by a dermatologist, maybe incidentally, was associated with a statistically significant additional effect on early diagnosis (OR, 0.45; 95% CI, 0.28-0.73). No significant effect of anatomical site (trunk compared with other sites: OR, 0.83; 95% CI, 0.59-1.17), presence of atypical nevi (OR, 0.78; 95% CI, 0.52-1.17), and patient's delay (Ͼ3 months compared with Յ3 months: OR, 1.12; 95% CI, 0.78-1.60) was found.
Conclusion:Future melanoma early diagnosis strategies should adequately stress the role of skin self-examination among the adult population, and should recommend that dermatologists perform a total skin examination to identify suspect lesions (such an examination should also be performed during consultations for other reasons).