Delay in the diagnosis of cutaneous malignant melanoma. A prospective study in 250 patients

Abstract

The extent and consequence of patient and professional delay in the diagnosis and treatment of 250 consecutive patients with primary cutaneous malignant melanoma was investigated. Mean total delay from the onset of observed change in a melanoma to appropriate therapy was 11.1 months. The major component of delay (9.8 months) was patient related. Seventy‐nine (31.6%) patients waited more than 6 months before seeking medical attention. Few patients recognized early melanoma, and 46% responded only to late features (i.e., ulceration or bleeding). Inappropriate professional delay (misdiagnosis or observation without specific action) occurred in 30 consultations (12.4%) and resulted in a further 1.3‐month mean delay in treatment. No correlation (r = 0.027) was found between delay in diagnosis and thickness of melanoma for the study population overall. A significant relationship (r = 0.2087; P < 0.05) was found between longer lag time and advanced disease in 92 patients with nodular melanoma. Asymptomatic melanomas incidentally diagnosed during routine skin surveillance were significantly more favorable (mean depth, 0.89 mm) than symptomatic melanoma (1.76 mm; P < 0.01). These data suggest that future public education campaigns should emphasize early signs of melanoma and that professional programs should stress routine skin surveillance and prompt referral of suspicious lesions for diagnostic biopsy.

Delays in diagnosis and melanoma prognosis (II): The role of doctors

“…It is thus crucial to assess the medical intervention in primary melanoma and to identify all possible problems that could be corrected by training and information. However, little is known about the responsibility of doctors in the delays before melanoma resection (Temoshok et al, 1984;Cassileth et al, 1988;Rampen et al, 1989;Krige et al, 1991).…”

Do Not Let to Be Late: Overview of Reasons for Melanoma Delayed Diagnosis

“…Patients do not seek a doctor until the skin lesion significantly raise their concerns (rapid change of shape or color, presence of bleeding or ulceration) (Krige et al, 1991;Kang et al, 2005). The delay associated with the patient (mean 9.8 months) was the major component of the overall delay in the start of treatment (average 11.1 months)-showed a prospective study in a group of 250 patients with stage I melanoma (Krige et al, 1991). As many as 16% of respondents postponed seeing a doctor for over a year.…”

“…Patients with I and II skin phototype were more likely to have tumors thicker than 1.5 mm than these with III and IV (27% and 14.6 %, respectively) (SchmidWendtner et al, 2002). There are some discrepancies in the relationship between delayed diagnosis and thickness of the lesion (Temoshok et al, 1984;Krige et al, 1991;Betti et al, 2003;Baade et al, 2006;Balch et al, 2009) and only few reports acknowledged it in relation to the all histopathological types (Temoshok et al, 1984;Betti et al, 2003). Superficial spreading melanoma (SSM) is the most common pathological variant for Caucasian ( Figure 1-B1,-B2), however a correlation between the stage and late diagnosis has been shown only for nodular melanoma (NM) (Krige et al, 1991).…”

“…Compared with the patients' self-reported symptomatic lesions, the incidental diagnosis of melanoma during a routine skin examination was associated with a lower depth. of invasion (0.89 vs 1.76mm, respectively) (Krige et al, 1991). Taking into an account that not all melanomas meet the clinical ABCD criteria (e.g., NM), adding the E parameter E ("evolving") was proposed in 2005.…”

“…In the bulk of cases (74.7-87.6%) diagnostic and curative process is not the source of delay (Krige et al, 1991;Schmid-Wendtner et al, 2002). Nonetheless, an improper physicians' approach in the face of melanoma was noted (Richard et al, 2000b).…”