Dermatologist Detection and Skin Self-examination Are Associated With Thinner Melanomas

Carli, Paolo; Giorgi, Vincenzo De; Palli, Domenico; Maurichi, Andrea; Mulas, P.; Orlandi, Catuscia; Imberti, G.; Stanganelli, Ignazio; Soma, Pierfranco; Dioguardi, D; Catricalà, Caterina; Betti, Roberto; Cecchi, Roberto; Bottoni, Ugo; Bonci, Angela; Scalvenzi, Massimiliano; Giannotti, B.

doi:10.1001/archderm.139.5.607

Cited by 167 publications

(124 citation statements)

References 19 publications

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“…This criteria required examination "always" or "almost always" of each of eight skin areas (arms and face, chest and front of legs, side of body, back of legs, upper back and tops of shoulders, sides of legs and bottoms of feet, middle and lower parts of back, and back of thighs), except one, which could be examined at least "sometimes" (14). Carli et al showed that 45.8% of their subjects in an Italian cohort reported performing SSE (20.4% regularly and 25.4% occasionally), although SSE criteria were not defined and were determined by the individual patients themselves (13). In an Australian telephone survey of 3,110 residents, Aitken et al defined SSE as having "deliberately checked the skin on your whole body," including "skin front and back," and found that only 25.9% of participants had performed SSE within the last year (10).…”

Section: Discussionmentioning

confidence: 99%

“…In 1996, Berwick et al reported that SSE could reduce melanoma mortality by as much as 63% (12). A 2003 study found that regular performance of SSE was associated with a significantly reduced likelihood of having tumors >1 mm thick at diagnosis [covariate-adjusted odds ratio (OR), 0.65; 95% confidence interval (95% CI), 0.45-0.93], although details regarding the thoroughness and frequency of SSE were not obtained (13). Improved understanding of the effectiveness of SSE has been hampered by variable study definitions of SSE, including the number or percent of body sites examined and the frequency and method of examination (14)(15)(16)(17) and the small number of studies examining the reported benefits of techniques to supplement SSE, such as the use of photographs (8,18,19).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

Pollitt

Geller

Brooks

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

101

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Although skin self-examination (SSE) may increase rates of early melanoma detection, the efficacy of different SSE practices has not been thoroughly studied. We examined associations between SSE practices and tumor thickness in patients with recently diagnosed melanoma. Methods: 321 melanoma patients at three hospitals completed questionnaires on demographics and SSE practices. Patient-reported SSE was measured by routine examination of 13 specific body areas, frequency of mole examination, and use of a melanoma picture aid to assist with SSE. Histologic diagnoses and Breslow depth were confirmed by dermatopathologists. Regression analyses were used to calculate ratios of geometric mean tumor thickness and odds ratios for having thicker versus thinner tumors for different SSE behaviors. Results: Rates of SSE varied considerably by SSE item. Patients routinely examining at least some of their skin had thinner melanomas [adjusted geometric mean tumor ratio, 0.73; 95% confidence interval (95% CI), 0.50-0.94]. Frequency of mole examination did not predict tumor thickness. Using a melanoma picture as a SSE aid was strongly associated with reduced tumor thickness (adjusted ratio, 0.75; 95% CI, 0.66-0.85 for ever versus never use). A composite measure of thoroughness of SSE was the best predictor of thickness (adjusted ratio, 0.58; 95% CI, 0.36-0.75) for high versus low thoroughness. Conclusions: SSE was associated with decreased tumor thickness by most measures. However, the diverse rates of SSE practices and the distinct associations between these practices and melanoma thickness suggest a complexity in SSE that should be addressed in future studies. SSE should be evaluated by more than one measure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

Pollitt

Geller

Brooks

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

101

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“…Skin screening examinations by medical professionals result in the identification of thinner melanomas (28,29). It is also well established that the majority of melanomas are detected by the patients or their spouses (28,30,31).…”

Section: Introductionmentioning

confidence: 99%

CDKN2A/p16 Genetic Test Reporting Improves Early Detection Intentions and Practices in High-Risk Melanoma Families

Aspinwall¹,

Leaf²,

Dola

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Genetic testing for melanoma has yet to enter routine clinical use because of the scarcity of available data on the effect of test reporting. A prospective study of 59 members of Utah CDKN2A/p16 mutation-positive pedigrees was conducted to establish the effect of CDKN2A/ p16 genetic test reporting on melanoma early detection intentions and behaviors (total body skin examination and skin self-examination) in a high-risk population. Behavioral assessments were made at baseline, immediately after CDKN2A/p16 test reporting and counseling, and at 1-month follow-up (42 participants). Baseline screening practices were poor relative to current recommendations, especially among participants without a personal history of melanoma. Changes from baseline practice were evaluated in three groups of participants (CDKN2A/p16 + with history of melanoma, CDKN2A/p16 + without melanoma history, and CDKN2A/p16 À ). Across multiple measures, test reporting caused CDKN2A/p16 mutation carriers without a melanoma history to improve to the level of adherence reported by participants with a melanoma history, without decreasing compliance of the CDKN2A/p16 À group. Compared with baseline, CDKN2A/p16 + participants without a melanoma history reported greater intention to obtain total body skin examinations (P < 0.0001), increased intentions and adherence to skin self-examination recommendations (P < 0.01 and P < 0.001, respectively), and increased number of body sites examined at 1 month (P < 0.002); further, 55% reported adopting a new screening behavior at follow-up. Test reporting also improved skin selfexamination adherence among CDKN2A/p16À participants (P < 0.03). The finding that CDKN2A/p16 test reporting enhances compliance with early detection measures among CDKN2A/p16 + participants without diminishing the compliance of CDKN2A/p16 À participants suggests a favorable risk-benefit ratio for melanoma genetic testing in high-risk patients. (Cancer Epidemiol Biomarkers Prev 2008;17(6):1510 -9)

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“…2 Guidelines highlight the role of general practitioners in prevention, 3 including primary prevention by counseling on sun exposure 4,5 and secondary prevention by regularly performing a total skin examination and encouraging self-examination. 3,6 Self-examination has been shown to improve the probability of early diagnosis 7 and may reduce melanoma-related mortality by 63%. 8 In more than one-half of cases of melanoma, patients may be the first to identify the lesion 7,9 ; however, less than 25% of patients perform skin self-examination.…”

Section: Introductionmentioning

confidence: 99%

“…3,6 Self-examination has been shown to improve the probability of early diagnosis 7 and may reduce melanoma-related mortality by 63%. 8 In more than one-half of cases of melanoma, patients may be the first to identify the lesion 7,9 ; however, less than 25% of patients perform skin self-examination. 10 There have been many advertising campaigns worldwide on melanoma prevention, but their effectiveness in modifying patient behavior is difficult to measure.…”

Section: Introductionmentioning

confidence: 99%

Targeted Melanoma Prevention Intervention: A Cluster Randomized Controlled Trial

Rat¹,

Quéreux²,

Rivière³

et al. 2014

The Annals of Family Medicine

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PURPOSE Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior. METHODSWe conducted a pilot clustered randomized controlled trial, comparing a targeted screening and education intervention with a conventional information-based campaign in 20 private surgeries in western France. In the intervention group, 10 general practitioners identified patients at elevated risk for melanoma with a validated assessment tool, the Self-Assessment Melanoma Risk Score (SAMScore), examined their skin, and counseled them using information leaflets. In the control group, 10 general practitioners displayed a poster and the leaflets in their waiting room and examined patients' skin at their own discretion. The main outcome measures were sunbathing and skin self-examinations among patients at elevated risk, assessed 5 months later with a questionnaire.RESULTS Analyses were based on 173 patients. Compared with control patients, intervention patients were more likely to remember the campaign (81.4% vs 50.0%, P = .0001) and to correctly identify their elevated risk of melanoma (71.1% vs 42.1%, P = .001). Furthermore, intervention patients had higher levels of prevention behaviors: they were less likely to sunbathe in the summer (24.7% vs 40.8%, P = .048) and more likely to have performed skin self-examinations in the past year (52.6% vs 36.8%, P = .029). The intervention was not associated with any clear adverse effects, although there were trends whereby intervention patients were more likely to worry about melanoma and to consult their general practitioner again about the disease. CONCLUSIONSThe combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk. Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research.

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Dermatologist Detection and Skin Self-examination Are Associated With Thinner Melanomas

Cited by 167 publications

References 19 publications

Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

Efficacy of Skin Self-Examination Practices for Early Melanoma Detection

CDKN2A/p16 Genetic Test Reporting Improves Early Detection Intentions and Practices in High-Risk Melanoma Families

Targeted Melanoma Prevention Intervention: A Cluster Randomized Controlled Trial

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