Dermatologists discovered more in situ, thinner melanomas

Melanomas were more likely to be detected as a result of a dermatologist-initiated full-body skin examination than due to patient complaint, according to the results of a retrospective study.

In addition, the melanomas discovered by the dermatologists were thinner and in an earlier stage, suggesting that “minimizing the substantial public health and financial impact of melanomas may be aided by a full-body skin examination,” according to researchers.

Two researchers performed a retrospective analytical case series on 126 patients with melanomas treated at a private dermatology practice from July 2005 to October 2008. There were 51 incidences of invasive disease and 75 instances of in situ melanomas.

Of all melanomas found, 56.3% were found by dermatologists and were not part of the presenting complaint. Overall, 60% of melanomas in situ were found by dermatologists. A higher mean percentage of melanomas detected by physicians were in situ compared with those detected by patients (63.4% vs. 54.5%).

Dermatologists were also more likely to discover melanoma when it was thinner; mean depth was 0.33 mm in the physician-detected group vs. 0.55 mm in the patient-detected group. The researchers found a statistically significant association between increasing melanoma depth and patient detection (OR=2.39). Conversely, dermatologist detection was associated with thinner melanomas (OR=0.42).

In an accompanying editorial, Daniel G. Federman, MD, a professor of medicine with Yale School of Medicine, and colleagues said that although the results were “provocative” they are “not definitive.”

Federman wrote that the “possibility of detecting cancers before they become more invasive is very appealing, especially when such a low-tech, well-accepted, relatively quick, inexpensive, noninvasive test — such as the full-body skin examination — is involved.”

Kantor J. Arch Dermatol. 2009;145:873-876.