Routine dermatologist-performed full-body skin examination and early melanoma detection

Abstract

Objective: To determine the proportion of patients in a private dermatology practice in whom melanoma was detected but was not the presenting complaint. Design: Retrospective analytical case series. Setting: Private dermatology practice in Florida, from July 2005 through October 2008. Patients: Patients with 126 melanomas, of which 51 were invasive and 75 were melanomas in situ. Main Outcome Measures: Proportion of melanomas detected as a result of patient complaint vs proportion determined by dermatologist-conducted full-body skin examination (FBSE). As a secondary analysis, we used logistic regression odds ratios (ORs) of association to examine whether dermatologist detection rather than patient complaint was associated with detecting thinner melanomas. A post hoc analysis was performed using a thickness cutoff of 1.0 mm to define a deep melanoma. Results: Overall, 56.3% (95% confidence interval [CI], 47.6%-65.1%) of melanomas were found by the dermatologist and were not part of the presenting complaint. Of melanomas in situ, 60.0% (95% CI, 48.7%-71.3%) were dermatologist detected. Dermatologist detection was significantly associated with thinner melanomas, with an OR of 0.42 (P=.04). We found a significant association between thinner melanomas as a group (thickness <1 mm) and dermatologist detection, with a logistic regression OR of 5.0 (95% CI, 1.0-25.3). Conclusions: Most melanomas detected in a general-practice dermatology setting were found as a result of dermatologist-initiated FBSE, not patient complaint. We found that dermatologist detection was associated with thinner melanomas and an increasing likelihood of the melanoma being in situ. ©2009 American Medical Association. All rights reserved.