Physicians ‘better than patients’ at detecting skin cancer
MedWire News: Specialist skin physicians are best-placed to screen people for skin cancer, say researchers, in findings that contradict the notion that skin lesions are generally found by the patient themselves.
"Although we recognize that high-risk patients… may be more vigilant in performing skin self-examination, we strongly believe that… the pigmented lesions clinic setting contributes to earlier detection of melanoma," write Ashfaq Marqhoob (Memorial Sloan-Kettering Cancer Center, New York, USA) and team.
Pigmented lesion clinics are dedicated medical centers for patients with potentially caspecial special cliccancer ncerous lesions. They are run by dermatologists with particular expertise in skin cancer and offer patients total body skin examination and education on how to perform self-examination.
In this study, Marqhoob and co-workers analyzed types of skin lesions found in patients attending the pigmented lesion clinics attached to Memorial Sloan-Kettering Cancer Center.
A total of 394 patients were diagnosed with melanoma skin cancer at the clinic over a 10-year period (1998-2008). For the purpose of the study, the researchers divided the patients into "established" patients who had had been attending the clinic for more than 3 months and "new" patients who had been seen only once.
Writing in the Archives of Dermatology, the researchers report that the skin tumors found in established patients differed in important ways from tumors found in new patients.
Specifically, the skin tumors detected in established patients tended to be thin, were still "in situ" (ie, still at the very earliest stage of development), and were not yet displaying features known to be associated with a poor prognosis.
By contrast, skin tumors in new patients tended to be thicker, were less likely to be in situ, and more often displayed characteristics such as ulceration. All these are signs of more advanced cancer.
Overall, just 18% of the cancers were first noticed by the patients themselves, while the remainder were found by a dermatologist. Of the patient-detected tumors, nearly two-thirds were noticed because they had changed in appearance. This supports current advice to see a doctor if you notice any change in your freckles or moles, the authors remark.
The researchers conclude that physicians are better able to detect skin cancer than patients; furthermore, doctors typically detect skin cancer at an earlier stage, when it is more likely to be treatable.
Nevertheless, they also stress the importance of patient self-examination in aiding the detections of tumors, concluding: "It is crucial to emphasize that a combined strategy of physician detection and patient participation must continue to be implemented to ensure early melanoma diagnosis."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Joanna Lyford