Context In cutaneous melanoma, tumor depth remains the best
biologic predictor of patient survival. Detection of prognostically
favorable lesions may be associated with improved survival in patients
Objective To determine melanoma detection patterns and relate them
to tumor thickness.
Design Interview survey.
Setting and Patients All patients with newly detected primary
cutaneous melanoma at the Melanoma Center, Johns Hopkins Medical
Institutions, between June 1995 and June 1997.
Main Outcome Measure Tumor thickness grouped according to
Results Of the 102 patients (47 men, 55 women) in the study, the
majority of melanomas were self-detected (55%), followed by detection
by physician (24%), spouse (12%), and others (10%). Physicians were
more likely to detect thinner lesions than were patients who detected
their own melanomas (median thickness, 0.23 mm vs 0.9 mm;
P<.001). When grouped according to thickness, 11 (46%) of
24 physician-detected melanomas were in situ, vs only 8 (14%) of 56
patient-detected melanomas. Physician detection was associated with an
increase in the probability of detecting thinner (≤0.75 mm) melanomas
(relative risk, 4.2; 95% confidence interval, 1.4-11.1; P =
Conclusions Thinner melanomas are more likely to have been
detected by physicians. Increased awareness by all physicians may
result in greater detection of early melanomas.