The impact of physician screening on melanoma detection

Objective: To compare melanoma characteristics and detection patterns in new vs established patients in a pigmented lesion clinic at Memorial Sloan-Kettering Cancer Center (MSKCC) during a 10-year period. Design: Single-center historical cohort study. Setting: Academic practice of 2 dermatologists with expertise in the management of pigmented skin lesions. Patients: The study included 394 patients diagnosed with cutaneous melanoma at MSKCC between 1998 and 2008. For the purposes of this study, we separated patients into 2 groups: established patients, defined as patients who have received professional services in a pigmented lesion clinic at MSKCC for at least 3 months, vs new patients, defined as patients new to our practice. Main Outcome Measures: Melanoma histologic characteristics and patterns of melanoma detection in established vs new patients. Results: Established patients had more in situ disease (70% vs 57%; P <.001) and thinner invasive melanomas (0.45 mm vs 0.82 mm; P = .002) and were less likely to present with negative prognostic attributes such as ulceration and dermal mitoses compared with new patients. In new patients, 63% of melanomas were physician detected vs 82% in established patients; 18% of all melanomas were patient detected. Dermatologist-detected melanomas were thinner compared with self-detected melanomas. The majority of self-detected melanomas were noted by patients because of change (64%). The overall benign to malignant biopsy ratio over the 10-year period was 5.4:1. Conclusion: Physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma.