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Melanoma in Middle-aged and Older MenA Multi-institutional Survey Study of Factors Related to Tumor Thickness
Susan M. Swetter, MD;
Timothy M. Johnson, MD;
Donald R. Miller, ScD;
Christle J. Layton, MD;
Katie R. Brooks, MPH;
Alan C. Geller, MPH, RN
Arch Dermatol. 2009;145(4):397-404.
Objectives To identify factors related to the detection of melanoma and to determine those that differ between thinner vs thicker tumors in middle-aged and older men.
Design Survey.
Setting Three institutional melanoma clinics.
Participants Men 40 years or older who had newly diagnosed invasive melanoma.
Main Outcome Measures Differences in melanoma awareness, skin examination practices, discovery patterns, and social/medical care factors relative to tumor thickness.
Results Two hundred twenty-seven men completed surveys within 3 months of melanoma diagnosis; 57 (25.1%) had thicker tumors (>2.00 mm). Thicker tumors were associated with nodular histologic features (43.9%), a lack of atypical nevi, having less than a high school education, and patient vs physician (dermatologist or nondermatologist) detection. Knowledge of melanoma (P = .007), attention to skin cancer detection information (P = .02), an interest in health topics (P = .003), and knowing the importance of physician skin examination (P = .05) were more common in those with thin tumors. Tumor thickness did not correlate with age, anatomic location, marital/cohabitation status, prior skin cancer, or sun sensitivity. Overall patient awareness of melanoma warning signs, skin self-examination practices, and Internet use were poor (<20%, <50%, and <14%, respectively).
Conclusions Physician discovery, the patient's higher level of education and detection-promoting awareness and attitudes, and the presence of clinically atypical nevi were related to thinner melanomas. Innovative outreach strategies and novel educational campaigns incorporating these factors, coupled with sharper messages regarding the importance of physician screening, are needed to improve early detection in middle-aged and older men.
Author Affiliations: Departments of Dermatology, Pigmented Lesion and Melanoma Program, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Swetter), and Stanford University Medical Center, Stanford, California (Drs Swetter and Layton); Departments of Dermatology, Otolaryngology, and Surgery, University of Michigan Medical School, Ann Arbor, Michigan (Dr Johnson); Center for Health Quality, Outcomes, and Economic Research, Veterans Affairs Medical Center, Bedford, Massachusetts (Dr Miller); and Department of Dermatology, Boston University School of Medicine (Dr Miller, Ms Brooks, and Mr Geller), and Boston University School of Public Health (Dr Miller), Boston, Massachusetts. Ms Brooks is now with Yale University School of Public Health, New Haven, Connecticut.
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