Surveillance of patients for early detection of melanoma: patterns in dermatologist vs patient discovery.

OBJECTIVE: To determine which groups of patients are most and least likely to detect their own melanomas independent of dermatologist evaluation.
DESIGN: Retrospective analysis.
SETTING: Academic dermatology department from January 1, 2003, through December 31, 2008. PATIENTS: One hundred sixty-seven consecutive patients with incident biopsy-confirmed melanomas. MAIN OUTCOME MEASURES: Proportion of melanomas found on dermatologist examination vs those brought to the attention of the examining dermatologist by the patient. Secondary analysis examined associations between who detected the melanoma (dermatologist vs patient) and patient age, personal history of skin cancer, family history of melanoma, and depth of lesion.
RESULTS: Of the 167 melanomas, 101 (60.5%) were brought to the attention of the dermatologist by the patient. Detection by a dermatologist was significantly associated with patient age of 50 years or older (P = .002), personal skin cancer history (P < .001), and a lesion depth of less than 0.75 mm at the time of detection (P = .03). Only 3.0% of all melanomas in this study were detected by dermatologists in patients who had a low baseline risk of melanoma (age <50 years, no personal history of skin cancer, and no family history of melanoma). These patients were much more likely to detect their own melanoma (odds ratio, 7.32 [95% confidence interval, 2.69-19.90]).
CONCLUSIONS: Screening for melanoma in asymptomatic patients younger than 50 years with no medical history of skin cancer or family history of melanoma yields few physician-detected melanomas because these patients are most likely to detect their melanomas themselves. Screening and surveillance efforts should focus on patients 50 years or older and those with a personal history of skin cancer or a family history of melanoma.