From Our 2009 Archives
Melanoma Detection: Waiting Is Risky for Men
Have a Doctor Check Out Suspicious Moles While They Are Small, Easier to Treat
Reviewed By Louise Chang, MD
April 20, 2009 -- Melanomas detected in older men by a doctor are more likely to be treatable, according to a new study. But many men may be waiting too long before seeing a doctor about suspicious moles.
Melanoma is the deadliest form of skin cancer. But less than a third of melanomas are first detected by doctors. Most of the irregularly shaped moles are discovered by a spouse, friend, or the patient.
A new survey shows doctors are more likely to detect melanomas in their early stages when they are thin and more susceptible to treatment.
But middle-aged men may be playing a dangerous game by waiting to have suspicious moles checked out by a doctor. A second analysis of the same survey shows physician detection of melanomas is most common among men over 65, men with a history of atypical moles, or men with cancers in areas they can't see, like their backs.
Researchers say the results may help explain why the death rate for melanomas is steadily rising among middle-aged and older men and decreasing among women in the same age group. White men over 50 make up nearly 50% of all melanoma deaths in the U.S.
"A growing body of sex-specific studies shows a trend among men, especially white middle-class men, of delaying seeking help when they become ill," write June Robinson, MD, of Northwestern University and colleagues in an editorial that accompanies the studies in the Archives of Dermatology. "By delaying seeking care, men present at a later stage of melanoma, when it is no longer treatable."
Melanoma Awareness Key to Early Detection
For the survey, 227 men 40 and over diagnosed with melanoma between 2004 and 2006 answered questions about melanoma detection and awareness within three months of diagnosis.
In the first study, researchers analyzed information about the thickness of the melanoma at the time of diagnosis. Tumor thickness is strongly related to the success of melanoma treatment, and thinner melanomas in their early stages are more susceptible to treatment.
Researchers found that 25% of the men had melanomas that were thicker than 2 millimeters. Men with thinner, easier-to-treat melanomas were more likely to have had the melanoma detected by a doctor, previous knowledge of skin cancer and melanoma, a high school education, or a history of atypical moles.
Overall, the results showed:
"Public education, in particular targeting less-educated, middle-aged, and older men for improved self-examination and physician skin surveillance, should become an integral component of skin cancer risk reduction strategies promoted by cancer advocacy organizations," write researcher Susan M. Swetter, MD, of Stanford University Medical Center, and colleagues.
Risky Wait for Melanoma Detection
In the second study, researcher Alan C. Geller, MPH, RN, of the Harvard School of Public Health, and colleagues used the same survey data to examine factors related to melanoma detection by doctors.
They found that men whose melanomas were detected by a doctor tended to be older (57% were 65 or older compared with 42% of those who detected the cancer themselves and 34% whose melanoma was detected by someone else).
Researchers say this may be because older men tend to visit their doctor more frequently than younger men. They may also have poorer eyesight for self-detection and are less likely to have a partner to look at their skin.
Melanoma detection by a doctor proved to be the best method of detecting melanomas in their early, thin stages. Ninety-two percent of doctor-detected melanomas on the back were less than 2 millimeters thick compared with 76% of those detected by other people and 63% of self-detected melanomas.
SOURCES: Swetter, S. Geller, A. Robinson, J. Archives of Dermatology, April 2009; vol 14: pp 397-404; 409-414; 469-473. News release, American Medical Association.
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