[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Original Investigation
May 2018

Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis

Author Affiliations
  • 1First Department of Dermatology–Venereology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
  • 2Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 3Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Palo Alto, California
  • 4Veterans Affairs Palo Alto Health Care System, Palo Alto, California
  • 5Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
  • 6Department of Dermatology, University of Colorado School of Medicine, Aurora
  • 7Department of Dermatology, University of Michigan, Ann Arbor
  • 8Second Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece
  • 9Department of Plastic Surgery, General Hospital of Athens Georgios Gennimatas, Athens, Greece
  • 10Department of Surgery, Laiko Hospital, Athens, Greece
JAMA Dermatol. 2018;154(5):544-553. doi:10.1001/jamadermatol.2018.0288
Key Points

Question  What examination practices and patient attitudes are associated with the detection of thinner nodular melanoma (NM) and superficial spreading melanoma (SSM)?

Findings  In this cross-sectional pooled analysis of 685 patients, whole-body physician skin examination was associated with thinner NM and SSM, while skin self-examination was associated with thinner SSM only. Increased skin cancer awareness was associated with thinner NM.

Meaning  Because NM is typically detected at greater than 2 mm thickness, understanding these factors for earlier detection may improve survival.


Importance  Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer.

Objective  To investigate the association of SSE, PSE, and patient attitudes with the detection of thinner superficial spreading melanoma (SSM) and nodular melanoma (NM), the latter of which tends to elude early detection.

Design, Setting, and Participants  This cross-sectional, questionnaire-based, multicenter study identified patients with newly diagnosed cutaneous melanoma at 4 referral hospital centers in the United States, Greece, and Hungary. Among 920 patients with a primary invasive melanoma, 685 patients with SSM or NM subtype were included.

Interventions  A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis.

Main Outcomes and Measures  Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM.

Results  Of 685 participants (mean [SD] age, 55.6 [15.1] years; 318 [46%] female), thinner melanoma was detected in 437 of 538 SSM (81%) and in 40 of 147 NM (27%). Patients who routinely performed SSE were more likely to be diagnosed with thinner SSM (odds ratio [OR], 2.61; 95% CI, 1.14-5.40) but not thinner NM (OR, 2.39; 95% CI, 0.84-6.80). Self-detected clinical warning signs (eg, elevation and onset of pain) were markers of thicker SSM and NM. Whole-body PSE was associated with a 2-fold increase in detection of thinner SSM (OR, 2.25; 95% CI, 1.16-4.35) and thinner NM (OR, 2.67; 95% CI, 1.05-6.82). Patient attitudes and perceptions focusing on increased interest in skin cancer were associated with the detection of thinner NM.

Conclusions and Relevance  Our findings underscore the importance of complementary practices by patients and physicians for the early detection of melanoma, including regular whole-body PSE, SSE, and increased patient awareness.