DELAYS IN DIAGNOSIS AND MELANOMA PROGNOSIS (I): THE ROLE OF PATIENTS Marie A. RICHARD 1,20 , Jean J. GROB 1,20 * , Marie F. AVRIL 2,20 , Miche `le DELAUNAY 3,20 , Johany GOUVERNET 4 , Pierre WOLKENSTEIN 5,20 , Pierre SOUTEYRAND 6,20 , Brigitte DRENO 7,20 , Jean J. BONERANDI 8,20 , Sophie DALAC 9,20 , Laurent MACHET 10,20 , Jean C. GUILLAUME 11,20 , Jacqueline CHEVRANT-BRETON 12,20 , Catherine VILMER 13,20 , Franc ¸ois AUBIN 14,20 , Bernard GUILLOT 15,20 , Marie BEYLOT-BARRY 16,20 , Catherine LOK 17,20 , Nadia RAISON-PEYRON 18 and Philippe CHEMALY 19,20 1 Service de Dermatologie, Ho ˆpital Sainte Marguerite, Marseille, France 2 Service de Dermatologie, Institut Gustave Roussy, Villejuif, France 3 Service de Dermatologie, Ho ˆpital Pellegrin, Bordeaux, France 4 Service d’Informatique Me ´dicale, Ho ˆpital Timone, Marseille, France 5 Service de Dermatologie, Ho ˆpital Henri-Mondor, Cre ´teil, France 6 Service de Dermatologie, Ho ˆpital Ho ˆtel-Dieu, Clermont-Ferrand, France 7 Service de Dermatologie, Ho ˆpital Ho ˆtel-Dieu, Nantes, France 8 Service de Dermatologie, Ho ˆpital Timone, Marseille, France 9 Service de Dermatologie, Ho ˆpital du Bocage, Dijon, France 10 Service de Dermatologie, Ho ˆpital Trousseau, Tours, France 11 Service de Dermatologie, Ho ˆpital Louis Pasteur, Colmar, France 12 Service de Dermatologie, Ho ˆpital Ho ˆtel-Dieu, Rennes, France 13 Service de Dermatologie, Centre Rene ´ Huguenin, Saint-Cloud, France 14 Service de Dermatologie, Ho ˆpital Saint-Jacques, Besanc ¸on, France 15 Service de Dermatologie, Ho ˆpital Caremeau, Nı ˆmes, France 16 Service de Dermatologie, Ho ˆpital du Haut-Le ´ve `que, Pessac, France 17 Service de Dermatologie, Ho ˆpital Sud, Amiens, France 18 Service de Dermatologie, Ho ˆpital Saint-Charles, Montpellier, France 19 Service d’Anatomie et Cytologie Pathologiques, Ho ˆpital Saint-Louis, Paris, France 20 Club de Cance ´rologie Cutane ´e, Socie ´te ´ Francaise de Dermatologie, France A prospective survey was conducted to assess the role of patients in the melanoma prognosis. Consecutive patients with primary melanoma were interviewed and examined using a comprehensive questionnaire including a psychologi- cal instrument. Main outcome measures were the delay be- fore medical intervention and the tumor thickness. Of 590 melanomas, 70.8% were detected by patients and this pro- portion was higher in females. Relatives were involved in the detection of half of the cases. Median delays before the pa- tient realized he had a suspicious lesion, before this lesion was seen by a doctor, and before the melanoma was re- moved were 4 months, 2 months, and 1 week, respectively. Delays up to several years were observed in some cases. The rate of self-detection tended to be lower, the delays before seeking medical advice to be longer, and the tumor thickness to be higher in old people, in males, in lower-educated indi- viduals, in those living out of towns, and in people with a low awareness about melanocytic tumors than in other cases. Conversely, individuals with a high number of atypical nevi, those who were aware to be at risk, and those who regularly visited a dermatologist tended to detect their melanoma more rapidly. No specific psychological traits were associated with a late reaction, although negligence and anxiety tended to prolong the delays. Knowledge about melanoma was poor in many patients, especially in males, and wrong beliefs were widespread. This study provides the targets of future educa- tion programs. Int. J. Cancer (Pred. Oncol.) 89:271–279, 2000. © 2000 Wiley-Liss, Inc. The incidence of cutaneous malignant melanoma has rapidly increased in Caucasian populations during last decades (Hall et al.; 1999). Since survival of patients is strongly correlated with the thickness of the primary lesion, early resection is considered as crucial. Many factors are probably involved in the delays before final diagnosis of melanoma: Some are related to patient’s educa- tion, awareness, and psychology, and some to the physician’s training and competence, both being influenced by the tumor characteristics (Langley and Sober; 1997). As skin melanoma is a visible lesion, the patient plays a major role in tumor detection: Early or late diagnosis depends on the ability of each individual first to recognize a suspicious lesion and second to seek rapidly medical attention. This two-phase process is the target of education campaigns, which are probably the most cost-effective way of improving melanoma prognosis (Grob, 1997). Although a few studies have assessed delays in melanoma diagnosis (Temoshok et al., 1984, 1985; Doherty and McKie, 1986; Cassilleth et al., 1988; Rampen et al., 1989; Krige et al., 1991; Henrikus et al., 1991; Baccard et al., 1997), the factors that influence these 2 phases have not been thoroughly investigated. A prospective multicentric survey was designed to assess sep- arately all patient- and doctor-related components in the delay before melanoma resection. Data concerning patient-related fac- tors are presented herein. MATERIAL AND METHODS Patients Eighteen French dermatological departments of the public hos- pital system participated in the study conducted between 1995 and 1996. Consecutive patients referred for cutaneous melanoma in these centers entered the study on the condition they fulfilled inclusion criteria: at least 12 years of age, histological confirmation of diagnosis of melanoma, and interview within 12 weeks after Presented at 4th World Conference on Melanoma. Sydney, 1997: 10 –14 June; Journ´ ees Dermatologiques de Paris. Paris, 1997: 3– 6 December; EDEN Congress. 2nd International Meeting on Epidemiology and Preven- tion of Skin diseases. Bamberg, 1998: 2– 4 May. Grant sponsor: Association “Vaincre Le M´ elanome”, Sanofi, France. *Correspondence to: Service de Dermatologie, Hˆ opital Sainte Mar- guerite, 270 Bd de Sainte Marguerite, 13009 Marseille, France. Fax: 00 33 4 91 74 47 81. E-mail: jgrob@mail.ap-hm.fr Received 22 October 1999; Revised 15 February 2000 Int. J. Cancer (Pred. Oncol.): 89, 271–279 (2000) © 2000 Wiley-Liss, Inc. Publication of the International Union Against Cancer