Most Melanoma Skin Cancers Found by Physicians are
on Male Senior Citizens
These doc-detected cancers tend to be thinner,
found on back, more treatable
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Melanoma is one of the rarer types
of skin cancer but causes the majority of skin cancer related
deaths.
More at
Wikipedia |
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April 20, 2009 When a physician finds a melanoma
skin cancer on an older man, it is more likely to be thinner and,
therefore, more treatable. And, too, it is more common for doctors to
find these thin melanomas on men who are at least 65 years old, have
them on their backs or have a history of atypical moles. These
conclusions come from two studies in the April issue of Archives of
Dermatology, one of the JAMA/Archives journals.
Both studies used the same base research data.
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Melanoma is becoming more common and mortality
rates from melanoma are steadily increasing among older men, according
to background information in one of the articles.
Tumor thickness at diagnosis strongly predicts the
management and outcomes of melanoma, and the thickest tumors (4
millimeters or thicker) are increasingly common in white men age 60 and
older.
"Rigorous assessment of behavioral, social and
medical access factors that differ between men 40 years or older with
thinner vs. thicker melanomas may identify potential modifiable
variables," the authors write.
"A clearer understanding of these factors provides
fundamental knowledge for additional studies and public health messages
aimed at earlier melanoma detection in this high-risk subset of men."
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About Melanoma
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Melanoma is the most
serious type of
skin cancer. Often the first sign of melanoma is a change in the
size, shape, color or feel of a mole. Most melanomas have a black or
black-blue area. Melanoma may also appear as a new mole. It may be
black, abnormal or "ugly looking."
Melanoma can be cured if
it is diagnosed and treated early. If melanoma is not removed in its
early stages, cancer cells may grow downward from the skin surface and
invade healthy tissue. If it spreads to other parts of the body it can
be difficult to control.
>>
More information at MedlinePlus
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In one study, Susan M. Swetter, M.D., of Stanford
University Medical Center, Calif., and colleagues surveyed 227 men age
40 and older between 2004 and 2006, within three months of their
melanoma diagnosis. The men responded to questions about their previous
melanoma awareness, skin examination practices, how their cancer was
discovered and social and medical care factors.
Of the 227 men, 57 (25.1 percent) had tumors
thicker than 2 millimeters. These men were more likely to have less than
a high school education, less likely to have a history of atypical nevi
(moles) and their melanomas were more often discovered by the patient
themselves or a friend or family member than by a physician.
Men with thinner melanomas were more likely to have
previous knowledge of melanoma, have paid attention to skin cancer
detection information, be interested in health topics and be aware of
the importance of physician skin examination.
Tumor thickness was not associated with patients'
age, whether or not they were married or lived with a partner, skin
cancer history, sun sensitivity or the anatomic location of the cancer.
Overall, few patients were aware of melanoma
warning signs (less than 20 percent), practiced skin self-examination
(less than 50 percent) or used the Internet (less than 14 percent) as a
source of skin cancer information.
"For men 40 years or older, who constitute more
than half of all melanoma deaths in the United States, we have
identified at least two key variables (physician skin examination and
improved public awareness, particularly for patients in lower
socioeconomic groups) as major targets for new interventions to promote
earlier melanoma detection," the authors write.
"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."
Men with physician-found cancers were older
In the second study, Alan C. Geller, M.P.H., R.N.,
of Boston University, and colleagues report a separate analysis of the
same survey data. Patients whose melanomas were detected by a physician
tended to be older - 57 percent were 65 years or older, compared with 42
percent of patients who detected cancer themselves and 34 percent whose
cancer was detected by another non-physician.
This may be because older patients visit their
physicians more frequently, providing more opportunities for skin
examination, and they may rely more heavily on physician skin evaluation
because they tend to have poorer eyesight and are less likely to have a
partner.
Forty-six percent of physician-detected melanomas,
16 percent of self-detected melanomas and 56 percent of melanomas
detected by other means were on the patient's back; these
back-of-the-body melanomas were smaller than 2 millimeters in 92 percent
of physician-detected cases, 63 percent of self-detected cases and 76
percent of those detected by other means.
"Skin screenings of at-risk middle-aged and older
American men can be integrated into the routine physical examination,
with particular emphasis on hard-to-see areas, such as the back of the
body," the authors conclude.
"Watch your back' professional education campaigns
should be promoted by skin cancer advocacy organizations and should
incorporate the importance of physician screening and the benefit of
spouse or partner assistance for early detection of melanoma,
particularly in the high-risk population of middle-aged and older men."
Editorial: Physicians Must Help Men Overcome
Barriers to Care
"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," writes June K. Robinson, M.D., of
Northwestern University Feinberg School of Medicine, Chicago, and editor
of Archives of Dermatology, and colleagues in an accompanying editorial.
"By delaying seeking care, men present at a later
stage of melanoma when it is no longer treatable."
"The tasks associated with seeking help from
physicians, such as relying on others, admitting a need for help or
appearing vulnerable, may be in conflict with some individuals' societal
and normative beliefs that men are self-reliant, physically tough,
invincible and in control of their destiny.
For example, some men may be thought of as the
strong, silent type'; thus, they are reluctant to make a fuss over a
little mole or to admit their fear that something could be wrong, even
to themselves."
"This latter issue leads to the question of how
physicians can interact with their patients in a manner that overcomes
some of these interpersonal and psychological barriers to improve
treatment outcomes," the authors write.
Building strong, trusting physician-patient
relationships, using appropriate patient education materials, asking
patients about their concerns and demonstrating empathy may improve the
care of all patients with melanoma.
Editor's Note: This study was supported in part by
a National Cancer Institute grant to Dr. Robinson.
In 2008 there were 62,480 new cases of melanoma and 8,420
deaths. More
at the National Cancer Institutes homepage of melanoma.
Melanoma is often curable if you find it early. These
melanoma pictures from the Mayo Clinic can help you determine what to
look for.
Click Here.
Melanoma Research Foundation encourages Americans not to rely solely on
sunscreen.
Click Here.
