Psychosocial aspects of melanoma

Seventy-five patients with melanoma were surveyed for recent history of major stress, coping styles, and psychiatric disturbance. Recurrence of disease was strongly related to biological variables (stage and Breslow depths) but not to psychological measures. Major life stress was not related to stage, Breslow, Clark level, or estimates of lymphocytic infiltration of tumor. Coping styles were paradoxically related to major life stress such that history of major stresses was associated with greater confrontation of the melanoma diagnosis, greater will to fight the disease, and less avoidance of its frightening aspects. Experience with fewer major life stresses was associated with a defeatist attitude characterized by an expectation of a poor prognosis and little control over outcomes. More than 50% of the sample had experienced at least one major life stress in the past 5 years. This figure is consistent with prior work and indicative of a higher than normal rate of major life stress in the years before diagnosis.