Patients' and doctors' delay in the diagnosis and treatment of cutaneous melanoma

Factors involved in patients' and doctors' delay in the diagnosis and treatment of primary or metastatic cutaneous melanoma were studied in an inquiry of 284 patients in 12 hospitals. The most important patients' delay factors were: unawareness of the danger of the earliest and to a lesser extent the late signs and symptoms in the evolution of melanoma. Age and socio-economic status were of negligible importance in this respect. When the primary melanoma was easily visible, patients noticed the first signs of the developing melanoma significantly earlier than when the primary was not visible; nevertheless visibility had no impact on tumor thickness. This again shows that the early signs were not experienced as signs that required a visit to a doctor. Patients who showed their melanoma as a secondary complaint while they visited the doctor for another condition, had a more favorable tumor thickness than those who only came for their melanoma. The most important factors in doctors' delay were lack of suspicion (often due to amelanosis), and the performance of an incisional or punch biopsy and treatment without histopathology. Melanomas discovered by chance during a physical examination while the patient was totally unaware of the lesion had a most favorable tumor thickness. These observations indicate that a better education of the general public and of the medical profession is warranted, in order to improve the prognosis of cutaneous melanoma.