Reasons for poor prognosis in British patients with cutaneous malignant melanoma

One hundred and twenty five patients presenting in the west of Scotland with primary cutaneous malignant melanoma answered a detailed questionnaire to establish whether there was any evidence of inappropriate delay in receiving surgical treatment for a new or changing pigmented lesion. The survey was carried out because of the relatively high proportion of patients in Scotland with melanoma presenting with primary lesions categorised as "thick, poor prognosis" and the poor five year survival figures as compared with many other countries. Of the 125 patients questioned, only 20 (16%) had received appropriate surgical treatment within three months of becoming aware of a suspicious cutaneous pigmented lesion; 63 (50%) had received surgical treatment three to 12 months after first noticing such a change, and in 42 cases (34%) this interval was over one year. In 102 of 105 patients in whom the interval exceeded three months the patient alone was responsible for the delay; in only three cases was the family doctor partially at fault. No evidence of delay by the hospital service was identified. Because of these findings a public education campaign was launched in the west of Scotland in June 1985 with the aim of improving recognition of early malignant melanoma. In the next six months the proportion of patients in the west of Scotland with primary melanomas categorised as "thin, good prognosis" had risen from 38% to 62%, and the proportion with tumours categorised as "thick, poor prognosis" had fallen from 34% to 15%.