SLR - February 2012 - Elisa Lear-Rayborn
Reference:: Kovalyshyn I, Dusza SW, Siamas K, Halpern AC, Argenziano G, and Marghoob AA, Arch Dermatol, 147(11):1269-75, 2011.
Scientific Literature Review
Reviewed by: Elisa Lear-Rayborn, DPM, MHA
Residency Program: Detroit Medical Center
Podiatric Relevance:
The podiatric relevance of this paper reinforces that melanoma identified and diagnosed by a physician provides less morbidity and mortality for the patient. When patients undergo self-diagnosis of melanoma, the lesions are thicker and already undergoing change. Although we ourselves see our bodies on a more regular basis the necessity to evaluate the dermis as a physician is an ever growing need. Most patients do not likely evaluate their feet, especially the plantar aspect on any regular basis. Although this study has dermatologists performing the evaluation, the take home point is that we are all physicians and a thorough physical examination of all aspects of the foot and ankle are necessary including a good history to evaluate for cancer risks and previous diagnoses. The old adage that knowledge is power holds true in this instance as well, if we are all more aware of our patient’s skin we can discover the lesion at a lesser stage.
Methods:
The design of the study is a single historical cohort study involving 394 patients over a ten year period at the Memorial Sloan Kettering Cancer Center. The time span encompasses from 1998 to 2008. The evaluation was detection of a pigmented lesion in a new patient versus an established patient in the clinic.
Results:
The results reveal that established patients had thinner invasive melanomas. Also, the established patient group was less likely to present with further skin changes noted to the pigmented skin lesion, such as ulceration and dermal mitosis. In general, only 18 percent of melanomas were detected by the patient and were detected secondary to the lesion undergoing change.
Conclusions:
In conclusion, physician detection led to the discovery of the lesion in a thinner state, as well as higher rates of detection when compared to patient discovery.