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Saturday, August 22, 2009

Who Spots Melanoma?

How is Melanoma Most Often Detected?

Statistics surrounding melanoma, the most lethal form of skin cancer, are grim. The World Health Organization reports about 48,000 deaths due to melanoma each year, with approximately 160,000 new cases diagnosed yearly. A study in this week's Archives of Dermatology: Routine Dermatologist-Performed Full-Body Skin Examination and Early Melanoma Detection sheds new light on diagnosis.

First of all, Rick and I would like to offer kudos to the author, who simply took it upon himself to assess whether melanomas were detected more often when a patient asked him to look at a skin lesion or if he did a full body skin examination. Surprise! About 60% of these skin cancers were detected by the physician, not because the patient came in and said, hey doc, look at this. And when the lesions were detected by the physician they were smaller and thinner, and therefore less likely to have spread and certainly easier to remove.
Full body skin examinations have been discussed for years among medical professionals, with some saying they should be done annually. This study would suggest that people should ask their dermatologist to conduct such an exam if one isn't suggested to them. Melanomas are notorious for popping up in all sorts of unlikely places: between the toes, on the scalp beneath a full head of hair, inside the ear. Certainly places it would be difficult or impossible to examine on your own.
If you or a partner or friend do see something suspicious, the ABCDE method of assessing potential melanomas may be applied: A for asymmetrical, B for irregular border, C for color, with most lesions having more than one color, D for diameter, often greater than 5 mm, and E for elevation, since raised lesions may be more troublesome, or evolution, with the lesion changing over time to get bigger.
Prevention, as always, is preferable: avoiding the sun from 10am to 2pm, wearing protective clothing and a hat, and perhaps sunscreen, although that's controversial. Other topics in the podcast this week include Effects of a Palliative Care Intervention on Clinical Outcomes in Patients With Advanced Cancer and Postlicensure Safety Surveillance for Quadrivalent Human Papillomavirus Recombinant Vaccine in JAMA, and Systematic Review: Elective Induction of Labor Versus Expectant Management of Pregnancy in Annals of Internal Medicine. Until next week, y'all live well.

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