M. Cicchiello, M.J. Lin, J.W. Kelly
Introduction: Nodular melanomas (NMs) are aggressive
tumours which contribute disproportionately to melanoma
associated deaths. Their atypical clinical presentation may
result in delays in diagnosis and missed opportunities for
diagnosis.
Method: 60 patients with primary cutaneous NMs were
randomly identified from the prospectively maintained
database of the Victorian Melanoma Service in the period
between April 2008 and September 2012. This database
includes all biopsy proven melanomas referred to the institution
from a variety of general practitioners, dermatologists
and surgeons in the community. 60 patients with
primary cutaneous invasive superficial spreading melanomas
(SSMs) were then identified from the database, using a
matching process to account for the variables of age, sex
and date of biopsy. A single interviewer conducted phone
interviews for all patients using a standardised questionnaire.
Information on the pathway to melanoma diagnosis
was compared for NMs and SSMs.
Results: Patients with NMs had more consultations with
doctors prior to biopsy compared to patients with SSMs.
NMs were less likely than SSMs to be immediately biopsied
on the first consultation (32% vs 57%, p = 0.01). Compared
to patients with SSMs, patients with NMs were almost twice
as likely to be falsely reassured by the first doctor they
consulted that their melanoma was benign (27% vs 50%,
p = 0.01). The maximum number of doctor visits prior to
biopsy of a SSM was 3 (in 7% of SSM cases). In comparison,
33% of NMs were biopsied after 3 or more visits to a doctor,
including 5% which required 6 visits to a doctor prior to
biopsy.