Dermatologists Superior to Other Physicians at Flagging Early Melanoma

ATLANTA, April 18 -- When melanomas are diagnosed by a dermatologist, patients are likelier to have early-stage disease and longer survival than those whose lesion was diagnosed by a non-dermatologist, researchers reported.Patients diagnosed by a dermatologist had a preponderance of thin melanoma at stages zero, or I or II, with higher survival rates at two and five years than those diagnosed by a non-dermatologist, Suephy C. Chen, M.D., of Emory University here, and colleagues reported in the April 16 issue of the Archives of Dermatology.
Melanoma is the fifth most common malignancy for men and the sixth most common for women, with a sharp increase since the 1930s. Patients diagnosed early have a 90% cure rate, compared with five-year survival rates of less than 20% for metastatic disease, the researchers wrote.
Non-dermatologists included family practitioners, internists, ob-gyns, plastic surgeons, and oncologists.
The data emerged from a retrospective analysis using Medicare claims (codes for different kinds of physician visits), and the National Cancer Institute's SEER database (cancer diagnoses and outcomes) from 1991 to 1996. The registries came from 12 U.S. sites. However, those diagnosed by a dermatologist were more likely to live in an urban area.
Of 2,020 participants in the study sample, 1,467 (73%) were diagnosed by a dermatologist and 553 (27%) were diagnosed by a non-dermatologist. Tumor detection by a dermatologist versus a non-dermatologist was associated with an earlier stage melanoma (stage 0, stage I, and stage II versus stage III and stage IV; x2 test, P<0.01) and a thinner tumor (Breslow thickness, 0.86 mm vs. 1.00 mm; P<0.05).