August 20, 2007 (Insidermedicine) The farther a patient has to travel to reach their physician, the more likely they are to have thicker skin cancer at diagnosis, according to research published in the Archives of Dermatology.

Here are some important points regarding the diagnosis and management of melanoma:

•    Increased size, variation in color, irregular borders and bleeding of a pigmented lesion are suggestive of melanoma. In suspected cases, patients should be urgently referred for biopsy to confirm diagnosis.
•    Patients with a melanoma should be followed-up every 3 months until 2 years have elapsed from the diagnosis. Thereafter, follow-up is continued every 6 months for 5 years.
•    Recurrent melanoma may present with subcutaneous nodules close to the site of excision and may appear as dark spots under the skin.

Survival for patients with melanoma is dependent on the stage at diagnosis. As the depth of tumour cells in the skin increases, referred to as Breslow thickness, overall survival decreases. Patients with lesions that are less than 1 mm thick have a greater than 85% 5-year survival; whereas those whose lesion is greater than 4 mm have a less than 50% 5-year survival.

Many factors can affect diagnosis and survival from cancer, including a person’s level of education, socioeconomic status, and the availability of doctors in the area. It is thought that the distance a person has to travel to their doctor who performs the diagnostic biopsy may also influence diagnosis and survival.

In the present study, researchers from University of North Carolin in Chapel Hill examined the effect of travel distance, and other factors, for more than 600 patients with melanoma.

They found that for each one mile increase in distance, average Breslow thickness at diagnosis increased by 0.6%. Patients who traveled more than 15 miles had tumours 20% thicker than those of patients who traveled 15 miles or less. As well, age and poverty were also associated with Breslow thickness, while sex, rurality, and supply of dermatologists were not.

Physicians should encourage their patients to report any changes in moles promptly, so they can be referred to urgent skin biopsy and definitive treatment. Improved access to dermatologists would likely improve the outcome for many people with melanoma. As well, counseling people, especially children, to reduce excessive sun exposure and to use sunscreen, may help reduce the rate of melanoma.

For Insidermedicine in Depth, I'm Dr. Petra Joller.