Routine Dermatologist-Performed Full-Body Skin Examination and Early Melanoma Detection
Routine Dermatologist-Performed Full-Body Skin Examination and Early Melanoma Detection
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DOI：
10.1001/archdermatol.2009.137
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发表时间：
2009-08-01
影响因子：
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通讯作者：
Kantor, Deborah E.
中科院分区：
文献类型：
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作者：
Kantor, Jonathan;Kantor, Deborah E.
目的：确定私人皮肤科诊所中检测出黑色素瘤但并非主诉的患者比例。设计：回顾性分析病例系列。背景：佛罗里达州私人皮肤科诊所，2005 年 7 月至 2008 年 10 月。患者：患有 126 例黑色素瘤的患者，其中 51 例为侵袭性黑色素瘤，75 例为原位黑色素瘤。主要结果指标：根据患者主诉检测出的黑色素瘤与由皮肤科医生进行的全身皮肤检查 (FBSE) 确定的比例。作为二次分析，我们使用逻辑回归关联比值比（OR）来检查皮肤科医生的检测而不是患者的投诉是否与检测较薄的黑色素瘤相关。使用 1.0 毫米的厚度截止值进行事后分析来定义深部黑色素瘤。结果：总体而言，皮肤科医生发现了 56.3%（95% 置信区间 [CI]，47.6%-65.1%）的黑色素瘤，但不属于主诉的一部分。在原位黑色素瘤中，60.0%（95% CI，48.7%-71.3%）是由皮肤科医生检测到的。皮肤科医生的检测与较薄的黑色素瘤显着相关，OR 为 0.42 (P=.04)。我们发现较薄的黑色素瘤作为一个组（厚度
Objective: To determine the proportion of patients in a private dermatology practice in whom melanoma was detected but was not the presenting complaint.Design: Retrospective analytical case series.Setting: Private dermatology practice in Florida, from July 2005 through October 2008.Patients: Patients with 126 melanomas, of which 51 were invasive and 75 were melanomas in situ.Main Outcome Measures: Proportion of melanomas detected as a result of patient complaint vs proportion determined by dermatologist-conducted full-body skin examination (FBSE). As a secondary analysis, we used logistic regression odds ratios (ORs) of association to examine whether dermatologist detection rather than patient complaint was associated with detecting thinner melanomas. A post hoc analysis was performed using a thickness cutoff of 1.0 mm to define a deep melanoma.Results: Overall, 56.3% (95% confidence interval [CI], 47.6%-65.1%) of melanomas were found by the dermatologist and were not part of the presenting complaint. Of melanomas in situ, 60.0% ( 95% CI, 48.7%-71.3%) were dermatologist detected. Dermatologist detection was significantly associated with thinner melanomas, with an OR of 0.42 (P=.04). We found a significant association between thinner melanomas as a group ( thickness