In the article entitled, “Delayed treatment and continued growth of nonmelanoma skin cancer,” published online in the Journal of the American Academy of Dermatology, dermatologist Murad Alam, MD, MSCI, FAAD, chief of cutaneous and aesthetic surgery, and associate professor of dermatology, otolaryngology, and surgery at Northwestern University, Chicago, presented results of a study examining why patients delay seeking medical attention for suspicious growths and the consequences of their procrastination.
“Studies show that various patient-specific factors appear to be responsible for the delay in the treatment of cancers in general, and skin cancer in particular,” said Dr. Alam. “The purpose of this study was to determine the patient- and physician-specific reasons, including physical, financial, social, intellectual, and psychological factors, to which patients attribute delays in the diagnosis and treatment of nonmelanoma skin cancers.”
Patients reported that denial was the most frequent reason for waiting to see a doctor about a suspicious lesion – accounting for 71 percent of all cases. Specifically, the two most commonly listed reasons why patients waited to see their doctor were “thought it would go away” (36 percent), and “thought it wasn’t important” (24 percent).
“Denial may be a normal response to health concerns, with patients minimizing the psychological burden of their illness, or it may be a learned coping mechanism,” said Dr. Alam. “But denial can interfere with obtaining treatment and result in more serious or advanced skin cancers.”
When analyzing the association of delay with the size of a skin cancer from the time patients first realized that they had a problematic lesion to the time they saw a physician, Dr. Alam found that there was a significant increase in tumor size in patients who waited an average of six months to see a physician. On average, skin cancers grew during this delay period, with the average lesion enlarging from the size of a pimple (2-3 mm) to between the size of a pimple and a dime (10 mm). The longest reported delays were associated with relatively greater increases in tumor sizes.
“Delayed treatment of skin cancer may result in tumor enlargement, loss of function in affected areas, and the need for larger excisions that may impact a person’s appearance and mobility,” noted Dr. Alam. “That is why dermatologists encourage everyone to perform regular skin exams and report suspicious lesions to a dermatologist as soon as possible.”
Dr. Alam stressed that it is important for patients to understand that early diagnosis and treatment of skin cancer can lead to simpler surgeries, smaller scars, and decreased illnesses. If a patient has a suspicious lesion, he or she should make an appointment to see a dermatologist as soon as possible.
To collect data for this study, a four-page questionnaire eliciting patient medical history, skin cancer history, demographic information, initial and subsequent lesion size, and reasons for delay in seeking treatment for nonmelanoma skin cancers was administered to 982 patients undergoing Mohs micrographic surgery for nonmelanoma skin cancer at a private surgery practice between March and December 2005.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.