The duty to inspect the skin and counsel those at risk to develop melanoma

Objective: To determine factors associated with physician discovery of early melanoma in middle-aged and older men. Design: Survey. Setting: Three institutional melanoma clinics. Participants: A total of 227 male participants (aged ≥40 years) with invasive melanoma who completed surveys within 3 months of diagnosis. Intervention: Survey. Main Outcome Measures: Factors associated with physician-detected thin melanoma. Results: Patients with physician-detected melanoma were older, 57% were 65 years or older compared with 34% for other-detected (odds ratio [OR], 2.57; 95% confidence interval [CI], 1.19-5.55) and 42% for patient-detected melanoma (P=.07). Physician-detected melanoma in the oldest patients (aged ≥65 years) had tumor thickness equal to that of self-detected melanoma or melanoma detected by other means in younger patients. Back lesions composed 46% of all physician-detected melanoma, 57% of those detected by other means, and 16% of self-detected lesions (physicianvs self-detected: OR, 4.25; 95% CI, 1.96-9.23). Ninety-two percent of all physician-detected back-of-the-body melanomas were smaller than 2 mm compared with 63% of self-detected lesions (P=.004) and 76% of lesions detected by other means (P=.07). Conclusions: Skin screenings of at-risk middle-aged and older American men can be integrated into the routine physical examination, with particular emphasis on hard-to-see areas, such as the back of the body. "Watch your back" professional education campaigns should be promoted by skin cancer advocacy organizations.