How long do you wait for a dermatological visit? What about confirming the diagnosis of melanoma? Who communicates the results of the exams? These questions were answered directly by patients and doctors involved in two surveys carried out as part of the “Target Melanoma” project. It emerged that almost 30% of patients wait from 3 months to a year before going for the first dermatological specialist visit. Between the latter and the confirmation of the diagnosis of melanoma it takes less than a month for 79% of patients. So far so good: what is causing some concern is the fact that 47% of patients personally withdraw the results of the examination at the medical office without going back to the doctor. The results of the two questionnaires are the subject of an abstract presented at the 17th Congress of the European Association of Oncological Dermatology (EADO), running in virtual form until April 17th and organized together with the 10th World Congress on Melanoma.
Patient surveys
The two surveys are part of the “Target Melanoma” project, carried out thanks to the unconditional contribution of Pierre Fabre and Eau Thermale Avène and promoted by the patient associations AIMAME, Melanoma Italia Onlus (MIO), Emme Rouge and APAIM, with the patronage of ADOI ( Italian Hospital Dermatologists-Venereologists Association), AIOM (Italian Association of Medical Oncology), IMI (Italian Melanoma Intergroup) and SIDeMaST (Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases), with the aim of understanding the reasons which can cause late diagnosis and thus highlight the strengths and weaknesses of the Italian prevention system, to reduce cases of melanoma identified in an advanced stage. The two questionnaires, consisting of 37 questions, were answered by 579 patients and 225 dermatologists.
The results
As anticipated, the waiting times for visits are not very long and also the removal time of the mole is short (within 15 days for 57%). But there are other aspects that could be improved. For example, even if the majority of dermatologists personally communicate the diagnosis of melanoma, there remains a consistent percentage of patients, equal to 47%, who personally collect the results of the examination at the report desk. The time devoted to explaining the diagnosis is also limited, not exceeding 10 minutes for about 40% of patients and 15 minutes for 18.5%.
Surveys reveal differences in the perception of patients and dermatologists also on the waiting times for the first dermatological specialist visit and on the parts of the body checked during this examination. Only 23.5% of patients wait less than a month to access the first visit, for 47% the time goes from 30 to 90 days and for 21% it exceeds 6 months. Instead, 42.4% of the dermatologists interviewed believe that the first visit takes place within a month and only 14.7% say that the wait ranges from 3 months to a year. The examination involved the whole body for 54.2% of patients compared to 87.6% of the clinicians interviewed, in addition 46.3% of the latter claim to have also checked hidden parts (such as genitals and scalp) compared to 11.4% of patients.
Looking for the team
On the other hand, 80% of the panel of dermatologists interviewed stated that they personally communicate the result of the report to the patient and 83.5% said they did not set time limits in explaining the diagnosis. “It is concerned that almost half of the specialists (49.1%) work in structures without a multidisciplinary team – he says Giovanni Pellacani, director of the Dermatology Complex of the University Hospital of Modena. ‘Target Melanoma’ aims to identify the problems that can determine the diagnostic delay of skin cancer and hinder the correct management of the patient, which is not always ensured uniformly throughout the territory. One of the obstacles is precisely the lack, in some cases, of multidisciplinary teams ”. The Skin Cancer Unit is the ideal model, because a group of dermatologists, pathologists, oncologists, plastic surgeons, radiotherapists and geneticists works there, dedicated to the management of the most complex cases from a diagnostic and therapeutic point of view.
Prevention
In 2020, 14,900 new cases of melanoma were estimated in Italy. “Prevention and early diagnosis are the two factors on which it is necessary to continue to intervene to fight melanoma, which can be cured if detected at an early stage – he explains Paola Queirolo, director of the Melanoma, Sarcoma and Rare Tumors Division at the European Institute of Oncology in Milan. 50% of patients state that they have never undergone a dermatological examination for the control of moles before being diagnosed and 43% stress that they have suspected a lesion at risk for themselves. We must insist on information and awareness projects, because 36% of patients say they have never heard of melanoma before diagnosis and only 30% declare that, in the Region of residence, primary and secondary prevention campaigns are organized dedicated to the melanoma”.
The role of associations
Patient organizations can help clinicians to have a global view of the disease. “Although the results of the survey show a good organization of the treatment process once started, the problem linked to communicating the diagnosis is very strong – conclude the Patient Associations. Letting a patient read a melanoma report by himself means generating a lot of concern in him, it means that he will search for clarifications and the information he will find, perhaps on the internet, is not always helpful. In fact, about a third of patients ask for a second opinion, probably precisely because too many withdraw the histological report themselves. Communication must be seen as a highly informative occasion with a great emotional impact for the person who receives it. This is why it must absolutely be strengthened and improved. Furthermore, the communication of the diagnosis must also include the explanation of the subsequent phases of the treatment and follow-up, leaving room for all the patient’s questions and doubts “.
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