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Melanoma diagnosed earlier from 2001
through 2011
Early detection of melanoma improved significantly, as measured by stage at diagnosis, over the
decade 2001–2011, report results of a crossover registry study.
Over a third of emergency department patients
admitted for cellulitis are misdiagnosed
Over a third of patients admitted through the emergency department with a diagnosis of cellulitis were
misdiagnosed, outcome of a retrospective chart review performed in a large urban hospital show.
A
dam B. Raff, MD, PhD, of Harvard
Medical School, Boston, Massa-
chusetts, explained that cellulitis is
a common diagnosis, with 2.3 million visits
annually to the emergency department and
an estimated at 15.2% admission rate. Cel-
lulitis accounts for 10% of infectious disease
– related US hospitalisations. Cellulitis ac-
counted for US$3.7 billion in outpatient and
emergency department costs.
Cellulitis is frequently misdiagnosed due to
numerous clinical entities with similar pres-
entations, so-called pseudocellulitis, such
as chronic venous stasis. Thirty to ninety
percent of patients referred to an inpatient
dermatologist for presumed severe lower limb
cellulitis were misdiagnosed in a study.
In an effort to better characterise the overall
impact of misdiagnosis, Dr Raff and col-
leagues analysed of the healthcare burden of
pseudocellulitis, including delay of effective
care, inappropriate use of antibiotics, unnec-
essary hospital admissions, complications,
and increased medical costs.
Dr Raff said, “I was challenged by patients
I was seeing as an inpatient dermatologist.
Many patients referred to me for cellulitis
G
iselle Prado, BS, of the Herbert Wertheim College of
Medicine, Florida International University, Miami,
explained that it is estimated that over 73,000 new
cases of melanoma will be diagnosed in the US this year.
While melanoma accounts for less than 2% of skin cancer
cases, it will account for most skin cancer related deaths.
Early detection of this highly aggressive cancer is the cor-
nerstone of treatment.
“We undertook this study,” said Ms Prado, “because we know
that melanoma incidence has been increasing. It’s important
to implement public health programs that help increase early
detection. Excising a superficial melanoma is much simpler
than dealing with the morbidity and mortality associated with
higher stages of melanoma. In addition, rising healthcare
costs are another important reason to detect melanomas at
an early stage.”
Ms Prado and colleagues employed data from 18 registries
reporting to the Surveillance, Epidemiology, and End Re-
sults (SEER) program from 2001–2011. They performed
multivariate logistic regression to obtain unadjusted and
adjusted associations between year of diagnosis and stage at
the time of diagnosis (in situ/localised vs regional/distant).
Demographic traits, age at diagnosis, primary site, laterality,
histologic subtype, and tumour size were used as predictors.
A total of 115,913 cases of melanoma were identified from
2001–2011. Men constituted 56.6%. Age at diagnosis was
evenly split between persons 40-64 years of age (45.4%) and
those >65 years of age (43.4%).
Primary site was distributed as follows: head and face 28.1%,
trunk 29.8%, upper limb 25.0%, and lower limb 17.0%. More
primary melanomas were located on the left side (51.8%).
Most cases were in situ or localised (92.5%) versus regional
and distant (7.5%).
A significant unadjusted association was observed be-
tween year and stage of diagnosis (odds ratio 0.95, 95% CI
0.95–0.96). After adjusting for sex, age at diagnosis, primary
site, and histology code subtype, the significant association
between year of diagnosis and stage remained (odds ratio
0.94, 95% CI 0.93–0.95).
Adjusted analysis also demonstrated that females were less
likely to be diagnosed at a higher stage than men (odds ratio
0.69, 95% CI 0.65–0.73). Persons >65 years of age were more
likely to be diagnosed with regional and distant cancer (odds
ratio 1.24, 95% CI 1.13–1.35) than those age 18–39 years.
Melanomas located on the trunk (odds ratio 0.77, 95%
CI 0.71 - 0.82) and upper limb (odds ratio 0.64, 95% CI
0.60–0.69) were less likely to be a higher stage than those
located on the face and head.
Nodular melanoma was more likely to be widespread at diag-
nosis than superficial spreading melanoma (odds ratio 10.63,
95% CI 9.77–11.57). Acral lentiginous melanoma was more
likely to be staged higher (odds ratio 6.75, 95% CI 5.70–8.00).
Ms Prado said that early detection improved significantly as
measured by stage at diagnosis. Men and older patients were
more likely to be diagnosed at a higher stage. Education and
interventions aimed at early detection are critical to reduce
the incidence of regional and distant melanoma.
“In the future,” she said, “we need more studies detailing
exactly why earlier detection occurred over this time period,
whether it was increased awareness, increased surveillance
by dermatologists, or other factors.”
PRACTICEUPDATE RHEUMATOLOGY & DERMATOLOGY
AMERICAN ACADEMY OF DERMATOLOGY 73RD ANNUAL MEETING
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