Rapid Fire Session 2014 World Cancer Congress

"This isn’t what mine looked like": A qualitative study of symptom appraisal and help seeking in UK patients recently diagnosed with melanoma (#434)

Fiona M. Walter 1 , Linda Birt 1 , Debbie Cavers 2 , Suzanne Scott 3 , Jon Emery 4 , Nigel Burrows 5 , Gina Kavanagh 6 , Rona Mackie 7 , David Weller 2 , Christine Campbell 2
  1. University of Cambridge, Cambridge, UK
  2. University of Edinburgh, Edinburgh, UK
  3. Kings College London Dental Institute, London, UK
  4. University of Melbourne, Melbourne, VIC, Australia
  5. Cambridge University Hospitals NHS Trust, Cambridge, UK
  6. Royal Infirmary of Edinburgh, Edinburgh, UK
  7. University of Glasgow, Glasgow, UK


Melanoma thickness at diagnosis is an important prognostic feature.


This qualitative study aimed to explore symptom appraisal and help-seeking decisions among patients recently diagnosed with melanomas, and to compare experiences of people with ‘thinner’ (<1mm) and ‘thicker’ (>2mm) melanomas.


In-depth interviews were conducted with adult patients recruited from UK dermatology clinics in Cambridge and Edinburgh within ten weeks of melanoma diagnosis.


63 patients were interviewed (29-93 years, 31 women, 30 thicker melanomas (superficial spreading 10, nodular 10, others 10). All described their skin changes using rich lay vocabulary. Many included unassuming features such as ‘just a little spot’ as well as common features of changes in size, colour and shape. There appeared to be subtly different patterns of symptoms: descriptions of vertical growth, bleeding, oozing and itch were features of thicker melanomas irrespective of pathological type.
Appraisal was influenced by explanations such as normal life changes, prior beliefs, and whether skin changes matched known melanoma descriptions. Most decisions to seek help were triggered by common factors such as advice from family and friends; family experiences of melanoma or media coverage also prompted people with thinner melanomas. Eleven patients reported previous reassurance about their skin changes by a healthcare professional, with little guidance on monitoring change or when it would be appropriate to re-consult.


Patients diagnosed with both thinner and thicker melanomas often did not recognise or interpret their skin changes as warning signs or prompts to seek timely medical attention. The findings provide guidance for melanoma awareness campaigns on more appropriate images, helpful descriptive language, and the need to stress the often apparently innocuous nature of potentially serious skin changes. The importance of appropriate advice, monitoring and safety-netting procedures by healthcare professionals for people presenting with skin changes is also highlighted.