| Abstract | Cilj istraživanja: Utvrditi način i učestalost provođenja samopregleda kože kod bolesnika s melanomom te ustanoviti razloge neadekvatnog provođenja samopregleda.
Ispitanici i metode: U razdoblju od prosinca 2019. do travnja 2020. u presječnom istraživanju uključeno je 30 bolesnika kojima je patohistološki potvrđena dijagnoza melanoma. Svaki ispitanik ispunio je „Upitnik o samopregledu kože bolesnika s melanomom“, uzeti su im podaci o melanomu i osobna anamneza. S obzirom na odgovore u upitniku, podijeljeni su u dvije skupine: adekvatno i neadekvatno provođenje samopregleda kože.
Rezultati: Samopregled kože provodi 90% bolesnika, međutim adekvatno ga provodi 50%, a samo 10% pregledava sve regije. Bolesnici su češće pregledavali noge, prsa, trbuh, ruke i vrat, a rjeđe stopala, glavu, leđa, genitalije, dok su nokte i vlasište pregledavali u najmanjem postotku. Korištenje ogledala i povećala te pomoć druge osobe nisu značajno utjecali na adekvatnost samopregleda. Pokazana je tendencija da bolesnici kojima je melanom otkrio laik, zatim bolesnici mlađi od 60 godina te oni sa 16 i više godina školovanja češće spadaju u skupinu adekvatno provođenog samopregleda kože (P=0,142, P=0,128, P=0,182). Razina samopouzdanja bolesnika prilikom samopregleda bila je niska (Medijan=3). Pozitivna obiteljska anamneza koju navodi 13% bolesnika, te hobi ili rad na otvorenom koji navodi 73% bolesnika, nisu utjecale na adekvatnost samopregleda kože. Za ABCDE pravilo zna 10% bolesnika, a 43% bolesnika smatra da nemaju povećan rizik za ponovni razvoj melanoma s tendencijom da češće spadaju u skupinu neadekvatnog samopregleda (P=0,056). Liječnik obiteljske medicine podsjeća 73% bolesnika da obavljaju samopregled kože, a samo 13% ih je dobilo upute za provođenje od istog. Preventivne preglede kože svi bolesnici obavljaju u dermatologa, i to 90% prije manje od 6 mjeseci. Bolesnici kojima je proteklo više vremena od ekscizije melanoma pokazuju trend prema adekvatnijem samopregledu (P=0,084). Debljina melanoma u mm nije utjecala na adekvatnost samopregleda. Bolesnici s melanomima stupnja I i II prema Breslowljevoj klasifikaciji značajno su mlađi od bolesnika s melanomima stupnja III i IV (P=0,018).
Zaključci: Istraživanje je pokazalo da se samopregled kože provodi neredovito i površno, da je znanje o melanomu manjkavo te je ukazalo na važnu ulogu liječnika obiteljske medicine i dermatologa u edukaciji i motiviranju bolesnika na samopregled kože. Adekvatnost samopregleda nije ovisila o Breslowljevom stupnju, obiteljskoj anamnezi te informatičkoj pismenosti. Uočen je trend, ali ne i statistički značajna povezanosti adekvatnosti samopregleda s dobi bolesnika, obrazovanjem i brojem nevusa kao i vremena proteklog od ekscizije melanoma. |
| Abstract (english) | Objectives: To determine the manner and frequency of SSE in melanoma patients and to establish the reasons for inadequate SSE.
Patients and methods: In the period from December 2019 to April 2020, a cross-sectional study enrolled 30 patients with a pathohistologically confirmed diagnosis of melanoma. Each examinee filled out a “Questionnaire about SSE for melanoma patients”, the melanoma data and their personal history was collected. Given the answers presented in the questionnaire, they were divided into two groups: adequate and inadequate SSE.
Results: SSE is performed by 90% of patients, however it is adequately performed by 50%, and only 10% examine all regions. The patients have examined their legs, chest, abdomen, arms and neck more frequently, their feet, head, back and genitals less frequently, while they examined their nails and scalp the least. The use of mirrors, magnifying glass and the assistance of another person did not significantly affect the adequacy of SSE. There is a tendency that patients whose melanoma was diagnosed by a layman, patients younger than 60 years of age, and those with 16 or more years of education, more often than not belong to the group whose SSE had been performed adequately (P=0.142, P=0.128, P=0.182). The level of self confidence among patients performing SSE was low (Median=3). Neither positive family history, that had been reported by 13% of the patients, nor hobbies or outdoor activities that had been reported by 73%, have affected the adequacy of SSE. Only 10% of the patients were familiar with the ABCDE rule, while another 43% believe that they are not at an increased risk of melanoma recurrence. The latter group has a tendency to belong into the inadequate SSE group (P=0.056). General practitioners have reminded 73% of all patients to perform SSE, yet only 13% of patients have received clear instructions on how to properly perform it from them. Preventive skin examinations had been performed by a dermatologist in all patients, while 90% of the patients have undergone an examination within the last 6 months. Patients with more time since their melanoma excision show an upward trend towards a more adequate SSE (P=0.084). The thickness of melanoma in millimetres did not affect the adequacy of SSE. Patients with melanoma levels I and II as per the Breslow classification are significantly younger than patients with melanoma levels III and IV (P=0.018).
Conclusions: The study has shown that the SSEs were performed irregularly and carelessly, that patient’s understanding about melanoma is insufficient and has highlighted the important role of general practitioners and dermatologists in motivating the patients to perform SSE. The adequacy of SSE did not depend on the Breslow classification, patient’s family history and computer literacy. On the other hand, there is a tendency, but no statistically confirmed correlation, between adequacy of SSE with patient’s age, level of education, number of nevi and with time that passed since their melanoma excision. |
