Background: Delayed diagnosis of squamous cell carcinoma (SCC) increases recurrence, metastatic potential, and management costs. This study aims to identify risk factors of patient-related delayed presentation in cutaneous SCC. Patients and Methods: A total of 513 patients, who first sought care for cutaneous lesions that were subsequently removed and histologically confirmed as SCCs, were included. Attitude to symptoms, psychosocial profile, and reasons for delayed presentation were obtained via a structured questionnaire-based interview. First presentation > 3 months from the onset of symptoms was considered as delayed. Results: Mean presentation time was 3.90 ± 2.05 months, while 186 patients delayed presentation. Multivariate logistic regression analysis revealed that serious co-morbidity (p = 0.003), low education level (p < 0.001), non-recognition of the seriousness of symptoms (p < 0.001), a ‘wait and see' attitude (p < 0.001), and fatalism (p = 0.005) were independent determinants of significantly higher risk for delayed presentation. In contrast, female sex (p = 0.006), new lesion (p = 0.012), accessible topography (p = 0.019), size increase (p = 0.002), color change (p = 0.017), non-healing wound (p = 0.048), and presence of social support/advice (p < 0.001) were independent determinants significantly associated with early presentation. Conclusion: Recognition of symptom seriousness and elimination of factors hindering self-referral may increase awareness and promote early patient presentation and diagnosis of cutaneous SCC.

1.
Chen JG, Fleischer AB, Smith ED, Kancler C, Goldman ND: Cost of non-melanoma skin cancer treatment in the United States. Dermatol Surg 2001;27:1035-1038.
2.
Brantsch KD, Meisner C, Schoenfisch B: Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 2008;9:713-720.
3.
Clouser MC, Harris RB, Roe DJ, Saboda K: Risk group, skin lesion history, and sun sensitivity reliability in squamous cell skin cancer progression. Cancer Epidemiol Biomarkers Prev 2006;15:2292-2297.
4.
Renzi C, Mastroeni S, Mannooranparampi TJ, Passarelli F, Caggiati A, Potenza C: Delay in diagnosis and treatment of squamous cell carcinoma of the skin. Acta Derm Venereol 2010;90:595-601.
5.
Andersen BL, Cacioppo JT, Roberts DC: Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes. Br J Soc Psych 1995;34:33-52.
6.
Hackett TP, Cassem NH, Raker JW: Patient delay in cancer. N Engl J Med 1973;289:14-20.
7.
Richard MA, Grob JJ, Avril MF, Delaunay M, Wolkenstein P: Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer 2000;89:271-279.
8.
MacLeod U, Mitchell ED, Burgess C, Macdonald S, Ramirez AJ: Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. Br J Cancer 2009;101:S92-S101.
9.
Smith L K, Pope C, Botha JL: Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 2005;366:825-831.
10.
De Nooijer J, Lechner L, De Vries H: Help-seeking behaviour for cancer symptoms: perceptions of patients and general practitioners. Psychooncology 2001;10:469-478.
11.
Tromp DM, Brouha XDR, De Leeuw JRJ: Psychological factors and patient delay in patients with head and neck cancer. Eur J Cancer 2004;40:1509-1516.
12.
Ackerman AB, Mones J: Squamous-cell carcinoma in situ is a fiction! J Cutan Pathol 2009;36:74-75.
13.
Oliveria SA, Christos PJ, Halpern AC, Fine JA: Patient knowledge, awareness, and delay in seeking medical attention for malignant melanoma. J Clin Epidemiol 1999;52:1111-1116.
14.
Nagore E, Oliver V, Moreno-Picot S, Fortea JM: Primary cutaneous melanoma in hidden sites is associated with thicker tumours - a study of 829 patients. Eur J Cancer 2001;37:79-82.
15.
Kakagia D, Tamiolakis D, Grekou A: Intraoperative cytological evaluation of Marjolin ulcers. Onkologie 2006;29:21-24.
16.
Worden JW, Weisman AD. Psychosocial components of lag time in cancer diagnosis. J Psychosom Res 1975;19: 69-79.
17.
Ming ME, Levy RM, Hoffstad OJ, Filip JF, Gimotty PA, Margolis DJ: Validity of patient self-reported history of skin cancer. Arch Dermatol 2004;140:730-735.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.