Socio-demographic factors

In SSE, several socio-demographic factors such as gender, age, educational attainment, marital status and cohabitation have been investigated. Females are more likely to self-detect their melanoma (Weinstock et al., 1999; Brady et al., 2000) and have been found to perform SSE for primary disease more often than males (Girgis et al., 1991; Hill et al., 1991; Berwick et al., 1996; Miller et al., 1996; Robinson et al., 1998). Similarities in both genders have however also been found (Robinson et al., 2002). Men are more likely to present with melanomas located on the back (Hanrahan et al., 1998). Individuals with melanomas on non-visible areas may incur difficulties in both detecting the primary tumour and performing self-examination. In addition, men are also less knowledgeable about melanoma and have less favourable attitudes (Brandberg et al., 1996; Miller et al., 1996). The psychological approaches to danger posed by melanoma may be different for men and women (Robinson et al., 2002).

Age and educational attainment have been found to both encourage and discourage the performance of self-examination (Girgis et al., 1991; Friedman et al., 1993; Balanda et al., 1994; Robinson et al., 1998; Oliveria et al., 1999b). Elderly patients have a lower rate of detection compared to younger people and are more likely to be diagnosed with thicker tumours which have a poorer prognosis (Roder et al., 1995). This may result from a failure to identify changes to melanoma more often than younger patients (Hanrahan et al., 1998) or as a result of a less frequent inspection of their skin compared to younger people.

Surprisingly, Miller et al. (1996) found that elderly patients are more likely to do selfexaminations. In primary disease, patients with a low median educational attainment are more likely to present later, whilst those from more affluent areas generally have thinner melanomas at the time of detection (Bonett et al., 1989; Roder et al., 1995). Patients with melanoma with a lower socioeconomic status are more likely to die of their disease (Vagero and Persson, 1984). Lower socioeconomic status has also been associated with less knowledge and awareness of melanoma. Research by Koh et al. (1996) confirms the importance of having a spouse in detecting many primary melanomas. In their study, a spouse was the third most common person (after the index patient and a physician) to detect a melanoma. Having a spouse or partner may provide encouragement or help to carry out the procedure (Brady et al., 2000). This may be especially important when examining inaccessible areas since it has been reported that melanoma arising on more visible body areas are more likely to be diagnosed at an early stage (Hemo et al., 1999). Higher rates of self-examination have been found in those married or cohabitating (Balanda et al., 1994).