Proposal for an annual skin examination by a general practitioner for patients at high risk for melanoma: a French cohort study

Cédric Rat, Charlotte Grimault, Gaelle Quereux, Maelenn Dagorne, Aurélie Gaultier, Amir Khammari, Brigitte Dreno, Jean-Michel Nguyen, Cédric Rat, Charlotte Grimault, Gaelle Quereux, Maelenn Dagorne, Aurélie Gaultier, Amir Khammari, Brigitte Dreno, Jean-Michel Nguyen

Abstract

Objective: To evaluate the efficacy of a targeted screening for melanoma in high-risk patients following the receipt of a mailed invitation to an annual skin examination by a general practitioner (GP).

Methods: A prospective cohort study was conducted in a primary care setting in western France. A total of 3897 patients at elevated risk of melanoma (identified using the Self-Assessment of Melanoma Risk Score) consented to participate in a targeted melanoma screening project in 2011. One year later, the participants were invited by mail to consult their GP for an annual skin examination. Efficacy of the procedure was evaluated according to patient participation and the number of melanomas detected. The consultation dates and results were collected during the 12 months postreminder and were analysed using SAS. Analyses of whether participation decreased compared with that during the year of inclusion and whether populations at risk for thick melanoma showed reduced participation in the screening were performed.

Results: Of the 3745 patients who received the mailed invitation, 61% underwent a skin examination. The participation of patients at risk for thick melanoma (any patient over 60 years of age and men over 50 years of age) was significantly greater than that of the patients in the other subgroups (72.4% vs 49.6%, p<0.001; and 66% vs 52.4%, p<0.001, respectively). The patients referred to the dermatologist after 1 year were more compliant compared with those referred during the first year (68.8% vs 59.1%, p=0.003). Six melanomas were detected within 1 year postreminder; therefore, the incidence of melanoma in the study population was 160/100 000.

Conclusions: This study confirms the benefits of developing a targeted screening strategy in primary care. In particular, after the annual reminder, patient participation and the diagnosis of melanoma remained high in the patients at elevated risk of thick melanomas.

Trial registration number: NCT01610531.

Keywords: PREVENTIVE MEDICINE; PRIMARY CARE; PUBLIC HEALTH.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Questionnaire used for the Self-Assessment of Melanoma Risk Score.
Figure 2
Figure 2
Participation among patients at elevated risk of melanoma at 6 months after a mailed reminder for an annual general practitioner skin examination.
Figure 3
Figure 3
Participation in skin examinations by general practitioners and dermatologists among patients at elevated risk of melanoma based on a 2-year follow-up.

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