Study proposes annual GP skin exam for patients at high risk for melanoma

August 13, 2015

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.

Strengths and limitations of this study

  • The study was conducted in a primary care setting.
  • The participants were patients at elevated risk of melanoma who were recruited using a validated and reproducible procedure based on the Self-Assessment of Melanoma Risk Score.
  • Six months after receiving an annual reminder to consult their general practitioner for a targeted screening for melanoma, 61% of the patients underwent a skin examination.
  • The participation of patients at risk for thick melanoma was significantly above average.
  • Six melanomas were detected. These results yielded a crude melanoma incidence of 160/100 000 in the cohort population and 469/100 000 in the men older than 50.

Source:

Rat, C, et al. Proposal for an annual skin examination by a general practitioner for patients at high risk for melanoma: a French cohort study. BMJ Open 2015;5:e007471 doi:10.1136/bmjopen-2014-007471 http://bmjopen.bmj.com/content/5/7/e007471.full


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