Targeted Melanoma Prevention Intervention: A Cluster Randomized Controlled Trial

Cédric Rat; Gaelle Quereux; Christelle Riviere; Sophie Clouet; Rémy Senand; Christelle Volteau; Brigitte Dreno; Jean-Michel Nguyen

doi:10.1370/afm.1600

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Melanoma screening
Olivier Saint-Lary

Published on: 21 March 2014
Targeted screening and prevention promotion by GP's could be more efficient than lesion detection training
Juliette Chambe

Published on: 06 March 2014
Improve melanoma detection and its prevention
Isabelle Auger-Aubin

Published on: 06 March 2014

Published on: (21 March 2014)
Page navigation anchor for Melanoma screening
Melanoma screening
Olivier Saint-Lary, Senior Lecturer
This paper provides interesting tools in order to improve melanoma prevention. It is particularly worthwhile that the combination of use of the SAMScore and general practitioner examination and counseling during consultations was validated as an efficient way to promote patient behaviors that may reduce melanoma risk. This is specifically notable in the area of sun tanning, were behaviors are strongly linked to anthropo...
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This paper provides interesting tools in order to improve melanoma prevention. It is particularly worthwhile that the combination of use of the SAMScore and general practitioner examination and counseling during consultations was validated as an efficient way to promote patient behaviors that may reduce melanoma risk. This is specifically notable in the area of sun tanning, were behaviors are strongly linked to anthropological and sociological factors. [1]
However, given the low incidence (10.9/100 000) of melanoma in France, [2] Health authorities did not estimate that this cancer should enter in a mass screening program. [3]
This work provides new evidence in the debate and might give a central place for the GPs. Demonstrating an impact on morbidity and mortality of use of the SAMScore and general practitioner examination and counseling is now the next step in order to implement this tool in GPs' practice.
1. Andrieu B. Bronzage: une petite histoire du soleil et de la peau. Paris: CNRS ed.; 2008.
2. Institut National Du Cancer. Epidemiologie du melanome cutane en France metropolitaine - Incidence. 2013. Available at: https://lesdonnees.e-cancer.fr/les-fiches-de-synthese/29-incidence-mortalite/37-melanomes-cutanes/50-epidemiologie-du-melanome-cutane-en-france-metropolitaine-incidence.html#ind5 . Accessed March 7, 2014.
3. HAS Sante. Rapport de Strategie de diagnostic precoce du melanome. 2006. Available at: http://www.has-sante.fr/portail/upload/docs/application/pdf/rapport_strategie_de_diagnostic_precoce_du_melanome.pdf . Accessed March 7, 2014.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (6 March 2014)
Page navigation anchor for Targeted screening and prevention promotion by GP's could be more efficient than lesion detection training
Targeted screening and prevention promotion by GP's could be more efficient than lesion detection training
Juliette Chambe, Medical Doctor
Other Contributors:
Targeted prevention for melanoma seems to be a valuable method to reduce incidence and to improve prognosis. The article by Rat and colleagues show it to be both feasible and efficient. First, they used a short scale, SAMSscore, one of the best-validated methods for detection of high-risk patients(1). This study indicated that it was easily used in everyday practice for general practitioners (GP). Second, they tested the...
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Targeted prevention for melanoma seems to be a valuable method to reduce incidence and to improve prognosis. The article by Rat and colleagues show it to be both feasible and efficient. First, they used a short scale, SAMSscore, one of the best-validated methods for detection of high-risk patients(1). This study indicated that it was easily used in everyday practice for general practitioners (GP). Second, they tested the effect of the prevention by skin examination and counseling on sun exposure on the identified high-risk patients. This was both efficient, and feasible on this targeted population, within the time given for consultation.
The estimated incidence of melanoma in France was 11 176 cases in 2012 (8.9/100 000), and a mortality rate of 1672, indicating that each GP will likely see less than one melanoma per year. Thus, we could conclude that this does not represent a major issue in primary care. However, improvement in prevention and early detection is important, as it directly impacts the mortality of this cancer. Additionally, in most cases the GP is the patients' first contact with the health care system.
Previous studies concerning melanoma evolution pointed to the fact that delays in care management are the major issues impeding prognosis of melanoma. This point concerns both patients' and GPs' awareness(2,3). Identification of risk population, and regular cutaneous examination are critical for reducing delays in the diagnosis. Systematic, yearly examinations by GPs are more effective than trying to increase their diagnostic performance.
Prevention of sun exposure is the second way to reduce incidence, though the current multimedia campaign has had a low impact on behavior(4). Therefore, health professionals have an important role in the population awareness.
Most studies have evaluated only short-term efficiency. Long-term efficiency should be improved by the repetition of this kind of intervention in primary care. GPs have a role in many screening and prevention policies; it seems unrealistic that they consider skin cancers during the whole year. For the past 16 years a "National prevention and screening skin cancer and melanoma day" has been organized in France before the summer holidays. A targeted, opportunist screening in GP offices could improve this campaign. Moreover, full-body skin examination is perceived as a barrier for the screening(5). The season of this campaign could help, as it is easier to ask patients to get undressed at this period of year than, for example, in winter.
1. Vuong K, McGeechan K, Armstrong BK, Cust AE. Risk prediction models for incident primary cutaneous melanoma: A systematic review. JAMA Dermatol 2014 epub: http://dx.doi.org/10.1001/jamadermatol.2013.8890
2. Richard MA, Grob JJ, Avril MF, Delaunay M, Gouvernet J, Wolkenstein P, et al. Delays in diagnosis and melanoma prognosis (I): the role of patients. Int J Cancer J Int Cancer. 2000;89(3):271-279.
3. Grange F, Barbe C, Mas L, Granel-Brocard F, Lipsker D, Aubin F, et al. The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France. Br J Dermatol. 2012;167(6):1351-1359.
4. Kiekbusch S, Hannich HJ, Isacsson A, Johannisson A, Lindholm LH, Sager E, et al. Impact of a cancer education multimedia device on public knowledge, attitudes, and behaviors: a controlled intervention study in Southern Sweden. J Cancer Educ Off J Am Assoc Cancer Educ. 2000;15(4):232-236.
5. Oliveria SA, Heneghan MK, Cushman LF, Ughetta EA, Halpern AC. Skin cancer screening by dermatologists, family practitioners, and internists: Barriers and facilitating factors. Arch Dermatol. 2011;147(1):39-44.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (6 March 2014)
Page navigation anchor for Improve melanoma detection and its prevention
Improve melanoma detection and its prevention
Isabelle Auger-Aubin, Professor
This article provides relevant tools to improve melanoma detection and its prevention. A complex intervention was carried out by general practitioners (GPs). They detected patients with risk factors, performed skin examinations, gave advice and delivered printed information on prevention. This highlights the different steps when screening for cancer.
The first step is at the GPs level. The GPs' ability to implemen...
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This article provides relevant tools to improve melanoma detection and its prevention. A complex intervention was carried out by general practitioners (GPs). They detected patients with risk factors, performed skin examinations, gave advice and delivered printed information on prevention. This highlights the different steps when screening for cancer.
The first step is at the GPs level. The GPs' ability to implement prevention is very important because it is not so easy to deal with prevention in daily practice. The second step is at the patient's level. Improving patients given knowledge and attitudes is another challenge. We already know that for all screening, providers' recommendations strongly influence patient's screening behavior. It includes primary prevention with specific advice for sunbathing, sunbed and "always tanned skins" and also secondary prevention after a first cutaneous cancer.
Managing multiple complaints can be a real obstacle to preventive care. On the other hand, a patient with no particular demands can be reticent to discuss certain issues. Using patient centered care models can help the GP to overcome this problem and find common ground more easily (1).
Because of high costs and low prevalence, mass screening for melanoma appeared inefficient (2). A key issue is to identify people at high risk of melanoma. The recent French recommendation remained unclear on this subject (3). The SAMScore appeared to be useful to target high risk population. This self-assessment score showed efficiency (lead to screen patients 11 times fewer than with a non-targeted screening) (4). It could be useful to spread it to all primary care stakeholders including nurses, or pharmacists.
It is important to organize better access to secondary care as French dermatologists often charge over the standard fee. Thus, those objectives need the participation of healthcare authorities and Media to spread information to organize healthcare pathways.
(1)Stewart M, Brown J, Weston W, McWhinney I, McWilliam C, Freeman T: Patient-Centered Medicine: transforming the clinical method. 2nd edn. Abingdon: Radcliffe Medical Press; 2003.
(2) Harbauer A, Binder M, Pehamberger H, Wolff K, Kittler H. Validity of an unsupervised self-administered questionnaire for self-assessment of melanoma risk. Melanoma Res. 2003;13:537-42.
(3) http://www.has-sante.fr/portail/jcms/c_1354947/fr/actualisation-de-la- revue-de-la-litterature-dune-recommandation-en-sante-publique-sur-la- detection-precoce-du-melanome-cutane?xtmc=&xtcr=1
(4)Quereux G, N'guyen JM, Cary M, Jumbou O, Lequeux Y, Dreno B. Validation of the Self-Assessment of Melanoma Risk Score for a melanoma-targeted screening. Eur J Cancer Prev. 2012;21:588-95.
Competing interests: None declared
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Competing Interests: None declared.