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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Figure 1
Questionnaire used for the Self-Assessment of Melanoma Risk Score (SAMScore).¹⁸

Note: According to the SAMScore, a patient is considered at elevated risk for melanoma if at least 1 of these 3 criteria is verified: (1) The patients has at least 3 risk factors among the following 7 risk factors: phototype I or II, freckling tendency, more than 20 melanocytic nevi on the arms, severe sunburn during childhood or teenage years, life in a country at low latitude, a history of previous melanoma, and a history of melanoma in a first-degree relative, (2) The patient is younger than 60 years of age and has more than 20 melanocytic nevi on the arms, (3) The patient is aged 60 years or older and has a freckling tendency.
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Figure 2
Flow diagram of the trial.

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Table 1

Patient Memory of the Melanoma Education Campaign

Measure	Intervention Group (n = 97)	Control Group (n = 76)	Covariance Cluster Effect Estimates	Covariance SD	Unadjusted P Value	Adjusted P Value^a
Remembered the poster in the waiting room, No. (%) [95% CI]	79 (81.4) [72.3–88.6]	38 (50.0) [38.3–61.7]	−0.003	0.027	.0001	.0001
Consulted the leaflets in the waiting room, No. (%) [95% CI]	62 (63.9) [53.5–73.4]	24 (31.6) [21.4–43.3]	−0.016	0.029	.0004	.0005

↵a Multivariate model adjusted for age, sex, and education level.

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Table 2

Patient Knowledge of Personal Risk of Melanoma and of Melanoma Risk Factors

Measure	Intervention Group (n = 97)	Control Group (n = 76)	Covariance Cluster Effect Estimates	Covariance SD	Unadjusted P Value	Adjusted P Value^a
Correctly knew they had an elevated risk of melanoma, No. (%) [95% CI]	69 (71.1) [61.1–79.9]	32 (42.1) [30.9–54.0]	−0.010	0.038	.001	.002
Correctly identified melanoma risk factors, No. (%) [95% CI]
Having >20 moles on the 2 arms	76 (78.4) [68.8–86.1]	48 (63.2) [51.3–73.9]	0.002	0.045	.045	.085
Having freckles	62 (63.9) [53.5–73.4]	34 (44.7) [33.3–56.6]	−0.016	0.033	.017	.038
Having phototype 1 or 2	90 (92.8) [85.7–97.1]	55 (72.4) [60.9–82.0]	−0.003	0.039	.003	.005
Having been sunburned during childhood	90 (92.8) [85.7–97.1]	61 (80.3) [69.5–88.5]	−0.030	0.025	.011	.053
Having lived for more than a year in a country with strong sunshine	77 (79.4) [70.0–86.9]	58 (76.3) [65.2–85.3]	0.011	0.048	.65	.97
Having a family history of melanoma	62 (63.9) [53.5–73.4]	32 (42.1) [30.9–54.0]	−0.006	0.034	.01	.006
Overall knowledge score,^b mean (SD)	4.71 (1.33)	3.79 (1.50)	1.47 e^−08c	0.0001	.007	.002

↵a Multivariate model adjusted for age, sex, and education level.
↵b Possible scores ranged from 0 to 6, with higher scores indicating greater knowledge.
c Mixed model.

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Table 3

Patient Report of Primary and Secondary Melanoma Prevention Behaviors

Behavior	Intervention Group (n = 97)	Control Group (n = 76)	Covariance Cluster Effect Estimates	Covariance SD	Unadjusted P Value	Adjusted P Value^a
Sunbathed in past year, No. (%) [95% CI]	24 (24.7) [16.5–34.5]	31 (40.8) [29.7–52.7]	0.020	0.043	.048	.040
Took protective actions during the most recent exposure, No. (%) [95% CI]	65 (67.0) [56.7–76.2]	42 (55.3) [43.4–66.7]	−0.065	0.018	.079	.060
Had a session in tanning bed, No. (%) [95% CI]	10 (10.3) [5.1–18.1]	5 (6.6) [2.2–14.7]	−0.057	NA	.21	.069
Sustained a sunburn in the past summer, No. (%) [95% CI]	26 (26.8) [18.3–36.8]	23 (30.3) [20.3–41.9]	0.018	0.044	.65	.42
Performed a skin self-examination in the past 12 months, No. (%) [95% CI]	51 (52.6) [42.2–62.8]	28 (36.8) [26.1–48.7]	−0.036	0.025	.029	.020
Used a mirror or person to assist with skin self-examination, No. (%) [95% CI]	73 (75.3) [65.5–83.5]	52 (68.4) [56.7–78.6]	0.057	0.12	.51	.47
Took a photograph for skin self-examination, No. (%) [95% CI]	8 (8.3) [3.6–15.6]	5 (6.6) [2.2–14.7]	−0.017	NA	.51	.62
Reported feeling able to detect a change in a mole, No. (%) [95% CI]	68 (70.1) [60.0–79.0]	41 (54.0) [42.1–65.5]	0.057	0.064	.023	.14

NA = not applicable.
↵a Multivariate model adjusted for age, sex, and education level.

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Supplemental Appendix

Supplemental Appendix. Telephone Questionnaire Assessing Patient Memory of the Campaign, Patient Knowledge of the Risk of Melanoma, and Patient Primary and Secondary Preventive Behaviors

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The Article in Brief

Targeted Melanoma Prevention Intervention: A Cluster Randomized Controlled Trial

Cedric Rat , and colleagues

Background Giving patients personalized information about whether or not they are at increased risk for melanoma could affect their perception of the risk. The Self-Assessment Melanoma Risk Score (SAMScore) provides such information. This study compares the effect of a targeted screening and education strategy using the SAMScore on patient prevention behavior with that of a conventional prevention campaign based on mass communication.

What This Study Found A targeted intervention to reduce risk and increase early detection of melanoma using the SAMSScore screening tool appears to be efficient and effective. Patients were randomized to either an intervention group, which was assessed using the SAMScore tool and underwent a total skin examination and counseling using information leaflets; or a control group, whose physicians displayed a poster and leaflets in their waiting room and examined patients' skin at their own discretion. Compared with control patients, intervention patients were more likely to remember the campaign and correctly identify their increased risk of melanoma. Intervention patients also had higher levels of prevention behaviors: they were less likely to sunbathe in summer and more likely to have performed skin self-examinations in the past year.

Implications

The combination use of the SAMScore and physician examination and counseling during consultations appears to be an efficient way to promote patient behaviors that may reduce melanoma risk.