title: The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France.
abstract: BACKGROUND
  Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma.
  
  
  OBJECTIVE
  To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants.
  
  
  METHODS
  A survey of cancer registries and pathology laboratories, and questionnaires to practitioners were used to identify incident melanomas in 2008, and evaluate characteristics of patients (age, sex, area of residence, social isolation), tumours (Breslow, ulceration, location, histological type), and GPs (training, conditions of practice), and their influence on patterns of diagnosis and Breslow thickness.
  
  
  RESULTS
  Among 898 melanomas, 376 (42%) were first diagnosed in a general practice setting (GP group). Breslow thickness was much higher in the GP group than in other melanomas (median: 0·95 vs. 0·61 mm, P < 0·0001). Multivariate analysis identified an older age, lower limb location, nodular subtype and Breslow thickness as factors associated with the GP group. Within this group, 52·5% of melanomas were detected by patients (median Breslow thickness: 1·30 mm) and 47·5% by GPs (median Breslow thickness: 0·80 mm, P = 0·0009), including 8% during a systematic full-body skin examination. Previous GP training on melanoma was associated with active detection by GPs. Male sex and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CMs.
  
  
  CONCLUSIONS
  GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumours. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma.
authors: Service de Dermatologie, Hôpital Robert Debré, Université de Reims-Champagne-Ardenne, avenue du général Koenig, 51092 Reims Cedex, France. fgrange@chu-reims.fr
authors: F
authors: F
authors: Grange
authors: C
authors: C
authors: Barbe
authors: L
authors: L
authors: Mas
authors: F
authors: F
authors: Granel-Brocard
authors: D
authors: D
authors: Lipsker
authors: F
authors: F
authors: Aubin
authors: M
authors: M
authors: Velten
authors: S
authors: S
authors: Dalac
authors: F
authors: F
authors: Truchetet
authors: C
authors: C
authors: Michel
authors: A
authors: A
authors: Mitschler
authors: G
authors: G
authors: Arnoult
authors: A
authors: A
authors: Buemi
authors: S
authors: S
authors: Dalle
authors: G
authors: G
authors: Reuter
authors: P
authors: P
authors: Bernard
authors: A S
authors: AS
authors: Woronoff
authors: F
authors: F
authors: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D010819:Physician's Role; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult