Targeted melanoma prevention intervention: a cluster randomized controlled trial.
OBJECTIVE
Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior.


METHODS
We conducted a pilot clustered randomized controlled trial, comparing a targeted screening and education intervention with a conventional information-based campaign in 20 private surgeries in western France. In the intervention group, 10 general practitioners identified patients at elevated risk for melanoma with a validated assessment tool, the Self-Assessment Melanoma Risk Score (SAMScore), examined their skin, and counseled them using information leaflets. In the control group, 10 general practitioners displayed a poster and the leaflets in their waiting room and examined patients' skin at their own discretion. The main outcome measures were sunbathing and skin self-examinations among patients at elevated risk, assessed 5 months later with a questionnaire.


RESULTS
Analyses were based on 173 patients. Compared with control patients, intervention patients were more likely to remember the campaign (81.4% vs 50.0%, P = .0001) and to correctly identify their elevated risk of melanoma (71.1% vs 42.1%, P = .001). Furthermore, intervention patients had higher levels of prevention behaviors: they were less likely to sunbathe in the summer (24.7% vs 40.8%, P = .048) and more likely to have performed skin self-examinations in the past year (52.6% vs 36.8%, P = .029). The intervention was not associated with any clear adverse effects, although there were trends whereby intervention patients were more likely to worry about melanoma and to consult their general practitioner again about the disease.


CONCLUSIONS
The combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk. Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research.
Department of General Practice, Faculty of Medicine of Nantes, France.
Cédric
C
Rat
Gaelle
G
Quereux
Christelle
C
Riviere
Sophie
S
Clouet
Rémy
R
Senand
Christelle
C
Volteau
Brigitte
B
Dreno
Jean-Michel
JM
Nguyen
D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005602:France; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000517:prevention & control*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D018570:Risk Assessment; D016353:Self-Examination / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D055108:Sunbathing / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
behavior change; health behavior; melanoma; practice-based research; prevention; randomized trial; screening, primary care