title: Melanoma incidence and patient compliance in a targeted melanoma screening intervention. One-year follow-up in a large French cohort of high-risk patients.
abstract: BACKGROUND
  Early diagnosis of melanoma can save lives. However, mass screening is not recommended, and few studies have addressed targeted screening.
  
  
  OBJECTIVE
  To evaluate a targeted melanoma screening intervention by measuring the cumulative melanoma incidence and patient compliance with the screening.
  
  
  METHODS
  This was a prospective one-year follow-up of a cohort of 3923 French patients at elevated risk of melanoma who were recruited from April to October 2011 by 78 GPs using the Self-assessment of melanoma risk score. Following standard practice, based on the GPs' opinions, a subset of these patients was referred to dermatologists. The dermatologists scheduled excisions when required. Melanomas were confirmed using pathology reports. Patient compliance with the clinical pathway was assessed retrospectively. The cohort was followed prospectively using three data sources (GPs, dermatologists and patients). Analyses of factors associated with compliance were performed using multiple logistic regression.
  
  
  RESULTS
  GPs examined the skin of 3923 high-risk patients, 1506 of whom were referred to dermatologists. Nine cases of melanoma were diagnosed, corresponding to a cumulative incidence of 229.4/100,000. Of the referred patients, 57.9% attended the dermatologist consultation. Patient attendance was better when the GPs provided a dermatologist's name (OR = 2.15, 95% CI: 1.51-3.09). A delay before consulting a dermatologist was inversely associated with the estimated lesion malignancy.
  
  
  CONCLUSIONS
  Performing this targeted screening in a high-risk population resulted in a high melanoma detection rate, despite moderate compliance. Observations suggest that naming a dermatologist is a simple, inexpensive means of increasing patient compliance with the screening.
authors.affiliation: Department of General Practice, Faculty of Medicine , Nantes , France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rat
authors.forename: Gaelle
authors.initials: G
authors.lastname: Quereux
authors.forename: Charlotte
authors.initials: C
authors.lastname: Grimault
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gaultier
authors.forename: Amir
authors.initials: A
authors.lastname: Khammari
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dreno
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
keywords: Melanoma; early detection of cancer; patient compliance; primary health care; screening