title: Proposal for an annual skin examination by a general practitioner for patients at high risk for melanoma: a French cohort study.
abstract: OBJECTIVE
  To evaluate the efficacy of a targeted screening for melanoma in high-risk patients following the receipt of a mailed invitation to an annual skin examination by a general practitioner (GP).
  
  
  METHODS
  A prospective cohort study was conducted in a primary care setting in western France. A total of 3897 patients at elevated risk of melanoma (identified using the Self-Assessment of Melanoma Risk Score) consented to participate in a targeted melanoma screening project in 2011. One year later, the participants were invited by mail to consult their GP for an annual skin examination. Efficacy of the procedure was evaluated according to patient participation and the number of melanomas detected. The consultation dates and results were collected during the 12 months postreminder and were analysed using SAS. Analyses of whether participation decreased compared with that during the year of inclusion and whether populations at risk for thick melanoma showed reduced participation in the screening were performed.
  
  
  RESULTS
  Of the 3745 patients who received the mailed invitation, 61% underwent a skin examination. The participation of patients at risk for thick melanoma (any patient over 60 years of age and men over 50 years of age) was significantly greater than that of the patients in the other subgroups (72.4% vs 49.6%, p<0.001; and 66% vs 52.4%, p<0.001, respectively). The patients referred to the dermatologist after 1 year were more compliant compared with those referred during the first year (68.8% vs 59.1%, p=0.003). Six melanomas were detected within 1 year postreminder; therefore, the incidence of melanoma in the study population was 160/100 000.
  
  
  CONCLUSIONS
  This study confirms the benefits of developing a targeted screening strategy in primary care. In particular, after the annual reminder, patient participation and the diagnosis of melanoma remained high in the patients at elevated risk of thick melanomas.
  
  
  BACKGROUND
  NCT01610531.
authors.affiliation: Department of General Practice, Faculty of Medicine, Nantes, France French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)-Team 2, Nantes, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Rat
authors.affiliation: Department of General Practice, Faculty of Medicine, Nantes, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Grimault
authors.affiliation: French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)-Team 2, Nantes, France Oncodermatology Department, Nantes University Hospital, Nantes, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Quereux
authors.affiliation: Department of General Practice, Faculty of Medicine, Nantes, France.
authors.forename: Maelenn
authors.initials: M
authors.lastname: Dagorne
authors.affiliation: Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Gaultier
authors.affiliation: French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)-Team 2, Nantes, France Oncodermatology Department, Nantes University Hospital, Nantes, France.
authors.forename: Amir
authors.initials: A
authors.lastname: Khammari
authors.affiliation: French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)-Team 2, Nantes, France Oncodermatology Department, Nantes University Hospital, Nantes, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Dreno
authors.affiliation: French National Institute of Health and Medical Research (INSERM U892)/National Centre for Scientific Research (CNRS U6299)-Team 2, Nantes, France Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005602:France; D058006:General Practice / Q000379:methods*; D058005:General Practitioners; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D010349:Patient Compliance; D010358:Patient Participation; D010808:Physical Examination / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000175:diagnosis*
keywords: PREVENTIVE MEDICINE; PRIMARY CARE; PUBLIC HEALTH