Funding sources This study was supported by a grant from the Ligue Contre le Cancer.
EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH
The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France
Article first published online: 20 NOV 2012
© 2012 The Authors. BJD © 2012 British Association of Dermatologists
British Journal of Dermatology
Volume 167, Issue 6, pages 1351–1359, December 2012
How to Cite
Grange, F., Barbe, C., Mas, L., Granel-Brocard, F., Lipsker, D., Aubin, F., Velten, M., Dalac, S., Truchetet, F., Michel, C., Mitschler, A., Arnoult, G., Buemi, A., Dalle, S., Reuter, G., Bernard, P., Woronoff, A.S. and Arnold, F. (2012), The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France. British Journal of Dermatology, 167: 1351–1359. doi: 10.1111/j.1365-2133.2012.11178.x
Conflicts of interest None declared.
- Issue published online: 26 NOV 2012
- Article first published online: 20 NOV 2012
- Accepted manuscript online: 26 JUL 2012 11:45PM EST
- Accepted for publication 20 July 2012
Background Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma.
Objectives To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants.
Materials and 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.