The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France.
Résumé
Background Little data is available concerning the role of general practitioners (GPs) in 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. Method 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, rurality, social isolation), tumors (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, the 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. The male gender and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CM. Conclusion GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumors. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma.