Melanoma is nowadays a major public health problem because of its increasing incidence. Targeted screening for patients at a high risk for melanoma is being promoted. The aim of our study was to assess the effectiveness of a targeted screening on the basis of the self-selection of high-risk individuals with the Self-Assessment of Melanoma Risk Score (SAMScore). Our main objective was to prove that this score allows the selection of a group of patients who are at a higher risk and in whom more melanomas may be detected. This prospective study was carried out in France in 2009. Consecutive patients, while visiting their doctor's office, filled out a melanoma risk factor questionnaire. Patients were assessed as being at high risk or not according to the SAMScore, and patients at a high risk were examined both by their general practitioner and by a dermatologist. The efficiency of the selection tool corresponded to the ratio of the prevalence of melanoma in a population selected with the SAMScore to the prevalence in the general population. A logistic model with a random effect was used. A total of 7977 patients filled out the questionnaire. Among the 2404 patients at high risk, histologically proven melanoma was screened in 10 cases: two in-situ and eight invasive melanomas. The SAMScore efficiency assessed was equal to 11.54 (P=0.0016). In conclusion, in this strategy, to detect a new case of melanoma, it is necessary to screen 11 times fewer patients than with a nontargeted screening. This is the first study to confirm the efficiency of a targeted screening on the basis of self-selection of high-risk individuals.

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Almost forty years ago, Starling (1) measured the osmotic pressure of serum protein and showed that exchanges of fluid between the blood plasma and interstitial spaces could be explained by the diminiution of the capillary hydrostatic pressure of blood in passing from the arteries to the veins and the osmotic pressure of the proteins. Krogh (2) has elaborated this idea and given more precise measurements of the factors governing the physiology of the capillaries.Clinical application of the physiological principles involving exchange of water across the capillaries has been surprisingly slow. Starling's conception of the exchange of water between the blood and interstitial spaces would seem to have occurred to Bright (3) and some such idea was definitely proposed by Sabatier (4) and Solon (5) about a hundred years ago. Although many writers seem to have appreciated the physiological rOle of serum proteins until the end of the nineteenth century, for a time their function was forgotten. However, Epstein (6) seems to have been the first to emphasize that edema of nephritis and nephrosis could be explained by the low serum protein concentration. Govaerts (7), Schade and Claussen (8), v. Farkas (9) and others have made numerious measurements of the osmotic pressure of serum proteins and have shown that edema in renal disease is regularly accompanied by low serum protein concentration and low colloidal osmotic (oncotic) pressure, while in edema of heart disease not accompanied by proteinuria there is usually a high venous pressure.

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