Identifying people at higher risk of melanoma across the U.K.: a primary-care-based electronic survey

Abstract

SummaryBackground Melanoma incidence is rising rapidly worldwide among white populations. Defining higher-risk populations using risk prediction models may help targeted screening and early detection approaches. Objectives To assess the feasibility of identifying people at higher risk of melanoma using the Williams self-assessed clinical risk estimation model in U.K. primary care. Methods We recruited participants from the waiting rooms of 22 general practices covering a total population of > 240 000 in three U.K. regions: Eastern England, North East Scotland and North Wales. Participants completed an electronic questionnaire using tablet computers. The main outcome was the mean melanoma risk score using the Williams melanoma risk model. Results Of 9004 people approached, 7742 (86%) completed the electronic questionnaire. The mean melanoma risk score for the 7566 eligible participants was 17Á15 AE 8Á51, with small regional differences [lower in England compared with Scotland (P = 0Á001) and Wales (P < 0Á001), mainly due to greater freckling and childhood sunburn among Scottish and Welsh participants]. After weighting to the age and sex distribution, different potential cut-offs would allow between 4% and 20% of the population to be identified as higher risk, and those groups would contain 30% and 60%, respectively of those likely to develop melanoma. Conclusions Collecting data on the melanoma risk profile of the general population in U.K. primary care is both feasible and acceptable for patients in a general practice setting, and provides opportunities for new methods of real-time risk assessment and risk stratified cancer interventions.

Protocol for the melatools skin self-monitoring trial: a phase II randomised controlled trial of an intervention for primary care patients at higher risk of melanoma

“…Eligible participants are individuals aged between 18 and 75 years who own a smartphone (Apple or Android), and, on completion of the Melatools-Q risk assessment tool, 21 are found to be at increased risk of melanoma. Participants are able to read and write English and to give informed consent.…”

“…The MelaTools-Q Study findings have already been reported. 21 Briefly, 7742 patients (86% of those approached) were recruited from the waiting rooms of 22 general practices in three UK regions: Eastern England, Northeast Scotland and North Wales. Using tablet computers, they completed an electronic questionnaire incorporating the Williams melanoma risk prediction model, 22 including items relating to seven risk factors: gender, age, natural hair colour at age 15, number of severe sunburns aged 2–18, prior non-melanoma skin cancer, number of raised moles on both arms and density of freckles on both arms before age 20.…”

“…People were also recruited in the waiting rooms of two suburban general practices and completed the Melatools-Q risk assessment tool. 21 Five identified to be at increased risk of melanoma were invited to participate in two other focus groups. A total of 16 participants tested at least one of the SSM Apps.…”

Effect of a Skin Self-monitoring Smartphone Application on Time to Physician Consultation Among Patients With Possible Melanoma

“…We collected information on sociodemographic and clinical variables as follows: age, sex, marital status, postcode, highest educational level, occupation, history of skin cancer, skin and hair type, and number of raised moles on both arms at baseline. 21,23 The coprimary clinical outcomes of this trial Downloaded From: https://jamanetwork.com/ on 07/03/2020 were as follows: (1) family practice consultation rates and (2) patient interval (ie, time between first noticing a change and consultation 24 ) for any skin changes or pigmented skin lesions. Data on consultations in the year before the trial and for 12 months after the trial consultation were collected through audits of general practitioner medical records.…”

Progress in the diagnosis and therapy of melanoma

“…To identify high‐risk patients efficiently, Usher‐Smith et al . approached more than 9000 patients in the waiting rooms of general practitioners in Great Britain.…”