Toward a new place for dermatologists in the diagnosis of melanoma in France?

Efficacy of a general practitioner training campaign for early detection of melanoma in France

“…most Americans do not have a dermatologist, few of them are screened for melanoma, most of them make frequent visits to their GP, most patients with melanoma have seen a physician in the year before diagnosis, many melanomas are not easily visible to patients), all are transposable to the French population and probably also to the populations of many developed countries. In France, a country counting 64 million inhabitants, 3400 dermatologists and 101 500 GPs at the beginning of the century, we recently brought to light an important decline in dermatologists as first medical caregivers to patients with melanoma between the years 2004 and 2008 . This may be explained both by an annual reduction in the number of dermatologists of about 6% since 2002, and by the modification of French legislation in 2004 which limited direct access to specialists, including dermatologists, and encouraged patients first to consult their referent GP .…”

“…These preliminary data provide a rationale for a larger campaign targeting GPs in France. They also lead to reconsidering the respective role of GPs and dermatologists, taking into account the recent and future abrupt decline in the number of dermatologists . GPs could act more widely as first medical caregivers to patients presenting with suspicious skin lesions, with dermatologists as trainers for GPs and second‐line experts.…”

“…In France, a country counting 64 million inhabitants, 3400 dermatologists and 101 500 GPs at the beginning of the century, 18 we recently brought to light an important decline in dermatologists as first medical caregivers to patients with melanoma between the years 2004 and 2008. 12,16 This may be explained both by an annual reduction in the number of dermatologists of about 6% since 2002, 18 and by the modification of French legislation in 2004 which limited direct access to specialists, including dermatologists, and encouraged patients first to consult their referent GP. 12,16,18 As reported by other authors, [32][33][34] we observed that melanoma diagnosed in a GP setting were much thicker than those diagnosed in other healthcare settings (particularly by dermatologists).…”

“…In more recent population‐based studies in six regions of France, we found that the percentage of melanomas diagnosed in a GP setting had increased from 26% in 2004 to 42% in 2008, but that GPs still frequently detected very thick melanomas (VTM) . In addition, thinner melanomas were detected by GPs who were used to performing active detection and had been specifically trained …”

“…16,17 In addition, thinner melanomas were detected by GPs who were used to performing active detection and had been specifically trained. 16,18 This prompted us to organize and evaluate a GP training campaign for the early detection of melanoma in one of these six regions (i.e. Champagne-Ardenne).…”