Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score

BMJ 1998;316:34-38 (3 January)

General practice

Can primary prevention or selective screening for melanoma be more precisely targeted through general practice? A prospective study to validate a self administered risk score

Arthur Jackson, general practitioner,^a Clare Wilkinson, senior lecturer in general practice,^a Margaret Ranger, research assistant,^a Roisin Pill, professor of research in general practice,^a Paul August, consultant dermatologist ^b

^a Department of General Practice, Maelfa Health Centre, Llanedeyrn, Cardiff CF3 7PN, ^b Department of Dermatology, Leighton Hospital, Crewe CW1 4QJ

Correspondence to: Dr Jackson Holmes Chapel Health Centre, London Road, Holmes Chapel, Cheshire CW4 7BB 100131.1162@compuserve.com

Objectives: To establish whether a questionnaire incorporatingMacKie's risk factor flow chart can identify patients at highrisk for melanoma so that they can be targeted for primary andsecondary prevention. To validate the risk score derived fromthe questionnaire and test the feasibility of self completionby comparing patients' self reported skin characteristics witha skin examination performed by an experienced general practitioner.
Design: Prospective questionnaire survey followed by a comparativestudy.
Setting: 16 randomly selected group practices in a health districtin Cheshire, United Kingdom.
Subjects: Questionnaire survey—3105 consecutive patientsaged 16 years and over attending for a primary care consultation;comparative study—a self selected subsample of 388 of the3105 patients.
Main outcome measures: MacKie risk group for melanoma. Comparisonof high risk skin characteristics reported by patients and thosenoted during a skin examination by a doctor ( {kappa} statistic).
Results: 4.3% of patients (87% women) were in the highest riskgroup and 4.4% (79% men) were in the second highest risk group,as defined by the MacKie score. Agreement between patients'self appraisal of skin characteristics and clinical skin examinationswas reflected in {kappa} values of 0.67 for freckles, 0.60 for moles,and 0.43 for atypical naevi.
Conclusion: This questionnaire helped to identify a group athigh risk for melanoma. Furthermore, good agreement was foundwhen the patient's risk scores were compared with results ofthe clinical skin examination. This risk score is potentiallyuseful in targeting primary and secondary prevention of melanomathrough general practice.

Key messages

Successful treatment of melanoma depends on its early diagnosis and excision
The MacKie risk factors score flow chart was used to identify a group of patients at high risk of melanoma from a sample of general practice patients who had completed a questionnaire
A good measure of agreement was achieved when self appraisal of high risk skin characteristics by patients was compared with a clinical skin examination
A self report risk score is a feasible means of identifying high risk patients and targeting prevention of melanoma

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