BMJ 1995;311:389-390 (5 August)

Letters

Screening for melanoma

EDITOR,--When Duncan Keeley states in his commentary to our paper that "feasibility studies . . . that fail to address these issues [workload, earlier diagnosis, and anxiety] should not be undertaken,"1 he ignores appropriate study design. Ours was a validation study: validity must be proved before money is spent on feasibility studies. Furthermore, such pragmatic outcomes are not appropriate in validation studies because the intensive assessment may well affect patient behaviour.

Keeley suggests that workload would "substantially increase." However, opportunistic screening when patients attend for other reasons would minimise the workload of mole counts--for example, general practitioners could send instructions for self screening or give a leaflet or perform a mole count, or both, when checking blood pressure. Alternatively, community campaigns could advise self screened people at high risk to avoid being sunburnt. The workload would partly depend on the potential to induce anxiety, and here Keeley also automatically assumes . . . [Full text of this article]


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Relevant Article

Self screening for risk of melanoma: validity of self mole counting by patients in a single general practice
Paul Little, Martin Keefe, and John White
BMJ 1995 310: 912-916. [Abstract] [Full Text]

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