Improving melanoma screening in primary care: the Experience of the Association of French General Practitioners Practicing Dermoscopy
Keywords:
Melanoma, skin cancer screening, Dermoscopy, general practitioner, facebookAbstract
Background: Melanoma constitutes an increasing global health burden. In the light of a growing shortage of dermatologists in several countries, primary care has emerged as an optimal setting for skin cancer screening. Historically, in France, skin cancer detection was typically managed by dermatologists, while general practitioners (GPs) were barely involved. In 2021, the Association of French GPs practicing Dermoscopy was created to address this gap by promoting and legitimizing dermoscopy practice among primary care physicians.
Objectives: To assess the number of melanomas detected by dermoscopy-trained GPs, three years after the association’s foundation and to compare the melanomas histopathological characteristics to those documented in existing literature.
Methods: A survey was shared via Google® Form with all the members of the association’s Facebook® account between November 26, 2024 to December 26, 2024.
Results: A total of 85 general practitioners responded the survey. They reported the detection of 266 melanomas, corresponding to approximately 1.6 per year of dermoscopy practice in median (mean: 2,9). Thirty nine point five percent of detected melanomas (105/266) were in situ, while only 22,4% (36/161) had a Breslow thickness above 1mm, which constitute a substantial improvement compared to previously reported data on GP-detected melanomas.
Conclusions : Empowerment of primary care medicine through dermoscopy learning appears to be a promising way to overcome the relative shortage of diagnostic offer observed in several countries. Integrating skin cancer screening into GPs practice may contribute to melanoma early detection and support ongoing efforts to lower melanoma mortality.
References
Haute Autorité de Santé. Stratégie de diagnostic précoce du mélanome : rapport stratégie de diagnostic précoce du mélanome. Updated October 2006. Accessed February 19 2023. https://www.has- sante.fr/upload/docs/application/pdf/rapport_strategie_de_diagnostic_precoce_du_melanom e.pdf
Institut National du Cancer. Survie des personnes atteintes de cancer en France métropolitaine 1989-2018 - Synthèse des résultats : tumeurs solides et hémopathies malignes. Updated August 23 2021. Accessed June 19 2023. https://www.santepubliquefrance.fr/docs/survie-des-personnes-atteintes-de-cancer-en-france-metropolitaine-1989-2018-melanome-de-la-peau
Haute Autorité de Santé. Rapport d’orientation sur les facteurs de retard au diagnostic du mélanome cutané. Updated July 2012. Accessed March 16 2023. https://www.has-sante.fr/upload/docs/application/pdf/2013-01/synthese_du_rapport_dorientation_facteurs_de_retard_au_diagnostic_du_melanome_cutane.pdf
Arasu A, Meah N, Sinclair R. Skin checks in primary care. Aust J Gen Pract. 2019 Sep;48(9):614-619. DOI: 10.31128/AJGP-03-19-4887.
Buckley D, McMonagle C. Melanoma in primary care. The role of the general practitioner. Ir J Med Sci. 2014 Sep;183(3):363-8. DOI: 10.1007/s11845-013-1021-z.
Salerni G, Terán T, Puig S, , et al. Meta-analysis of digital dermoscopy follow-up of melanocytic skin lesions: a study on behalf of the International Dermoscopy Society J Eur Acad Dermatol Venereol. 2013 Jul;27(7):805-14. DOI: 10.1111/jdv.12032.
Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. 2008 Sep;159(3):669-76. DOI: 10.1111/j.1365-2133.2008.08713.x.
Kittler H, Pehamberger H, Wolff K, Binder M. Diagnostic accuracy of dermoscopy. Lancet Oncol. 2002 Mar;3(3):159-65. DOI: 10.1016/s1470-2045(02)00679-4.
https://www.skincancercollege.org/
https://www.facebook.com/groups/475003700493511/
https://www.facebook.com/groups/dermatoscopy/
Hay J, Keir J, Jimenez Balcells C, et al. Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database. Australas J Dermatol. 2022 May;63(2):204-212. DOI: 10.1111/ajd.13843. Epub 2022 Apr 19. PMID: 35437755; PMCID: PMC9320831
Richard MA, Grob JJ, Avril MF, et alP. Delays in diagnosis and melanoma prognosis (II): the role of doctors. Int J Cancer. 2000 May 20;89(3):280-5. DOI: 10.1002/1097-0215(20000520)89:3<280::aid-ijc11>3.0.co;2-2. PMID: 10861505.
Grange F, Woronoff AS, Bera R, et al. Efficacy of a general practitioner training campaign for early detection of melanoma in France. Br J Dermatol. 2014 Jan;170(1):123-9. DOI: 10.1111/bjd.12585. PMID: 23937244.
Lorier Roy E, Gressier L, Marco Bonnet J, et al. MELALIB15 : étude observationnelle rétrospective de 383 mélanomes dépistés par des dermatologues libéraux [MELALIB 15: A retrospective observational study of 383 cases of melanoma diagnosed by dermatologists in private practice]. Ann Dermatol Venereol. 2020 Nov;147(11):706-712. French. DOI: 10.1016/j.annder.2020.05.004. Epub 2020 Jul 9. PMID: 32653218.
Moncayo AK, Ferguson JM, Dizon MP, et al. Area Deprivation Index and Melanoma Thickness in Veterans. JAMA Dermatol. 2025 Mar 6. DOI: 10.1001/jamadermatol.2025.0311. Epub ahead of print. PMID: 40047783.
Andremasse C, Anriot J, Duru G, Mismetti V, Perrot JL, Thomas L. Creation and evaluation of an online dermoscopy test for self-evaluation of competences in diagnosis of skin cancer. J Eur Acad Dermatol Venereol. 2025 Feb 6. DOI: 10.1111/jdv.20573. Epub ahead of print. PMID: 39912230.
Geller AC, Koh HK, Miller DR, Clapp RW, Mercer MB, Lew RA. Use of health services before the diagnosis of melanoma: implications for early detection and screening. J Gen Intern Med. 1992 Mar-Apr;7(2):154-7. DOI: 10.1007/BF02598004. PMID: 1487762.
https://www.assurance-maladie.ameli.fr/etudes-et-donnees/zoom-ps-dermatologues-liberaux
Morris J, Alfonso S, Hernandez N, Fernandez MI. Examining the factors associated with past and present dermoscopy use among family physicians. Dermatol Pract Concept. 31 oct 2017;7(4):63-70. DOI: 10.5826/dpc.0704a13
Fee JA, McGrady FP, Rosendahl C, Hart ND. Dermoscopy Use in Primary Care: A Scoping Review. Dermatol Pract Concept. 2019;9(2):98-104. DOI:10.5826/dpc.0902a04.
Fee JA, McGrady FP, Hart ND. Dermoscopy use in primary care: a qualitative study with general practitioners. BMC Prim Care. 2022;23(1):47. DOI:10.1186/s12875-022-01653-7.
Jones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM. Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. J Eur Acad Dermatol Venereol JEADV. 2019;33(9):1706-1712. DOI:10.1111/jdv.15614.
Chappuis P, Duru G, Marchal O, Girier P, Dalle S, Thomas L. Dermoscopy, a useful tool for general practitioners in melanoma screening: a nationwide survey. Br J Dermatol. 2016;175(4):744-750. DOI:10.1111/bjd.14495.
Whiting G, Stocks N, Morgan S, et al. General practice registrars’ use of dermoscopy: Prevalence, associations and influence on diagnosis and confidence. Aust J Gen Pract. 2019;48(8):547-553. DOI:10.31128/AJGP-11-18-4773.
Williams NM, Marghoob AA, Seiverling E, Usatine R, Tsang D, Jaimes N. Perspectives on Dermoscopy in the Primary Care Setting. J Am Board Fam Med JABFM. 2020;33(6):1022-1024. DOI:10.3122/jabfm.2020.06.200238.
Duarte AF, da Costa-Pereira A, Del-Marmol V, Correia O. Are General Physicians Prepared for Struggling Skin Cancer?-Cross-Sectional Study. J Cancer Educ Off J Am Assoc Cancer Educ. 2018;33(2):321-324. DOI:10.1007/s13187-016-1078-2.
Buckley D, McMonagle C. Melanoma in primary care. The role of the general practitioner. Ir J Med Sci. 2014;183(3):363-368. DOI:10.1007/s11845-013-1021-z.
Mathew T, Ianno DJ, Sidhu SK. Stage IA melanoma follow-up: Exploring the level of confidence of South Australian general practitioners in undertaking surveillance skin checks including considerations for shared care. Australas J Dermatol. 2023;64(2):e135-e144. DOI:10.1111/ajd.14026.
Argenziano G, Puig S, Zalaudek I, et al. Dermoscopy improves accuracy of primary care physicians to triage lesions suggestive of skin cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(12):1877-1882. DOI:10.1200/JCO.2005.05.0864.
Augustsson A, Paoli J. Effects of a 1-Day Training Course in Dermoscopy Among General Practitioners. Dermatol Pract Concept. 2019;9(3):195-199. DOI:10.5826/dpc.0903a04
Westerhoff K, McCarthy WH, Menzies SW. Increase in the sensitivity for melanoma diagnosis by primary care physicians using skin surface microscopy. Br J Dermatol. 2000;143(5):1016-1020. DOI:10.1046/j.1365-2133.2000.03836.x.
Gonna N, Tran T, Bassett RL, Farris DP, Nelson KC. Sensitivity and Specificity for Skin Cancer Diagnosis in Primary Care Providers: a Systematic Literature Review and Meta-analysis of Educational Interventions and Diagnostic Algorithms. J Cancer Educ Off J Am Assoc Cancer Educ. 2022;37(5):1563-1572. DOI:10.1007/s13187-022-02194-4.
Barten AHJ, Beyers CP, Vondenhoff MFR, Stergioulas L, Kukutsch NA. The effect of a dermoscopy training programme on diagnostic accuracy and management decisions regarding pigmented skin lesions: a comparison between dermal therapists and general practitioners. Clin Exp Dermatol. 2024;49(6):591-598. DOI:10.1093/ced/llad441.
Friche P, Moulis L, Du Thanh A, Dereure O, Duflos C, Carbonnel F. Training Family Medicine Residents in Dermoscopy Using an e-Learning Course: Pilot Interventional Study. JMIR Form Res. 2024;8:e56005. DOI:10.2196/56005.
Bouton C, Schmeltz H, Lévèque C, et al. Early diagnosis of melanoma: a randomized trial assessing the impact of the transmission of photographs taken with a smartphone from the general practitioner to the dermatologist on the time to dermatological consultation. BMC Health Serv Res. 2024;24(1):660. DOI:10.1186/s12913-024-11106-9.
Giavina-Bianchi M, de Sousa RM, Paciello VZ de A, et al. Implementation of artificial intelligence algorithms for melanoma screening in a primary care setting. PloS One. 2021;16(9):e0257006. DOI:10.1371/journal.pone.0257006.
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Copyright (c) 2025 Julien Anriot, Nadia Ikhlef, Gérard Duru, Sophie Darnis, Pauline Scouarnec, Younes Tamarat, Amini-Adle Mona, Luc Thomas
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