Authors' objectives:

The report aims to assess actions needed to improve the early diagnosis of melanoma (defining at-risk populations, training doctors, and optimising referral of patients to a dermatologist).

Authors' results and conclusions: i.Epidemiological data: the annual age-standardised prevalence of melanoma in France, as estimated from European studies, was 31 per 100 000 in 1995 (one of the lowest ratios in Europe). The estimated number of incident cases was 7 200 in 2000, and the estimated number of deaths was 1 364. ii.Natural history and pathophysiology: melanoma appears de novo (70-80% of cases) or on a pre-existing naevus. There are 4 main anatomical and clinical forms: superficial spreading melanoma (SSM, the most common form), nodular melanoma, lentigo maligna melanoma and acral-lentiginous melanoma. Risk factors multiplying the relative risk by 2 or more are: skin phototype I, pale skin, red or blonde hair, > 40 melanocytic lesions, 2 atypical naevi, congenital naevus > 20 cm in diameter, personal or family history of melanoma, history of sunburn. iii.Diagnostic methods: clinical diagnosis is based on two analytical visual methods (ABCDE rule, revised Glasgow 7-point checklist) and one cognitive visual method. Experience and training increase the practitioner's diagnostic performance. Dermoscopy differentiates between melanocytic and non-melanocytic pigmented lesions. However, it does not have enough diagnostic power to replace diagnostic resection of atypical naevi. Studies are needed to confirm the performance of dermoscopy in everyday practice. Histological examination confirms the clinical diagnosis and provides key prognostic information (Breslow index). iv.Treatment: surgical resection is the only curative therapy for non-metastatic melanoma. It is carried out in 2 stages: 1) complete resection of the melanoma followed by histological examination to determine the Breslow index and whether or not ulceration is present; 2) further surgery with resection margins (based on the Breslow value) which are between 1 and 3 cm according to French guidelines. v.Value of early diagnosis: the literature review highlighted strong arguments for encouraging early diagnosis of melanoma. Campaigns to promote early diagnosis seem to have a positive impact (increase in the number of melanomas detected, and reduced thickness of melanomas resected) although their effects are short-lived. SSM melanoma could be diagnosed early as its intra-epidermal horizontal growth phase lasts for several months. There is an inverse correlation between Breslow value and survival after treatment.

Authors' recommendations: An early diagnosis strategy depends on (i) the patient, who goes to see their doctor because of a suspicious lesion or because they consider themselves at risk of melanoma; (ii) the general practitioner, who identifies patients at risk or who identifies a suspicious lesion during a consultation; (iii) the dermatologist, who confirms or excludes the diagnosis of suspected melanoma; (iv) the pathologist, who confirms or excludes the diagnosis of melanoma. Looking ahead the following actions are needed: carrying out prospective studies to validate the risk factors for melanoma in a French population (the data can then be used to produce a checklist for use by doctors to identify at-risk individuals); measuring the cost of treatment for melanoma by stage of severity; setting up of training sessions for doctors in early diagnosis of melanoma and in identifying individuals at risk of melanoma; raising awareness among the general public of early diagnosis of melanoma.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-Sante.fr/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr