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

Objectives : To establish whether a questionnaire incorporating MacKie's risk factor flow chart can identify patients at high risk for melanoma so that they can be targeted for primary and secondary prevention. To validate the risk score derived from the questionnaire and test the feasibility of self completion by comparing patients' self reported skin characteristics with a skin examination performed by an experienced general practitioner. Design : Prospective questionnaire survey followed by a comparative study. Setting : 16 randomly selected group practices in a health district in Cheshire, United Kingdom. Subjects : Questionnaire survey—3105 consecutive patients aged 16 years and over attending for a primary care consultation; comparative study—a self selected subsample of 388 of the 3105 patients. Main outcome measures : MacKie risk group for melanoma. Comparison of high risk skin characteristics reported by patients and those noted during a skin examination by a doctor (κ statistic). Results : 4.3% of patients (87% women) were in the highest risk group 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 examinations was reflected in κ values of 0.67 for freckles, 0.60 for moles, and 0.43 for atypical naevi. Conclusion : This questionnaire helped to identify a group at high risk for melanoma. Furthermore, good agreement was found when the patient's risk scores were compared with results of the clinical skin examination. This risk score is potentially useful in targeting primary and secondary prevention of melanoma through 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