Melanoma is rare, but also the most dangerous form of skin cancer, with around 14,500 new cases diagnosed and 2600 deaths in the UK each year. Early detection is critical: overall, around 90 in every 100 patients with melanoma will still be alive five years after diagnosis. But for those diagnosed with advanced disease, only 25 out of 100 women and 10 out of every 100 men will still be alive after five years.
The UK does not currently have a screening programme for melanoma, as it is relatively rare and thus it is difficult to identify those at high risk in a way that can be rolled out cost-effectively across the NHS.
However, new research from the Universities of Cambridge and Melbourne, funded by NIHR, suggests that using a simple self-completed questionnaire could be a highly cost-effective way of identifying people at higher risk for melanoma.
Dr Ed Wilson, health economist and lead author of the study, said: “The questionnaire, originally developed by researchers at the University of Washington, gives you a personalised risk score. In this study, we have built on work in the Melatools programme to see whether the questionnaire works in the UK, and to determine the scores at which patients should get checked out by a nurse or GP, or be enrolled in a regular monitoring programme.”
It is critical to get these scores right: if we set it too low we will flood GP practices with otherwise healthy patients with a very low risk of melanoma, possibly crowding out other patients with greater needs. If we set it too high then we risk falsely reassuring patients and missing possible opportunities to catch their melanomas early.”
Dr Ed Wilson, Primary Care Unit, University of Cambridge
Dr Fiona Walter, GP and chief investigator of the Melatools programme, said: “Whilst this work shows the potential of a simple questionnaire, more work is needed before we can make a definitive recommendation. For example, we don’t yet know whether patients need to be examined by a GP or whether a specially trained nurse is just as good. This is important as GPs are already under a lot of pressure so dedicated teams of specialist nurses could make an important contribution.”
Wilson E, Usher-Smith J, Emery J, Corrie P, Walter FM. A modelling study of the cost-effectiveness of a risk stratified surveillance programme for melanoma in the UK. Value in Health 2018
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The Melatools programme is a research programme that aims to optimise early diagnosis of melanoma in primary care in the UK. It comprises a set of studies that aim to improve timely diagnosis of melanoma through optimisation of GP and patient assessment of pigmented skin lesions (‘skin lesion’ is a medical term for a patch, spot, lump or any other abnormality on otherwise normal skin).
The questionnaire on which this work is based was developed by Lisa Williams and team at the University of Washington, WA. (Williams, Shors, et al. Identifying Persons at Highest Risk of Melanoma Using Self-assessed Risk Factors. J Clin Exp Dermatol Res. 2011:2(6):1000129. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252382/).
If you have concerns about a mole, see this NHS information page or your GP for advice.
This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.