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Worldwide, malignant melanoma is the 15th commonest cancer with nearly 300,000 new cases of melanoma in 2018. Melanoma has one of the fastest rising incidence rates of any cancer, and among white populations, incidence has quadrupled over the last 30 years.

Most skin lesions first present in primary care where distinguishing rare melanomas from benign lesions can be challenging. More accurate triage of suspicious pigmented skin lesions in primary care could lead to more prompt diagnosis of melanoma at earlier stages and improved outcomes, and reduce unnecessary biopsies and referrals.

Melatools

The MelaTools programme is a portfolio of studies with the overall aim of optimising early diagnosis of the serious skin cancer, melanoma, in the UK primary care. The studies investigate the use of electronic tools to help both patients and GPs to recognise and assess potentially suspicious pigmented skin lesions/moles.

MelaTools has its own dedicated website.

MelaTools Publications

1. Walter FM, Pannebakker MP, Barclay ME, Mills K, Saunders CL, Murchie P, Corrie P, Hall P, Burrows N, Emery JD. Effect of a skin self-monitoring smartphone application on time to physician consultation among patients with possible melanoma: A phase 2 randomized clinical trial. JAMA Network Open. 2020. doi:10.1001/jamanetworkopen.2020.0001
2. Pannebakker MM, Mills K, Johnson M, Emery JD, Walter FM. Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation. BJGP Open. 2019. doi:10.3399/bjgpopen18X101635
3. Wilson E, Usher-Smith J, Emery J, Corrie PG, Walter FM. Expert elicitation of multinomial probabilities for decision-analytic modeling: an application to rates of disease progression in undiagnosed and untreated melanoma. Value Health. 2018. doi:10.1016/j.jval.2017.11.009
4. Wilson E, Usher-Smith J, Emery JD, Corrie P, Walter FM. A modelling study of the cost-effectiveness of a risk stratified screening programme for melanoma in the UK. Value Health. 2018. doi:10.1016/j.jval.2017.11.009
5. Mills K, Emery J, Lantaff R, Radford M, Pannebakker M, Hall P, Burrows N, Williams K, Saunders CL, Murchie P, Walter FM. Protocol for the MelaTools Skin Self-Monitoring Trial: a phase II randomised controlled trial of an intervention for primary care patients at higher risk of melanoma. BMJ Open. 2017. doi:bmjopen-2017-017934
6. Usher‐Smith JA, Kassianos AP, Emery JD, Abel GA, Teoh Z, Hall S, Neal RD, Murchie P, Walter FM. Identifying people at higher risk of melanoma across the UK: a primary‐care‐based electronic survey. Brit J Dermatol. 2017. doi:10.1111/bjd.15181
7. Kassianos AP, Emery JD, Murchie P, Walter FM. Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review. Br J Dermatol. 2015. doi:10.1111/bjd.13665
8. Usher-Smith JA, Emery J, Kassianos AP, Walter FM. Risk prediction models for melanoma: a systematic review. Cancer Epidemiol Biomarkers Prev, 2014. doi:10.1158/1055-9965.EPI-14-0295

Related Publications

1. Habgood E, Walter FM, O’Hare E, McIntosh J, McCormack C, Emery JD. Using an electronic self-completion tool to identify patients at increased risk of melanoma in Australian primary care. Aust J of Derm. 2020. doi:10.1111/ajd.13244
2. Walter FM & Emery JD. Further evaluation is required for smartphone-aided diagnosis of skin cancer. Lancet Digital Health. 2020. doi:1016/S2589-7500(20)30021-2
3. Freeman K, Dinnes J, Chuchu N, Takwoingi Y, Bayliss SE, Matin RN, Jain A, Walter FM, Williams HC, Deeks JJ. Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies. Brit Med J. 2020. doi:10.1136/bmj.m127
4. Jones OT, Ranmuthu CK, Hall PN, Funston G, Walter FM.. Recognising skin cancer in primary care. Adv Ther. 2020. doi:1007/s12325-019-01130-1
5. Murchie P, Masthoff J, Walter FM, Rahman K, Allan JL, Burrows N, Proby C, Lee AJ, Johnston M, Durrani A, Depasquale I. Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma. Trials. 2019. doi:10.1186/s13063-019-3453-x
6. Dinnes J, Deeks JJ, Grainge MJ, Chuchu N, di Ruffano LF, Matin RN, Thomson DR, Wong KY, Aldridge RB, Abbott R, Fawzy M. Visual inspection for diagnosing cutaneous melanoma in adults. Cochrane Database Syst Rev. 2018. doi:10.1002/14651858.CD013194
7. Dinnes J, Deeks JJ, Chuchu N, di Ruffano LF, Matin RN, Thomson DR, Wong KY, Aldridge RB, Abbott R, Fawzy M, Bayliss SE. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev. 2018. doi:10.1002/14651858.CD011902
8. Chuchu N, Takwoingi Y, Dinnes J, Matin RN, Bassett O, Moreau JF, Bayliss SE, Davenport C, Godfrey K, O’Connell S, Jain A. Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma. Cochrane Database Syst Rev. 2018. doi:10.1002/14651858.CD013192
9. Chuchu N, Dinnes J, Takwoingi Y, Matin RN, Bayliss SE, Davenport C, Moreau JF, Bassett O, Godfrey K, O’Sullivan C, Walter FM. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev. 2018. doi:10.1002/14651858.CD013193
10. Dinnes J, Matin RN, Moreau JF, Patel L, Chan SA, Chuchu N, Bayliss SE, Grainge M, Takwoingi Y, Davenport C, Walter FM. Tests to assist in the diagnosis of cutaneous melanoma in adults: a generic protocol (Protocol). Cochrane Database Syst Rev. 2015. doi:10.1002/14651858.CD011902
11. Emery JD, Usher-Smith JA, Walter FM. Predicting the risk of melanoma. JAMA Dermatol. 2016. doi:10.1001/jamadermatol.2016.1574
12. Walter FM, Abel GA, Lyratzopoulos G, Melia J, Greenberg D, Brewster DH, Butler H, Corrie PG, Campbell C. Seasonal variation in diagnosis of invasive cutaneous melanoma in Eastern England and Scotland. Cancer Epidemiol. 2015. doi:10.1016/j.canep.2015.06.006

For more information on MelaTools please contact Chief Investigator: Fiona Walter

Dermoscopy

Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by primary care physicians. However, when used by untrained clinicians, some studies suggest that accuracy may be no better than visual inspection; therefore, patients with suspicious skin lesions may have unnecessary referrals and excisions, or even inappropriate reassurance.

Our work explored two principle aspects:

1. A systematic review on the first presentation of suspicious skin lesions in primary care and whether dermoscopy and dermoscopy-related technologies, with suitable training, could be accurately and effectively used to triage suspicious skin lesions at this point in the healthcare pathway.
2. A nationwide survey of UK primary care practitioners regarding their usage and opinions of dermoscopy within a primary care setting.

For more information please contact: Owain Jones