Title: GP and patient interventions to improve early diagnosis of malignant melanoma in primary care.
Funder: Department of Health and Social Care

Abstract: In 2010 there were 11,870 new cases of malignant melanoma in the UK. Melanoma survival is determined by the thickness of the lesion at diagnosis: while thin melanomas have excellent survival rates, less than 20% of people diagnosed with a thick melanoma are alive five years later. To improve survival it is therefore critical to detect melanoma early. It is challenging for both patients and GPs to recognise changes in a mole which may be clinically suspicious, from the vast majority of normal moles. Recent studies have shown that GPs can make accurate assessments of moles when they routinely use guidelines such as the seven-point checklist. The overall aim of the proposed research is to help patients and GPs assess moles better to improve the timely diagnosis of melanoma. The first study aims to assess whether embedding the seven-point checklist in the electronic medical records of half the general practices in England can improve early detection of melanoma, measured using national routinely collected data from the cancer registries on the thickness of melanoma at diagnosis, and subsequent survival rates. This will be the first study to examine the effect of a new diagnostic strategy in general practice on clinical outcomes and survival for any cancer. The second set of studies aims to identify people at higher risk of melanoma and assess whether they can use a smartphone to monitor their moles and identify clinically important changes over time. Other smartphone applications match moles with images of melanomas, but this will be the first to analyse changes in moles over time. We will develop and evaluate the smartphone application through a series of studies to inform the design of a larger phase III randomised controlled trial.

Lay abstract: In 2010 there were 11,870 new cases of malignant melanoma in the UK. Melanoma survival is determined by the thickness of the lesion at diagnosis: while thin melanomas have excellent survival rates, less than 20% of people diagnosed with a thick melanoma are alive five years later. To improve survival it is therefore critical to detect melanoma early. It is challenging for both patients and GPs to recognise changes in a mole which may be clinically suspicious, from the vast majority of normal moles. Recent studies have shown that GPs can make accurate assessments of moles when they routinely use guidelines such as the seven-point checklist. The overall aim of the proposed research is to help patients and GPs assess moles better to improve the timely diagnosis of melanoma. The first study aims to assess whether embedding the seven-point checklist in the electronic medical records of half the general practices in England can improve early detection of melanoma, measured using national routinely collected data from the cancer registries on the thickness of melanoma at diagnosis, and subsequent survival rates. This will be the first study to examine the effect of a new diagnostic strategy in general practice on clinical outcomes and survival for any cancer. The second set of studies aims to identify people at higher risk of melanoma and assess whether they can use a smartphone to monitor their moles and identify clinically important changes over time. Other smartphone applications match moles with images of melanomas, but this will be the first to analyse changes in moles over time. We will develop and evaluate the smartphone application through a series of studies to inform the design of a larger phase III randomised controlled trial.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: CANCER AND NEOPLASMS