Family Physician Visits and Early Recognition of Melanoma

Background: Malignant melanoma is a deadly skin cancer with a rapidly-increasing incidence, mortality and public health burden. Thin melanomas are easily treated with good prognosis, while the thicker lesions have relatively poor survival. To broaden strategies for early recognition of melanoma, we investigated the relationship between primary care service and melanoma thickness at diagnosis. Methods: All 714 patients diagnosed with a primary malignant melanoma between January 1995 and December 1999 in Nova Scotia were included in the present study and linked to provincial physician billing databases to reveal the patients' use of family physician services prior to the diagnosis of melanoma. We examined the importance of physician use of services for tumour thickness using logistic regression while adjusting for potential confounders. Tumour thickness was dichotomized to thin and thick using 0.75 mm as a cutoff. Results: Patients who regularly visited their family physician (2 to 5 times during a two-year interval prior to diagnosis) were 66% (95% CI, 31-84) less likely to be diagnosed with thick melanoma as compared to patients who consulted their family physician less or not at all. Progression to thick tumours could have been reduced by 11.70% (95% CI, -1.33-25.77) if all patients had consulted their family physician at least once a year. Discussion: Increased awareness of the need for regular medical check-ups could reduce the public health burden of melanoma. Contexte : Le mélanome malin est un cancer mortel de la peau dont l'incidence, la mortalité et le fardeau pour la santé publique augmentent rapidement. Les mélanomes minces sont faciles à traiter et présentent un bon pronostic, mais les chances de survivre à une lésion plus épaisse sont relativement faibles. Pour étoffer les stratégies de dépistage précoce des mélanomes, nous avons étudié la relation entre les services de soins primaires et l'épaisseur du mélanome lors du diagnostic. Méthode : Les 714 patientes et patients ayant reçu un diagnostic de mélanome primaire entre janvier 1995 et décembre 1999 en Nouvelle-Ecosse ont été inclus dans la présente étude, et nous avons relié les informations à leur sujet aux bases de données de facturation des médecins de la province pour déterminer si ces patientes et patients avaient utilisé les services d'un médecin de famille avant leur diagnostic. Nous avons examiné l'importance du recours aux services d'un médecin selon l'épaisseur de la tumeur au moye