Lorier Roy E, Gressier L, Marco Bonnet J, Berrissoul E, Benjelloun F, Roudier Pujol C, Moyal Barracco M, Bonnet Got C
Cabinet de dermatologie, 16, rue Balard, 75015 Paris, France.
Cabinets de dermatologie, Paris, France.
Ann Dermatol Venereol. 2020 Nov;147(11):706-712. doi: 10.1016/j.annder.2020.05.004. Epub 2020 Jul 9.
Early detection of melanoma constitutes a major challenge and is a common reason for dermatological consultations. There is no recent data on melanomas diagnosed in the private medical sector in France, nor on the circumstances of diagnosis.
This was a retrospective observational study on records collating data on all new consecutive cases of melanoma diagnosed between January 2015 and June 2018, in the private sector only, by volunteer dermatologists belonging to the association for continuing medical education, "Dermatologie Paris XV". A data collection sheet was prepared on which to record information about the dermatologist, the patient, the main complaint, the characteristics of the melanoma, and the initial treatment given, using the computerized list provided by our dermatopathology offices.
The study involved 383 cases of melanoma, 37% in situ and 63% invasive, which consisted chiefly of superficial spreading melanoma. The median age of the cohort was 61 years and patients were predominantly female (58%). Follow-up of high-risk patients and complete routine examination (in those consulting for another reason) resulted in direct detection by a dermatologist of 202 of the 383 melanomas (52.7%); these melanomas had a lower median Breslow index than the rest of the cohort and were thin in the main. When patients consulted for a suspect lesion (139 cases), the lesion had been identified mostly by either the patient or by a relative (61% of cases). The decision to consult was made chiefly by the patients themselves, and the Breslow index was thicker. An initial consultation for nevus screening resulted in diagnosis of 42 melanomas, i.e. only 11% of the cohort. Dermoscopy was performed by 92% of the dermatologists participating in the study. Melanoma excision was performed in the office by the practitioner in 75% of cases, and management was validated at multidisciplinary meetings in 65% of cases.
In terms of French primary care, dermatologists in private practice play a key role in ensuring early detection and initial management of melanoma.
黑色素瘤的早期检测是一项重大挑战，也是皮肤科会诊的常见原因。目前尚无关于法国私立医疗部门诊断黑色素瘤的最新数据，也没有关于诊断情况的数据。
这是一项回顾性观察研究，收集了2015年1月至2018年6月期间，仅在私立部门，由属于继续医学教育协会“巴黎第十五区皮肤病学”的志愿皮肤科医生诊断的所有新的连续性黑色素瘤病例的数据。准备了一份数据收集表，使用我们皮肤病理学办公室提供的计算机列表记录有关皮肤科医生、患者、主要症状、黑色素瘤特征以及初始治疗的信息。
该研究涉及383例黑色素瘤，其中37%为原位癌，63%为浸润性癌，主要为浅表扩散性黑色素瘤。该队列的中位年龄为61岁，患者以女性为主（58%）。对高危患者的随访和完整的常规检查（因其他原因就诊者）导致皮肤科医生直接检测到383例黑色素瘤中的202例（52.7%）；这些黑色素瘤的中位Breslow指数低于队列中的其他病例，且主要为薄型。当患者因可疑病变就诊时（139例），病变大多由患者本人或亲属发现（61%的病例）。就诊决定主要由患者自己做出，且Breslow指数较厚。因痣筛查首次就诊导致诊断出42例黑色素瘤，即仅占队列的11%。参与研究的皮肤科医生中有92%进行了皮肤镜检查。75%的病例由医生在办公室进行黑色素瘤切除，65%的病例在多学科会议上进行了治疗验证。
就法国初级医疗而言，私人执业的皮肤科医生在确保黑色素瘤的早期检测和初始治疗方面发挥着关键作用。
