Marcé Diane, Le Vilain-Abraham Floriane, Bridou Morgiane, Quéreux Gaelle, Dupuy Alain, Lesimple Thierry, Le Corre Yannick, Wierzbicka-Hainaut Ewa, Legoupil Delphine, Célérier Philippe, Maillard Hervé, Machet Laurent, Caille Agnès
Service de Dermatologie, Centre Hospitalier Régional Universitaire de Tours, 37044 Tours, France.
INSERM, Université de Tours, Université de Nantes, SPHERE U1246, 37044 Tours, France.
Cancers (Basel). 2022 Aug 10;14(16):3864. doi: 10.3390/cancers14163864.
First-degree relatives (FDRs, defined as parents, children, and siblings) of melanoma patients are at a two-to-fivefold increased risk of developing melanoma themselves. FDRs are advised to perform self-skin examination (SSE) and annual medical total cutaneous examination (TCE) performed either by a dermatologist or a general practitioner, and to change their sun-related behavior. This advice is given orally to melanoma patients who are asked to relay the information to their FDRs.
Our aim was to determine the impact of providing a tip sheet to melanoma patients intended to their first-degree relatives (FDRs) on early detection and sun-related behaviors in this group at increased risk of melanoma.
A superiority, cluster-randomized trial was conducted at nine hospital centers. In the intervention group, dermatologists were asked to deliver to melanoma patients (index cases) the tip sheet and oral advice intended to their FDRs. The control group were asked to deliver the usual oral advice alone. The primary outcome was early detection of melanoma in FDRs with a medical TCE performed within one year after the first visit of the index case. Secondary outcomes were SSE and sun-related behaviors in FDRs.
A total of 48 index cases and 114 FDRS in the control group, 60 index cases and 166 FDRS in the intervention group were recruited. In the intervention group, 36.1% of FDRs performed a medical TCE as compared to 39.5% of FDRs in the control group (OR 0.9 [95% CI 0.5 to 1.5], = 0.63). We did not find a between-group difference in SSE and sun-related behaviors.
A tip sheet added to the usual oral advice did not increase medical TCE among FDRs of melanoma patients. Overall, the rate of TCE among FDRs was low. Research on other strategies is needed to increase melanoma detection in this population.
黑色素瘤患者的一级亲属（FDR，定义为父母、子女和兄弟姐妹）自身患黑色素瘤的风险增加了两到五倍。建议FDR进行自我皮肤检查（SSE）以及由皮肤科医生或全科医生进行的年度医学全皮肤检查（TCE），并改变与阳光相关的行为。此建议以口头形式告知黑色素瘤患者，要求他们将信息传达给其FDR。
我们的目的是确定向黑色素瘤患者提供一份针对其一级亲属（FDR）的提示单对该黑色素瘤风险增加群体的早期检测和与阳光相关行为的影响。
在九个医院中心进行了一项优效性、整群随机试验。在干预组中，要求皮肤科医生向黑色素瘤患者（索引病例）提供针对其FDR的提示单和口头建议。对照组仅要求提供常规口头建议。主要结局是在索引病例首次就诊后一年内通过医学TCE对FDR进行黑色素瘤的早期检测。次要结局是FDR的SSE和与阳光相关的行为。
对照组共招募了48例索引病例和114名FDR，干预组招募了60例索引病例和166名FDR。在干预组中，36.1%的FDR进行了医学TCE，而对照组为39.5%的FDR（OR 0.9 [95% CI 0.5至1.5]，P = 0.63）。我们未发现两组在SSE和与阳光相关行为方面存在差异。
在常规口头建议基础上增加一份提示单并未增加黑色素瘤患者FDR进行医学TCE的比例。总体而言，FDR中TCE的比例较低。需要研究其他策略以提高该人群中黑色素瘤的检测率。
