Effects of a health education campaign for the earlier diagnosis of melanoma.

As part of a national campaign to combat the rising incidence of and mortality from cutaneous malignant melanoma, a programme of improved clinical services and professional and public education was set up in Nottingham in January to July 1987. The public education campaign in July led to an immediate increase in the weekly number of referrals to the pigmented lesion clinic from 10 to 54. The effect on general practitioner workload was less dramatic, the weekly number of consultations for discrete pigmented lesions rising from 0.5 to 3. In materials sent to GPs, we recommended that patients with three or more of seven specified signs should be referred for specialist opinion. Only 40% of the patients referred to the pigmented lesion clinic fulfilled this criterion, but 6% of these patients had a melanoma, compared to only 0.4% of those who did not meet the criterion. In the 6 months following the campaign, 64% of melanomas diagnosed in Nottingham residents had a Breslow thickness of less than 1.5 mm whereas only four (16%) were greater than 3.5 mm. However, this distribution was not significantly different from that seen in the three and a half years before the campaign. These results suggest that attempts to improve early diagnosis of the disease by health education are justified, but, in view of the service implications, full evaluation of such campaigns by large scale and long-term studies is essential. Future campaigns should give greater stress to referral criteria.