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Community responses (n=925, response rate=71%) of a series of eight photographs of pigmented skin lesions were compared against those of general practitioners (n=114, response rate=77%), considered to be the most relevant gold standard. The eight photographs included three melanomas, two potentially malignant lesions and three benign pigmented lesions. Over the pool of lesions examined, the average probability that community members thought a lesion was likely to be skin cancer (0.68 [99% CI=0.66-0.69]) was higher (p<0.0001) than that of the comparison general practitioners 0.58 [99% CI=0.55-0.62]. This reflects a general (but not consistent) inflated propensity to over-diagnose among community members. The average probability that respondents indicated they would seek medical advice for a lesion was 0.71 [99% CI=0.70-0.73]. As expected, this was strongly associated with their perceptions of the skin lesion. These results suggest that the community can play a valuable role in assessing the need for medical evaluation of pigmented skin lesions.

Background: The ability of general practitioners to make important clinical decisions about the diagnosis and management of skin lesions is poorly understood., Methods: A questionnaire on the diagnosis and management of eight photographed skin lesions was sent to 150 GPs in southeast Queensland., Results: The questionnaire was completed by 114 GPs (response rate 77%). General practitioners' provisional diagnoses and management of photographed skin lesions were mostly or always correct, and there was general high consistency between diagnosis and intended management. Pigmented seborrhoeic keratoses were the most difficult lesions for GPs to diagnose correctly. Whether a lesion was different to usual moles appears to have the strongest association with clinical diagnosis., Discussion: The high ability of GPs as measured in this artificial study is encouraging. The strong association between identifying moles that appear different to usual and correct clinical diagnoses suggest that unless GPs can increase the number of skin lesions they see as part of their typical workload, their clinical ability may not increase further.

Objectives: Melanoma is a significant cause of morbidity and mortality worldwide and incidence is increasing. Survival after treatment is inversely related to the thickness of the tumour at diagnosis. Population screening has the potential to reduce mortality but there is no conclusive evidence of benefit. Such evidence can come best from a randomised trial. Here we describe the design of a community based randomised trial of a population screening programme for melanoma in Queensland, Australia and early results of the first phase of the trial., Methods: A total of 44 communities (aggregate population 560 000 adults aged 30 years or more) will be randomised to receive either a community based screening programme for 3 years or normal practice. The screening programme promotes thorough skin self examination and whole body skin examination by a doctor and provides open access skin cancer screening clinics. In its first phase, the trial is underway in nine intervention and nine control communities. The primary outcome measure is mortality from melanoma during 15 years of follow up., Results: The first phase of the trial has shown the feasibility of implementing a population skin screening programme including regular skin cancer screening clinics, and has shown the strong support of communities and doctors for the programme. There has been a significant 2.5-fold increase in participation in screening in the intervention communities in this first phase after the first 12 months of the trial and no significant increase in participation in screening in control communities during this period., Conclusions: The design of a community based randomised trial of screening for melanoma has been successfully peer reviewed and the intervention has been shown to be feasible in practice. This randomised trial may be one of the last opportunities to develop the evidence required for public health recommendations for population screening for melanoma.

Background: Detecting melanoma early often relies on patient concern about a particular pigmented lesion. However, it is not clear what specific features the public views as being important., Objective: Our purpose was to explore the importance persons place on various features of skin lesions when looking for early signs of melanoma., Methods: This study comprised 1148 respondents (participation rate, 78%) from 60 rural communities in Queensland, Australia, who participated in a telephone interview., Results: The following features were considered important and are listed in order of importance: change in the lesion (clearly identified as the most important), more than one color, uneven edges, elevation, large size (the last three of equal importance), and hairiness of the lesion. Age, sex, education, self-efficacy, perceived knowledge, and recent self-examination influenced importance levels, but having a recent skin examination by a family physician did not., Conclusion: To increase the skin self-examination skills of the community, guidelines may have to become more specific and all opportunities fully utilized to educate the public.

Queensland has the highest reported incidence of malignant melanoma in the world, and early detection offers the possibility of reducing the burden of this cancer in the short term. We report on a survey of 995 residents of the Gold Coast, Queensland, regarding behavioural aspects of the early detection of skin cancer. Survey results suggest that although many people report some form of skin examination behaviour, by either checking their own skin, having another nonmedical person check their skin, or by going to their general practitioner for a skin check, much of this activity may be inadequate. They indicate that current early detection could be enhanced by encouraging individuals and general practitioners to extend the coverage of the examinations they already conduct.