Public education programmes to encourage survival from malignant melanoma—the Glasgow experience

Abstract

At a previous annual meeting we demonstrated the need for public education to encourage earlier presentation of malignant melanoma and thus treatment of thinner lesions and subsequently improved survival.1. A grant-funded public education programme was organized in the West of Scotland during the spring of 1985 with the specific aim of encouraging early recognition of curable melanoma. An integral part of this project was measurement of the increased workload generated with regard to all types of pigmented lesions. It was considered that an early marker of a beneficial effect of educational activities would be a rise in the proportion of thin, good prognosis melanomas 0–1.5 mm thick and a fall in both absolute numbers and proportions of poor prognosis tumours thicker than 35 mm. In 1984, the year prior to the campaign, 158 cutaneous melanomas were first diagnosed in the West of Scotland. Of these, 69 (44%) were in the thin, good prognosis group and 47 (30%) were in the thick, poor prognosis group. Intensive public education took place in May and June 1985. 192 cutaneous melanomas were first diagnosed in the West of Scotland during 1985, including 104 (54%) thin melanomas and 46 (24%) thick melanomas. Both the rise in proportions and numbers of thin tumours and the fall in proportions of thick tumours are statistically significant by comparison with 1984 figures and also for all pooled figures for the years 1979–1984 inclusive. Numbers of non-melanoma pigmented lesions referred and also numbers of such lesions subsequently excised were recorded, to give a measure of increase in non-melanoma workload. Small rises in such referrals for June and July 1985 were noted by comparison with June and July 1984 for three of four Glasgow teaching hospitals. The great majority of these referrals, however, were directed through the pigmented lesion clinic (40 patients June/July 1984 and 151 patients June/July 1985). This pigmented lesion clinic currently sees 25 non-melanoma pigmented lesions per new melanoma, a figure which compares favourably with 160 patients screened per new melanoma quoted by Arundell (personal communication) for American Skin Cancer Health Fairs. A survey of a sample of patients suggests that television is the most effective educational approach, with radio, leaflets and posters in descending order of efficacy. Numbers of pigmented lesions considered to require excision rose in the laboratory receiving material from the pigmented lesion clinic in 1985 by comparison with 1984, but numbers of similar lesions fell in the laboratory receiving material from the plastic surgery service. The Glasgow experience suggests that the public is receptive to public education and that a detectable increase in attendance with pigmented lesions is apparent 2 weeks after a public education exercise. Analysis of tumour thickness suggests that the proportion of thin tumours has risen in association with educational activities. Any increase in non-melanoma workload should be taken in context with the prior workload for these lesions and also with changes in referral pattern during the period of educational activities.