Résumé
Melanoma is the most dangerous skin cancer because of its high risk of metastasis. The prognosis is directly correlated with early detection. General practitioners are crucial in the patient’s health pathway and are required in the cutaneous screening. Objective: to explore the practice and the factors influencing melanoma screening by general practitioners of the french department Hérault. Methods: qualitative study by semi-structured interviews conducted with 14 general practitioners in Hérault, France. Thematic analysis with phenomenological inspiration, then construction of coding-trees to present synthetic results. Results: general practitioners’atitude and practice towards skin screening was diverse. Most of the GPs weren’t performing a systematic skin screening for their patients. The main limiting factors in melanoma screening were: the lack of patients’ knowledge in terms of skin cancers; difficulty of access to the dermatologist; the lack of communication between GPs and dermatologists; the limited time in a GP consultation, the lack of confidence in the GPs skin examination, the lack of training, tools and means. The use of dermatoscopy and teleexpertise were the main favoring factors of this screening and could help to improve the access to the specialist. Other favoring factors for a GP were the presence of a dermatologist in his network and to have done an internship in dermatology during his curriculum. Possible improvement were mentionned. First the improvement in patient education and awareness in primary prevention towards skin cancers and the ability to obtain skin cancer screening. Additionally, the creation of tools to help GPs in identifying their patients with a high risk of skin cancers; the improvement of both initial and continuous training in dermatology of the GPs, with the idea of a systematic dermatoscopic training in their curriculum, to familiarise themselves with the dermatoscope to be confident with its use thereafter in daily practice. Finally, help from the Health Autorities with the creation of a dedicated consultation for screening, with a dedicated financial quotation. The creation of a "melanoma pathway" for patients at risk, organised by regional health autorities could also help to improve the access to the dermatologist. Discussion: the practitioners interviewed were aware of the main role of the GPs in skin cancer screening. Nevertheless, they are facing multiple limiting factors in their daily practice leading to a non-systematic screening of their patients. Numerous improvements were spontaneously mentionned in the interviews and completed by research in scientific literature, which could possibly change their practice in the future. It is important to note that improvements encompass all actors of skin cancer screening, from the patients (education and understanding of prevention) to the GPs and dermatologists (daily practice and organisation).