51
|
Nader Marta G, Munhoz RR, Teixeira MLP, Waldvogel BC, Pires de Camargo V, Feher O, Sanches JA. Trends in Melanoma Mortality in Brazil: A Registry-Based Study. JCO Glob Oncol 2020; 6:1766-1771. [PMID: 33201742 PMCID: PMC7713536 DOI: 10.1200/go.20.00426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE A substantial increase in melanoma incidence has been consistently observed worldwide over the past decades. However, melanoma mortality rates have remained stable or declined over the past years in most regions. Given the paucity of melanoma mortality data for different Brazilian regions, we sought to describe melanoma mortality trends in southeastern Brazil and their relationship with demographic variables. MATERIALS AND METHODS A cross-sectional registry-based analysis was conducted to describe melanoma mortality trends in the state of São Paulo, Brazil, from 1996 to 2016. Demographic information from melanoma-related death records, including sex and age, was collected from the Fundação Sistema Estadual de Análise de Dados database. The annual percentage change (APC) was calculated to identify mortality trends over the period. RESULTS An increasing melanoma mortality trend was detected among males, regardless of age (APC, 1.72%; P < .001), and was more pronounced for men ≥ 60 years old (APC, 2.63%; P < .001). Melanoma mortality rates have also increased for patients ≥ 60 years old, regardless of sex (APC, 1.11%; P < .001). A non–statistically significant increase in the overall melanoma mortality rate was observed over the 20-year period analyzed (APC, 0.36%; P = .4). CONCLUSION Our data suggest a stable melanoma mortality over the past two decades for the overall population studied; however, a significant increase in melanoma mortality rates has been demonstrated among males and in the population ≥ 60 years old, emphasizing the need to implement prevention strategies and expand access to effective therapies for this population.
Collapse
Affiliation(s)
- Guilherme Nader Marta
- Medical Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Oncologia D'Or, Rio de Janeiro, Brazil
| | - Rodrigo Ramella Munhoz
- Medical Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Medical Oncology Service, Hospital Sírio Libanês, São Paulo, Brazil
| | | | | | - Veridiana Pires de Camargo
- Medical Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Oncologia D'Or, Rio de Janeiro, Brazil
| | - Olavo Feher
- Medical Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Medical Oncology Service, Hospital Sírio Libanês, São Paulo, Brazil
| | - Jose Antonio Sanches
- Dermatology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
52
|
Mulder EEAP, Dwarkasing JT, Tempel D, van der Spek A, Bosman L, Verver D, Mooyaart AL, van der Veldt AAM, Verhoef C, Nijsten TEC, Grunhagen DJ, Hollestein LM. Validation of a clinicopathological and gene expression profile model for sentinel lymph node metastasis in primary cutaneous melanoma. Br J Dermatol 2020; 184:944-951. [PMID: 32844403 PMCID: PMC8247350 DOI: 10.1111/bjd.19499] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Clinicopathological and Gene Expression Profile (CP-GEP) model was developed to accurately identify patients with T1-T3 primary cutaneous melanoma at low risk for nodal metastasis. OBJECTIVES To validate the CP-GEP model in an independent Dutch cohort of patients with melanoma. METHODS Patients (aged ≥ 18 years) with primary cutaneous melanoma who underwent sentinel lymph node biopsy (SLNB) between 2007 and 2017 at the Erasmus Medical Centre Cancer Institute were eligible. The CP-GEP model combines clinicopathological features (age and Breslow thickness) with the expression of eight target genes involved in melanoma metastasis (ITGB3, PLAT, SERPINE2, GDF15, TGFBR1, LOXL4, CXCL8 and MLANA). Using the pathology result of SLNB as the gold standard, performance measures of the CP-GEP model were calculated, resulting in CP-GEP high risk or low risk for nodal metastasis. RESULTS In total, 210 patients were included in the study. Most patients presented with T2 (n = 94, 45%) or T3 (n = 70, 33%) melanoma. Of all patients, 27% (n = 56) had a positive SLNB, with nodal metastasis in 0%, 30%, 54% and 16% of patients with T1, T2, T3 and T4 melanoma, respectively. Overall, the CP-GEP model had a negative predictive value (NPV) of 90·5% [95% confidence interval (CI) 77·9-96.2], with an NPV of 100% (95% CI 72·2-100) in T1, 89·3% (95% CI 72·8-96·3) in T2 and 75·0% (95% CI 30·1-95·4) in T3 melanomas. The CP-GEP indicated high risk in all T4 melanomas. CONCLUSIONS The CP-GEP model is a noninvasive and validated tool that accurately identified patients with primary cutaneous melanoma at low risk for nodal metastasis. In this validation cohort, the CP-GEP model has shown the potential to reduce SLNB procedures in patients with melanoma.
Collapse
Affiliation(s)
- E E A P Mulder
- Departments of, Department of, Surgical Oncology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands.,Department of, Medical Oncology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - J T Dwarkasing
- Department of Scientific & Clinical Development, SkylineDx, Rotterdam, the Netherlands
| | - D Tempel
- Department of Scientific & Clinical Development, SkylineDx, Rotterdam, the Netherlands
| | - A van der Spek
- Department of Scientific & Clinical Development, SkylineDx, Rotterdam, the Netherlands
| | - L Bosman
- Department of Scientific & Clinical Development, SkylineDx, Rotterdam, the Netherlands
| | - D Verver
- Departments of, Department of, Surgical Oncology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - A L Mooyaart
- Department of, Pathology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - A A M van der Veldt
- Department of, Medical Oncology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands.,Department of, Radiology & Nuclear Medicine, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - C Verhoef
- Departments of, Department of, Surgical Oncology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - T E C Nijsten
- Department of, Dermatology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - D J Grunhagen
- Departments of, Department of, Surgical Oncology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands
| | - L M Hollestein
- Department of, Dermatology, Erasmus Medical Centre (MC) Cancer Institute, Rotterdam, the Netherlands.,Department of Research, Comprehensive Cancer Centre The Netherlands (IKNL), Utrecht, the Netherlands
| |
Collapse
|
53
|
Abstract
Please add expansion for AL. Melanoma is the most common fatal type of skin cancer and is an important and growing public health problem in the United States, Australia, New Zealand, and Europe. The mortality rate in most of the world has been rising as well, albeit slower than that for incidence. Likely due to the availability of new treatments for stage 4 melanoma, mortality rates in the United States dropped 18% from 2013 to 2016. We further describe trends in melanoma incidence and mortality, review the literature on risk factors, and provide an up-to-date assessment of population-wide screening and some of the inherent concerns.
Collapse
Affiliation(s)
- Nicole L Bolick
- Harvard T.H. Chan School of Public Health, Kresge Building Room 718, 677 Huntington Ave, Boston, MA 02115, USA; Department of Internal Medicine, East Carolina University/Vidant Medical Center, 600 Moye Boulevard, MA-350, Greenville, NC 27834, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Kresge Building, Room 718, 677 Huntington Avenue, Boston, MA 02115, USA.
| |
Collapse
|
54
|
La Selva D, Kozarek RA, Dorer RK, Rocha FG, Gluck M. Primary and metastatic melanoma of the GI tract: clinical presentation, endoscopic findings, and patient outcomes. Surg Endosc 2020; 34:4456-4462. [PMID: 31659505 DOI: 10.1007/s00464-019-07225-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/04/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Melanoma incidence has increased worldwide with a concurrent rise in both primary and metastatic melanomas of the gastrointestinal tract. MATERIALS AND METHODS This retrospective single-center case series includes patients with histopathology-confirmed primary or metastatic melanoma of the GI tract between 1998 and 2018. RESULTS Thirty-four patients were identified for inclusion, of whom 7 were primary and 27 were metastatic cases of gastrointestinal melanoma. For both primary and metastatic cases, the majority of patients presented with frank or occult GI bleeding (57.1% and 70.4%). Primary and metastatic lesions were predominantly diagnosed endoscopically (100% and 63.0%), with 71.4% of primary lesions found at the anorectal junction and 51.9% of metastatic lesions in the small bowel. Endoscopically diagnosed lesions were either polypoid (50%) or a luminal mass (37.5%) in the majority of cases. Common features included: amelanotic (83%), ulcerated (50%), and friable (33.3%). All primary patients were treated with surgical excision or resection. Of the metastatic patients, 56% were resected. The median interval between initial primary and gastrointestinal metastases was 65 months (ranging from 1 month to 24 years). At the time of data analysis, 85.7% of primary and 29.6% of metastatic patients remained alive. CONCLUSIONS The majority of patients in this series were diagnosed endoscopically while investigating a source of gastrointestinal blood loss. Heightened clinical suspicion and recognition of the endoscopic features of gastrointestinal melanoma during evaluation of GI symptoms in a patient with a personal history of primary melanoma are advised.
Collapse
Affiliation(s)
- Danielle La Selva
- Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, USA
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, USA
| | - Russell K Dorer
- Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, USA
| | - Flavio G Rocha
- Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, USA
| | - Michael Gluck
- Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, USA.
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Virginia Mason Medical Center, C3-GAS, 1100 Ninth Avenue, Seattle, WA, 98101, USA.
| |
Collapse
|
55
|
|
56
|
Køster B, Meyer MKH, Søgaard J, Dalum P. Benefit-Cost Analysis of the Danish Sun Safety Campaign 2007-2015: Cost Savings from Sunburn and Sunbed Use Reduction and Derived Skin Cancer Reductions 2007-2040 in the Danish Population. PHARMACOECONOMICS - OPEN 2020; 4:419-425. [PMID: 31617085 PMCID: PMC7426353 DOI: 10.1007/s41669-019-00182-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ninety percent of skin cancers are avoidable. In Denmark, 16,500 cases of melanoma and keratinocyte cancers were registered in 2015. The Danish Sun Safety Campaign has campaigned since 2007, targeting overexposure to ultraviolet radiation. During 2007-2015, the key indicators of skin cancer, i.e. sunbed use and sunburn, showed annual reductions of 6% and 1%, respectively. OBJECTIVES We aimed to examine the financial savings to society as a result of the campaign reductions in skin cancer cases (2007-2040), and to examine the campaign's cost-benefit and return on investment (ROI). METHODS The analysis is based on existing data: (1) annual population-based surveys regarding the Danish population's behavior in the sun; (2) skin cancer projections; (3) relative risks of skin cancers from sunburn and sunbed use and (4) historical cancer incidences, combined with new data; (5) benefits from the avoided costs of skin cancer reductions; and (6) the costs of the Danish Sun Safety Campaign. RESULTS The results were based on a reduction of 9000 skin cancer cases, saving €29 million of which €13 million were derived from sunburn reductions and €16 million from reductions in sunbed use. The ROI was €2.18. CONCLUSION Skin cancer prevention in Denmark is cost effective. Every Euro spent by the Danish Sun Safety Campaign saved the Danish health budget €2.18 in health expenses.
Collapse
Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Maria K. H. Meyer
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| | - Jes Søgaard
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen Ø, Denmark
| |
Collapse
|
57
|
Bucchi L, Mancini S, Crocetti E, Dal Maso L, Baldacchini F, Vattiato R, Giuliani O, Ravaioli A, Caldarella A, Carrozzi G, Ferretti S, Filiberti RA, Fusco M, Gatti L, Gili A, Magoni M, Mangone L, Mazzoleni G, Michiara M, Panato C, Piffer S, Piras D, Rosso S, Rugge M, Scala U, Tagliabue G, Tumino R, Stanganelli I, Falcini F. Mid-term trends and recent birth-cohort-dependent changes in incidence rates of cutaneous malignant melanoma in Italy. Int J Cancer 2020; 148:835-844. [PMID: 33405292 DOI: 10.1002/ijc.33259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023]
Abstract
In Oceania, North America and north-western Europe, after decades of increase, cutaneous malignant melanoma (CMM) rates began to stabilise or decline before 2000. Anecdotal evidence suggests that the reversal of the incidence trend is extending to southern Europe. To obtain a formal confirmation, this nationwide study from Italy investigated the incidence trends by birth cohort. Twenty-one local cancer registries covering a population of 15 814 455 provided incidence data for primary CMM registered between 1994 and 2013. Trends in age-standardised rates were analysed using joinpoint regression models and age-period-cohort models. Age-standardised incidence showed a consistent increase throughout the period (estimated annual percent change, 3.6 [95% confidence interval, 3.2-4.0] among men and 2.5 [2.0-3.1] among women). This pattern was confirmed by a sensitivity analysis with removal of low-risk populations of southern Italy. The rates, however, showed a stabilisation or a decrease in men and women aged below 35. Using the cohort of 1949-the median cohort with respect to the number of cases for both genders-as a reference, the incidence rate ratio increased for successive cohorts born until 1973 (women) and 1975 (men), and subsequently tended to decline. For the most recent cohorts in both genders, the risk of disease returned to the level of the cohort of 1949. The changes observed in the latest generations can be interpreted as the earliest manifestations of a birth-cohort-dependent incidence decrease. Our study adds to previous data indicating that the reversal of the long-term upward incidence trend of CMM is extending to southern Europe.
Collapse
Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, section of Ferrara, Local Health Authority, and University of Ferrara, Ferrara, Italy
| | | | | | - Luciana Gatti
- Mantova Cancer Registry, Epidemiology Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantova, Italy
| | - Alessio Gili
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Michele Magoni
- Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, Brescia, Italy
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute - ATS, Sassari, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.,Department of Dermatology, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Forlì, Italy.,Cancer Prevention Unit, Local Health Authority, Forlì, Italy
| |
Collapse
|
58
|
Stevenson LJ, Mackey DA, Lingham G, Burton A, Brown H, Huynh E, Tan IJ, Franchina M, Sanfilippo PG, Yazar S. Has the Sun Protection Campaign in Australia Reduced the Need for Pterygium Surgery Nationally? Ophthalmic Epidemiol 2020; 28:105-113. [PMID: 32729768 DOI: 10.1080/09286586.2020.1797120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Slip! Slop! Slap! Sunsmart safety campaign was an Australian initiative implemented in the 1980s. To assess this campaign's effect on pterygium, we examined the rate of pterygium surgery across Australia and described the prevalence and associations of pterygium in Perth, Australia's sunniest capital city. METHODS The rate of pterygium surgery was examined using Australian Medicare data. A cross-sectional analysis of the Generation 1 (Gen1) cohort of the Raine Study was performed to investigate the prevalence of pterygium in Perth. We investigated the association between pterygium and conjunctival ultraviolet autofluorescence (CUVAF) area, an objective biomarker of sun exposure, and demographics and health variables derived from a detailed questionnaire. RESULTS Between 1994 and 2017, the rate of Medicare funded pterygium surgery in Western Australia fell 11%, well below the national average decline of 47%. Of the 1049 Gen1 Raine Study participants, 994 (571 females; mean age 56.7 years, range = 40.9-81.7) were included in the analysis. The lifetime prevalence of pterygium was 8.4% (n = 83). A higher prevalence of pterygium was associated with outdoor occupation (p-trend = 0.007), male sex (p-trend 0.01) and increasing CUVAF area (p-value <0.001). CONCLUSIONS The effect of Australia's Slip! Slop! Slap! Sunsmart safety campaign on pterygium been mixed. Since 1994, the rate of private pterygium surgery has declined significantly in all Australian states except Western Australia. Perth, Western Australia, has the highest pterygium prevalence of any mainland-Australian cohort. Higher CUVAF area, male sex, and outdoor occupation were associated with an increased risk of pterygium.
Collapse
Affiliation(s)
- Louis J Stevenson
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, New South Wales, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Gareth Lingham
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Alex Burton
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Holly Brown
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Emily Huynh
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Irene J Tan
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Maria Franchina
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| | - Paul G Sanfilippo
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Victoria, Australia
| | - Seyhan Yazar
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands, Western Australia
| |
Collapse
|
59
|
Villani A, Costa C, Fabbrocini G, Cinelli E, Greco V, Scalvenzi M. Trends in epidemiology of melanoma in situ in a center of South-Italy: Data from a melanoma reference center during the period 2004-2018. Int J Dermatol 2020; 59:e444-e445. [PMID: 32597497 DOI: 10.1111/ijd.15029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Claudia Costa
- Dermatology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Eleonora Cinelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Vincenzo Greco
- Dermatology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| |
Collapse
|
60
|
Dessinioti C, Dimou N, Geller AC, Stergiopoulou A, Lo S, Keim U, Gershenwald JE, Haydu LE, Ribero S, Quaglino P, Puig S, Malvehy J, Kandolf-Sekulovic L, Radevic T, Kaufmann R, Meister L, Nagore E, Traves V, Champsas GG, Plaka M, Dreno B, Varey E, Ramirez DM, Dummer R, Mangana J, Hauschild A, Egberts F, Peris K, Del Regno L, Forsea AM, Zurac SA, Vieira R, Brinca A, Zalaudek I, Deinlein T, Linos E, Evangelou E, Thompson JF, Scolyer RA, Garbe C, Stratigos AJ. Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers. J Natl Cancer Inst 2020; 111:1314-1322. [PMID: 30863861 DOI: 10.1093/jnci/djz034] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/26/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nodular melanoma (NM) is more likely to be fatal compared with other melanoma subtypes, an effect attributed to its greater Breslow thickness. METHODS Clinicopathological features of NM and superficial spreading melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), the United States, and Australia between 2006 and 2015, were analyzed by multivariable logistic regression analysis, with emphasis on thin (T1 ≤ 1.0 mm) melanomas. Cox analysis assessed melanoma-specific survival. All statistical tests were two sided. RESULTS In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included. Compared with T1 SSM, T1 NM was less likely to have regression (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI = 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm2, P < .001). Cox multivariable analysis showed a higher risk for melanoma-specific death for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting for center heterogeneity, the difference was statistically significant only for T1 (HR = 2.20, 95% CI = 1.28 to 3.78). The NM subtype did not confer increased risk within each stratum (among localized tumors or cases with regional metastasis). CONCLUSIONS T1 NM (compared with T1 SSM) was associated with a constellation of aggressive characteristics that may confer a worse prognosis. Our results indicate NM is a high-risk melanoma subtype that should be considered for inclusion in future prognostic classifications of melanoma.
Collapse
|
61
|
Melanocytic lesion in children and adolescents: an Italian observational study. Sci Rep 2020; 10:8594. [PMID: 32451385 PMCID: PMC7248059 DOI: 10.1038/s41598-020-65690-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/21/2020] [Indexed: 11/29/2022] Open
Abstract
Malignant melanoma is a rare neoplasm in the pediatric age group. One of the main risks factors is represented by the presence of a high number of melanocytic nevi. Sun exposure in pediatric age represents a predictor of melanocytic nevi number in the adult age and there is a direct correlation between the presence of melanocytic moles in early childhood and the development of many nevi in adults, suggesting that a high number of nevi in childhood should be considered as a predictor of melanoma development during adult life. The predominance of dermoscopic types of melanocytic nevi varies according to the individual’s age and depends on endogenous or exogenous signaling, suggesting different pathways of nevogenesis. We evaluated the total amount of melanocytic nevi of pediatric patients and their prevalent dermoscopic pattern. We investigated the reasons for dermatological examination, pointing out the role of older parents’ populations in the decision to refer to a dermatological consultant. We performed a prospective observational study on 295 pediatric outpatients consecutively enrolled from July 2018 to July 2019. Descriptive and inferential statistical analyses were performed using logistic and linear regression. 49% of children were characterized by less than 10 nevi, 45% of children by a number of nevi between 10 and 30, whilst 17 patients (5%) had a number of nevi between 30 and 50. The most prevalent dermoscopic pattern was the globular one. An older parenting age was correlated with an autonomous reason for referral and a later first visit. Our data agreed with previous suggestions demonstrating a strong influence of latitude, sun exposure and ethnic background in the development of the number of nevi. To our knowledge, this is the first study, which evaluated the reasons for dermatological examination and the role of older parents’ populations in the decision to refer to a dermatological consultant
Collapse
|
62
|
Bernhard GH, Neale RE, Barnes PW, Neale PJ, Zepp RG, Wilson SR, Andrady AL, Bais AF, McKenzie RL, Aucamp PJ, Young PJ, Liley JB, Lucas RM, Yazar S, Rhodes LE, Byrne SN, Hollestein LM, Olsen CM, Young AR, Robson TM, Bornman JF, Jansen MAK, Robinson SA, Ballaré CL, Williamson CE, Rose KC, Banaszak AT, Häder DP, Hylander S, Wängberg SÅ, Austin AT, Hou WC, Paul ND, Madronich S, Sulzberger B, Solomon KR, Li H, Schikowski T, Longstreth J, Pandey KK, Heikkilä AM, White CC. Environmental effects of stratospheric ozone depletion, UV radiation and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2019. Photochem Photobiol Sci 2020; 19:542-584. [PMID: 32364555 PMCID: PMC7442302 DOI: 10.1039/d0pp90011g] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022]
Abstract
This assessment, by the United Nations Environment Programme (UNEP) Environmental Effects Assessment Panel (EEAP), one of three Panels informing the Parties to the Montreal Protocol, provides an update, since our previous extensive assessment (Photochem. Photobiol. Sci., 2019, 18, 595-828), of recent findings of current and projected interactive environmental effects of ultraviolet (UV) radiation, stratospheric ozone, and climate change. These effects include those on human health, air quality, terrestrial and aquatic ecosystems, biogeochemical cycles, and materials used in construction and other services. The present update evaluates further evidence of the consequences of human activity on climate change that are altering the exposure of organisms and ecosystems to UV radiation. This in turn reveals the interactive effects of many climate change factors with UV radiation that have implications for the atmosphere, feedbacks, contaminant fate and transport, organismal responses, and many outdoor materials including plastics, wood, and fabrics. The universal ratification of the Montreal Protocol, signed by 197 countries, has led to the regulation and phase-out of chemicals that deplete the stratospheric ozone layer. Although this treaty has had unprecedented success in protecting the ozone layer, and hence all life on Earth from damaging UV radiation, it is also making a substantial contribution to reducing climate warming because many of the chemicals under this treaty are greenhouse gases.
Collapse
Affiliation(s)
- G H Bernhard
- Biospherical Instruments Inc., San Diego, California, USA
| | - R E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - P W Barnes
- Biological Sciences and Environment Program, Loyola University, New Orleans, USA
| | - P J Neale
- Smithsonian Environmental Research Center, Edgewater, Maryland, USA
| | - R G Zepp
- United States Environmental Protection Agency, Athens, Georgia, USA
| | - S R Wilson
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - A L Andrady
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - A F Bais
- Department of Physics, Aristotle University of Thessaloniki, Greece
| | - R L McKenzie
- National Institute of Water & Atmospheric Research, Lauder, Central Otago, New Zealand
| | - P J Aucamp
- Ptersa Environmental Consultants, Faerie Glen, South Africa
| | - P J Young
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - J B Liley
- National Institute of Water & Atmospheric Research, Lauder, Central Otago, New Zealand
| | - R M Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - S Yazar
- Garvan Institute of Medical Research, Sydney, Australia
| | - L E Rhodes
- Faculty of Biology Medicine and Health, University of Manchester, and Salford Royal Hospital, Manchester, UK
| | - S N Byrne
- School of Medical Sciences, University of Sydney, Sydney, Australia
| | - L M Hollestein
- Erasmus MC, University Medical Center Rotterdam, Manchester, The Netherlands
| | - C M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - A R Young
- St John's Institute of Dermatology, King's College, London, London, UK
| | - T M Robson
- Organismal & Evolutionary Biology, Viikki Plant Science Centre, University of Helsinki, Helsinki, Finland
| | - J F Bornman
- Food Futures Institute, Murdoch University, Perth, Australia.
| | - M A K Jansen
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - S A Robinson
- Centre for Sustainable Ecosystem Solutions, University of Wollongong, Wollongong, Australia
| | - C L Ballaré
- Faculty of Agronomy and IFEVA-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - C E Williamson
- Department of Biology, Miami University, Oxford, Ohio, USA
| | - K C Rose
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - A T Banaszak
- Unidad Académica de Sistemas Arrecifales, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | - D -P Häder
- Department of Biology, Friedrich-Alexander University, Möhrendorf, Germany
| | - S Hylander
- Centre for Ecology and Evolution in Microbial Model Systems, Linnaeus University, Kalmar, Sweden
| | - S -Å Wängberg
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | - A T Austin
- Faculty of Agronomy and IFEVA-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - W -C Hou
- Department of Environmental Engineering, National Cheng Kung University, Tainan City, Taiwan, China
| | - N D Paul
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - S Madronich
- National Center for Atmospheric Research, Boulder, Colorado, USA
| | - B Sulzberger
- Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - K R Solomon
- Centre for Toxicology, School of Environmental Sciences, University of Guelph, Guelph, Canada
| | - H Li
- Institute of Atmospheric Environment, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - T Schikowski
- Research Group of Environmental Epidemiology, Leibniz Institute of Environmental Medicine, Düsseldorf, Germany
| | - J Longstreth
- Institute for Global Risk Research, Bethesda, Maryland, USA
| | - K K Pandey
- Institute of Wood Science and Technology, Bengaluru, India
| | - A M Heikkilä
- Finnish Meteorological Institute, Helsinki, Finland
| | - C C White
- , 5409 Mohican Rd, Bethesda, Maryland, USA
| |
Collapse
|
63
|
Alberg AJ, LoConte NK, Foxhall L, Weinstock MA, Gomez SL, Francisco M, Moushey EA, Gershenwald JE. American Society of Clinical Oncology Policy Statement on Skin Cancer Prevention. JCO Oncol Pract 2020; 16:490-499. [PMID: 32374709 DOI: 10.1200/jop.19.00585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Lewis Foxhall
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | |
Collapse
|
64
|
Janda M, Cust AE, Neale RE, Aitken JF, Baade PD, Green AC, Khosrotehrani K, Mar V, Soyer HP, Whiteman DC. Early detection of melanoma: a consensus report from the Australian Skin and Skin Cancer Research Centre Melanoma Screening Summit. Aust N Z J Public Health 2020; 44:111-115. [DOI: 10.1111/1753-6405.12972] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of MedicineThe University of Queensland
| | - Anne E. Cust
- Sydney School of Public Health and Melanoma Institute AustraliaThe University of Sydney New South Wales
| | | | | | | | - Adele C. Green
- QIMR Berghofer Medical Research Institute, Queensland
- CRUK Manchester Institute and University of ManchesterManchester Academic Health Sciences Centre UK
| | - Kiarash Khosrotehrani
- The University of Queensland Diamantina InstituteThe University of Queensland, Dermatology Research Centre Queensland
| | - Victoria Mar
- School of Public Health and Preventive MedicineMonash University Victoria
| | - H. Peter Soyer
- The University of Queensland Diamantina InstituteThe University of Queensland, Dermatology Research Centre Queensland
| | | |
Collapse
|
65
|
Abstract
In this article, we summarize the research that eventually led to the classification of the full ultraviolet (UV) radiation spectrum as carcinogenic to humans. We recall the pioneering works that led to the formulation of novel hypotheses on the reasons underlying the increasing burden of melanoma in light-skinned populations. It took long before having compelling evidence on the association between UV and melanoma, in particular, the importance of UV exposure during childhood for both the occurrence of melanoma and death. The role of UVA was established only after 2005. If molecular lesions caused by UV radiation are better known, the precise mechanism by which UV exposure drives melanoma occurrence and progression still needs to be elucidated. More research on the UV-melanoma relationships has led to more evidence-based sun-protection recommendations, especially for children, and to effective control of the artificial UV tanning fashion. Since around 1985-1995, the mortality because of melanoma has started to decrease in younger age groups in most light-skinned populations. If sun protection among children remain on top of public health agendas, there is a fairly great chance that melanoma mortality will stabilize and steadily decrease in all light-skinned populations. The introduction of effective therapies against metastatic disease will improve this reversal in mortality trends.
Collapse
Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health, International Prevention Research Institute (iPRI), Dardilly, France
| | | |
Collapse
|
66
|
Using Media to Promote Public Awareness of Early Detection of Kaposi's Sarcoma in Africa. JOURNAL OF ONCOLOGY 2020; 2020:3254820. [PMID: 32280342 PMCID: PMC7115145 DOI: 10.1155/2020/3254820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
Background Despite its hallmark cutaneous presentation, most Kaposi's sarcoma (KS) in Africa is diagnosed too late for effective treatment. Early diagnosis will only be achievable if patients with KS present earlier for care. We hypothesized that public awareness about KS can be enhanced through exposure to common media. Methods We developed educational messages regarding early detection of KS for the general African public portraying a three-part theme: “Look” (regularly examine one's skin/mouth), “Show” (bring to the attention of a healthcare provider any skin/mouth changes), and “Test” (ask for a biopsy for definitive diagnosis). We packaged the messages in three common media forms (comic strips, radio, and video) and tested their effect on increasing KS awareness among adults attending markets in Uganda. Participants were randomized to a single exposure to one of the media and evaluated for change in KS-related knowledge and attitudes. Results Among 420 participants, media exposure resulted in increased ability to identify KS (from 0.95% pretest to 46% posttest); awareness that anyone is at risk for KS (29% to 50%); belief that they may be at risk (63% to 76%); and knowledge that definitive diagnosis requires biopsy (23% to 51%) (all p < 0.001). Most participants (96%) found the media culturally appropriate. Conclusion Exposure to media featuring a theme of “Look,” “Show,” and “Test” resulted in changes in knowledge and attitudes concerning KS among the general public in Uganda. High incidence and poor survival of KS in Africa are an impetus to further evaluate these media, which are freely available online.
Collapse
|
67
|
Theile H, Moore J, Dunn N, Cossio D, Forristal CE, Green AC, Smithers BM. Regional nodal metastasis and 5-year survival in patients with thin melanoma in Queensland: a population-based study. ANZ J Surg 2020; 90:503-507. [PMID: 32162780 DOI: 10.1111/ans.15804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Optimal management of regional lymph nodes for thin cutaneous melanoma is uncertain. We evaluated regional lymph node involvement and 5-year melanoma-specific survival (MSS) in patients with thin (≤1 mm) primary melanoma. METHODS Patients with a melanoma, American Joint Committee on Cancer Staging 8th Edition pT1a (<0.8 mm) or pT1b (ulceration; and/or 0.8-1.0 mm), diagnosed during 2001-2015 were identified from the Queensland Oncology Repository. We extracted demographic, pathology and clinical details, including sentinel lymph node biopsy (SLNB), regional nodal dissection and nodal recurrence. Poisson regression was used to assess recurrence risk in patients who did not undergo SLNB. The 5-year MSS was calculated using the Kaplan-Maier method with Cox regression to compare survival outcomes according to SLNB performance. RESULTS Of the 27 824 eligible patients, 240 (0.9%) underwent SLNB. One hundred and seventy-eight patients (0.6%) without SLNB had nodal recurrence. Of the 4848 patients with a pT1b lesion, 166 (3.4%) had SLNB with 12 (7.2%) positive; of the remainder, 99 (2.1%) had clinical recurrence. Risk of recurrence was higher in males, nodular subtype and T1b lesions and lower if patients were aged >60 years. The 5-year MSS was similar for observed and SLNB cohorts (99.66% versus 98.92%) but worse for T1b lesions (98.90%) and clinical nodal recurrence (66.89%). CONCLUSION Overall prognosis for T1 melanoma is excellent with nodal involvement being rare. However, the American Joint Committee on Cancer 8th Edition T1b melanoma correlates with significantly worse 5-year MSS and increased regional nodal recurrence (notably for 0.8-1.0 mm lesions with ulceration). Further characterization of high-risk groups for nodal positivity that impacts patient outcome is needed for the pT1 melanoma cohort.
Collapse
Affiliation(s)
- Harrison Theile
- Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Julie Moore
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Nathan Dunn
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Danica Cossio
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Catherine E Forristal
- Queensland Melanoma Collaborative, Brisbane, Queensland, Australia.,Mater Research Institute, Brisbane, Queensland, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - B Mark Smithers
- Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland Melanoma Collaborative, Brisbane, Queensland, Australia.,Mater Research Institute, Brisbane, Queensland, Australia
| |
Collapse
|
68
|
Baade PD, Whiteman DC, Janda M, Cust AE, Neale RE, Smithers BM, Green AC, Khosrotehrani K, Mar V, Soyer HP, Aitken JF. Long-term deaths from melanoma according to tumor thickness at diagnosis. Int J Cancer 2020; 147:1391-1396. [PMID: 32067220 DOI: 10.1002/ijc.32930] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 12/20/2022]
Abstract
There is little long-term follow-up information about how the number of melanoma deaths and case fatality vary over time according to the measured thickness of melanoma at diagnosis. This population-based longitudinal cohort study examines patterns and trends in case fatality among 44,531 people in Queensland (Australia) diagnosed with a single invasive melanoma (International Classification of Diseases for Oncology, third revision [ICD-O-3], C44, Morphology 872-879) between 1987 and 2011, including 11,883 diagnosed between 1987 and 1996, with up to 20 years follow-up (to December 2016). The 20-year case fatality increased by thickness, with the percentage of melanoma deaths within 20 years of diagnosis being up to 4.8% for melanomas with measured thickness <0.80 mm, 10.6% for tumors 0.8 to <1.0 mm and generally more than 30% for melanomas measuring 3 mm and more. For melanomas <1.0 mm, most deaths occurred between 5 and 20 years after diagnosis, whereas for thicker melanomas the reverse was true with most deaths occurring within the first 5 years. Five-year case fatality decreased over successive calendar time periods for melanomas <1.0 mm, but not for melanomas ≥1.0 mm. These findings demonstrate that the time course for fatal melanomas varies markedly according to tumor thickness at diagnosis. Improved understanding of the patient factors and characteristics of melanomas, in addition to tumor thickness, which increase the likelihood of progression, is needed to guide clinical diagnosis, communication with patients and ongoing surveillance pathways of patients with potentially fatal lesions.
Collapse
Affiliation(s)
- Peter D Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia
| | - David C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne E Cust
- Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Bernard Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Kiarash Khosrotehrani
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
69
|
Gordon L, Olsen C, Whiteman DC, Elliott TM, Janda M, Green A. Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study. BMJ Open 2020; 10:e034388. [PMID: 32107270 PMCID: PMC7202703 DOI: 10.1136/bmjopen-2019-034388] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths. DESIGN Cost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses. SETTING Queensland, Australia. PARTICIPANTS Men and women with a mean age 50 years modelled for 30 years. INTERVENTIONS Daily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo. PRIMARY AND SECONDARY OUTCOMES Costs, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years. RESULTS Per 100 000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%). CONCLUSIONS Compared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.
Collapse
Affiliation(s)
- Louisa Gordon
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Olsen
- Cancer Control Group, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - David C Whiteman
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Cancer Control Group, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Thomas M Elliott
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adele Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- CRUK Manchester Institute and Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
70
|
McMeniman EK, Duffy DL, Jagirdar K, Lee KJ, Peach E, McInerney-Leo AM, De'Ambrosis B, Rayner JE, Smithers BM, Soyer HP, Sturm RA. The interplay of sun damage and genetic risk in Australian multiple and single primary melanoma cases and controls. Br J Dermatol 2020; 183:357-366. [PMID: 31794051 DOI: 10.1111/bjd.18777] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Skin phenotype, host genotype and ultraviolet (UV) damage play a role in the development of melanoma. OBJECTIVES To ascertain whether the level of UV damage at the site of melanomas was associated with genetic polymorphisms. METHODS Deep phenotyping was performed on 1244 individuals; 281 with multiple primary melanomas (MPMs), 304 with single primary melanoma (SPM) and 659 convenience controls. Genotype data was generated using the Illumina CoreExome microarray platform, assaying over 500 000 single-nucleotide polymorphisms. A subset of variants were combined to assess a polygenic risk score (PRS) for melanoma. RESULTS Most MPM cases were diagnosed in patients aged > 40 years, in sites with visible chronic UV damage. Women and those diagnosed at age ≤ 40 years were less likely to have perilesional UV damage. Patients with MPM had higher frequencies of MITF E318K, MC1R R-alleles and the ASIP risk haplotype. Individuals who had melanoma in a visibly UV-damaged site were more likely to carry MC1R rs75570604 [odds ratio (OR) 2·5], 9q31.2 rs10816595 (OR 1·4) and MTAP rs869329 (OR 1·4). These same alleles were more common in patients with MPM who were diagnosed at age ≤ 40 years. The mean PRS was significantly higher in MPM than in SPM and controls. Naevus count was comparable in early-onset MPM cases and those diagnosed at age > 40 years. CONCLUSIONS Our cohort demonstrated higher frequencies of previously reported alleles associated with melanoma. MPM melanomas more commonly occur in UV-damaged areas, and these individuals are more likely to carry MC1R red hair colour alleles. Awareness of the interplay of genetic vulnerability with UV damage can stratify risk and guide recommendations for melanoma screening. What's already known about this topic? Skin phenotype, host genotype and ultraviolet (UV) damage all play a role in melanoma development. One of the main risk factors is a personal history of melanoma; second and subsequent primary melanomas account for over 20% of all melanomas registered in Queensland. Multiple loci are associated with melanoma risk, including many low-penetrance loci, which may have a cumulatively significant risk. Population-wide screening programmes for melanoma are not yet economically viable. What does this study add? Patients diagnosed with melanoma at age ≤ 40 years were more likely than older patients to have melanomas in non-UV-damaged sites. Patients with multiple melanomas had higher frequencies of MITF E318K, MC1R R-alleles, and the ASIP extended risk haplotype than patients with single melanoma. CDKN2A, MC1R and MTAP variants were more frequent in patients who developed melanomas at a younger age, but also in those whose melanomas were all on visibly UV-damaged sites. What is the translational message? Incorporating these genetic findings into the known risk factors of skin phenotype and visible UV damage may allow for a more customized and economically feasible approach to early detection of melanoma, particularly in younger patients. Plain language summary available online.
Collapse
Affiliation(s)
- E K McMeniman
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D L Duffy
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - K J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - E Peach
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B De'Ambrosis
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,South East Dermatology, Annerley Square, Annerley, Brisbane, Queensland, Australia
| | - J E Rayner
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| |
Collapse
|
71
|
Hille DM. Differences in the incidence and mortality of melanoma between socioeconomic groups in the Australian state of Queensland: 2001–2016. J Dermatol 2020; 47:193-194. [DOI: 10.1111/1346-8138.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
|
72
|
de Wet J, Steyn M, Jordaan HF, Smith R, Claasens S, Visser WI. An Analysis of Biopsies for Suspected Skin Cancer at a Tertiary Care Dermatology Clinic in the Western Cape Province of South Africa. J Skin Cancer 2020; 2020:9061532. [PMID: 32411476 PMCID: PMC7204328 DOI: 10.1155/2020/9061532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Skin cancer is a growing health concern worldwide. It is the most common malignancy in South Africa and places a large burden on the public healthcare sector. There is a paucity of published scientific data on skin cancer in South Africa. OBJECTIVES To report the findings of biopsies performed in patients with suspected skin cancer attending the Tygerberg Academic Hospital (TAH) Dermatology outpatient department (OPD) in the Western Cape Province of South Africa. Methodology: A retrospective chart review identified all patients who underwent a biopsy for a suspected skin cancer diagnosis between September 2015 and August 2016 at the TAH dermatology OPD. RESULTS A total number of 696 biopsies from 390 participants were identified, of which 460 were histologically confirmed as malignant lesions. The proportion of clinically suspected skin cancers that were histologically confirmed as cancer was 68%. The most commonly occurring malignancies were basal cell carcinoma (BCC) (54.8%), squamous cell carcinoma (SCC) (18.9%), squamous cell carcinoma in-situ (SCCI) (8.0%), Kaposi's sarcoma (KS) (6.7%), malignant melanoma (MM) (6.1%), and keratoacanthoma (KA) (4.6%). The number needed to treat (NTT) for all cancers diagnosed and for MM was 1.5 and 4 respectively. BCC (89.3%) and KS (67.7%) was the most common skin cancer in the white and black population respectively. The ratio of BCC to SCC was 2.03. CONCLUSION This study provides valuable scientific data on the accuracy of skin cancer diagnosis, distribution and patient demographics in the Western Cape Province of South Africa, on which further research can be based. The study highlights the burden of skin cancer on this specific population group and calls for standardised reporting methods and increased surveillance of skin cancers.
Collapse
Affiliation(s)
- Johann de Wet
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Minette Steyn
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Henry F. Jordaan
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Rhodine Smith
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Saskya Claasens
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Willem I. Visser
- Division of Dermatology, Department of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
73
|
Schuurman MS, Hollestein LM, Bastiaannet E, Posthuma EF, van Akkooi AJ, Kukutsch NA, Aarts MJ, Wakkee M, Lemmens VE, Louwman MW. Melanoma in older patients: declining gap in survival between younger and older patients with melanoma. Acta Oncol 2020; 59:4-12. [PMID: 31347929 DOI: 10.1080/0284186x.2019.1643914] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Older people have the highest incidence of melanoma and the population in most Western countries is ageing. We evaluated how the gap in incidence and survival between younger and older patients has developed during the past decades.Material and methods: All patients diagnosed with cutaneous melanoma between 1989 and 2015 (n = 84,827) were identified from the Netherlands Cancer Registry. Elderly were defined as aged ≥70 years. Differences in patient and tumor characteristics were described, age-specific incidence rates were calculated, and relative survival (RS) and multivariable analyses estimating the Relative Excess Rate of dying (RER) were conductedResults: In older men, the melanoma age-standardized incidence increased from 18 to 103/100,000 person-years (py) between 1989 and 2015 and in older women from 23 to 70/100,000 py. In younger men and women, it increased from 8 to 21 and from 13 to 28/100,000 py, respectively. Median Breslow thickness declined from 1.8 to 1.1 mm and from 1.6 to 1.1 mm in older men and women (2003 versus 2015), and from 1.1 to 0.9 mm and 0.9 to 0.8 mm in younger men and women. In older men, 5-year RS increased from 67% (95% CI: 63%-72%) in 1989-1997 to 85% (95% CI: 83%-87%) in 2007-2015 and in older women from 81% (95% CI: 78%-85%) to 89% (95% CI: 87%-91%). In younger men and women, RS increased from 82% (95% CI: 81%-83%) to 90% (95% CI: 90%-91%) and from 92% (95% CI: 92%-93%) to 96% (95% CI: 95%-96%). After case-mix correction , older men and women no longer showed an improved survival over time (RER 2010-2015 versus 2003-2009: 0.97; 95% CI: 0.81-1.16 and 0.95; 95% CI: 0.79-1.16). Whereas in younger men and women survival remained improved (RER 0.75; 95% CI: 0.67-0.83 and 0.77; 95%CI: 0.67-0.89).Conclusion: The gap in melanoma incidence between younger and older people is increasing due to a strong increase in incidence in older adults. Disparities in survival are declining, related to a narrowing gap in Breslow thickness.
Collapse
Affiliation(s)
| | - Loes M. Hollestein
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Eduardus F.M. Posthuma
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Alexander J.C. van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Nicole A. Kukutsch
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Valery E.P.P. Lemmens
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | |
Collapse
|
74
|
Abstract
Melanoma and keratinocyte skin cancer (KSC) are the most common types of cancer in White-skinned populations. Both tumor entities showed increasing incidence rates worldwide but stable or decreasing mortality rates. Rising incidence rates of cutaneous melanoma (CM) and KSC are largely attributed to increasing exposure to ultraviolet (UV) radiation, the main causal risk factor for skin cancer.Incidence rates of KSC, comprising of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are much higher than that of melanoma. BCC development is mainly the cause of an intensive UV exposure in childhood and adolescence, while SCC development is related to chronic, cumulative UV exposure over decades. Although mortality is relatively low, KSC is an increasing problem for health care services causing significant morbidity.Cutaneous melanoma is rapidly increasing in White populations, with an estimated annual increase of around 3-7% over the past decades. In contrast to SCC, melanoma risk is associated with intermittent and chronic exposure to sunlight. The frequency of its occurrence is closely associated with the constitutive color of the skin and the geographical zone. Changes in outdoor activities and exposure to sunlight during the past 70 years are an important factor for the increasing incidence of melanoma. Mortality rates of melanoma show stabilization in the USA, Australia, and in European countries. In the USA even dropping numbers of death cases were recently reported, probably reflecting efficacy of the new systemic treatments.Among younger cohorts in some populations (e.g., Australia and New Zealand,), stabilizing or declining incidence rates of CM are observed, potentially caused by primary prevention campaigns aimed at reducing UV exposure. In contrast, incidence rates of CM are still rising in most European countries and in the USA. Ongoing trends towards thinner melanoma are largely ascribed to earlier detection.
Collapse
|
75
|
Glasziou PP, Jones MA, Pathirana T, Barratt AL, Bell KJ. Estimating the magnitude of cancer overdiagnosis in Australia. Med J Aust 2019; 212:163-168. [PMID: 31858624 PMCID: PMC7065073 DOI: 10.5694/mja2.50455] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022]
Abstract
Objectives To estimate the proportion of cancer diagnoses in Australia that might reasonably be attributed to overdiagnosis by comparing current and past lifetime risks of cancer. Design, setting, and participants Routinely collected Australian Institute of Health and Welfare national data were analysed to estimate recent (2012) and historical (1982) lifetime risks (adjusted for competing risk of death and changes in risk factors) of diagnoses with five cancers: prostate, breast, renal, thyroid cancers, and melanoma. Main outcome measure Difference in lifetime risks of cancer diagnosis between 1982 and 2012, interpreted as probable overdiagnosis. Results For women, absolute lifetime risk increased by 3.4 percentage points for breast cancer (invasive cancers, 1.7 percentage points), 0.6 percentage point for renal cancer, 1.0 percentage point for thyroid cancer, and 5.1 percentage points for melanoma (invasive melanoma, 0.7 percentage point). An estimated 22% of breast cancers (invasive cancers, 13%), 58% of renal cancers, 73% of thyroid cancers, and 54% of melanomas (invasive melanoma, 15%) were overdiagnosed, or 18% of all cancer diagnoses (8% of invasive cancer diagnoses). For men, absolute lifetime risk increased by 8.2 percentage points for prostate cancer, 0.8 percentage point for renal cancer, 0.4 percentage point for thyroid cancer, and 8.0 percentage points for melanoma (invasive melanoma, 1.5 percentage points). An estimated 42% of prostate cancers, 42% of renal cancers, 73% of thyroid cancers, and 58% of melanomas (invasive melanomas, 22%) were overdiagnosed, or 24% of all cancer diagnoses (16% of invasive cancer diagnoses). Alternative assumptions slightly modified the estimates for overdiagnosis of breast cancer and melanoma. Conclusions About 11 000 cancers in women and 18 000 in men may be overdiagnosed each year. Rates of overdiagnosis need to be reduced and health services should monitor emerging areas of overdiagnosis.
Collapse
Affiliation(s)
- Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD
| | | | | | - Katy Jl Bell
- Sydney School of Public Health, University of Sydney, Sydney, NSW
| |
Collapse
|
76
|
Claeson M, Baade P, Brown S, Soyer HP, Smithers BM, Green AC, Whiteman DC, Khosrotehrani K. Clinicopathological factors associated with death from thin (≤ 1·00 mm) melanoma. Br J Dermatol 2019; 182:927-931. [PMID: 31562769 DOI: 10.1111/bjd.18560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thin cutaneous melanomas (≤ 1·00 mm) are increasing worldwide, causing around a quarter of all melanoma deaths in the U.S.A. and Australia. Identification of predictive factors for potentially fatal thin melanomas could allow better use of resources for follow-up. OBJECTIVES To identify the clinicopathological factors associated with fatal thin melanomas. METHODS This large, nested case-case study extracted data from the population-based Queensland Cancer Registry, Australia. Our cohort consisted of Queensland residents aged 0-89 years who were diagnosed with a single, locally invasive thin melanoma (≤ 1·00 mm) between 1995 and 2014. Fatal cases (eligible patients who died from melanoma) were individually matched to three nonfatal cases (eligible patients who were not known to have died from melanoma) according to sex, age, year of diagnosis and follow-up interval. Using conditional logistic regression, we calculated odds ratios (ORs) for melanoma-specific death, adjusting for all collected clinicopathological variables. RESULTS In the cohort, 27 660 eligible patients were diagnosed with a single, thin melanoma. The final case-case series included 424 fatal cases and 1189 nonfatal cases. Fatal cases were sixfold as likely to arise on the scalp as on the back [OR 6·39, 95% confidence interval (CI) 2·57-15·92] and six times as likely to be of thickness 0·80-1·00 mm as of < 0·30 mm (OR 6·00, 95% CI 3·55-10·17). CONCLUSIONS Scalp location is a strong prognostic factor of death from thin melanoma. Further, this study provides support that melanomas with a thickness of 0·80-1·00 mm are the more hazardous thin lesions. Patients with these tumour characteristics require specific attention during follow-up. What's already known about this topic? Thin invasive melanomas (≤ 1·00 mm) contribute a substantial proportion of melanoma fatalities, owing to the high volume of disease. There is a need to find prognostic factors that will better identify fatal thin melanomas at the time of diagnosis. What does this study add? In this large population-based study, fatal thin tumours were sixfold as likely to be located on the scalp as on the back. Thin melanomas of 0·80-1·00 mm thickness were six times as likely to be associated with death as tumours < 0·30 mm. Scalp location and increasing thickness are strong predictive factors of fatal thin melanomas, indicating that patients with these tumour characteristics require close follow-up.
Collapse
Affiliation(s)
- M Claeson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Baade
- Cancer Council Queensland, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - S Brown
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - B M Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - A C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - D C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - K Khosrotehrani
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| |
Collapse
|
77
|
Tabbakh T, Volkov A, Wakefield M, Dobbinson S. Implementation of the SunSmart program and population sun protection behaviour in Melbourne, Australia: Results from cross-sectional summer surveys from 1987 to 2017. PLoS Med 2019; 16:e1002932. [PMID: 31593565 PMCID: PMC6782093 DOI: 10.1371/journal.pmed.1002932] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Australia has one of the highest skin cancer rates in the world. 'SunSmart' is a multi-component, internationally recognised community-wide skin cancer prevention program implemented in Melbourne, Australia, since summer 1988-1989. Following recent reductions in melanoma rates among younger Australian cohorts, the extent of behaviour change and the potential contribution of prevention programs to this decline in melanoma rates are of interest. Sun protection is a multifaceted behaviour. Measures previously applied to monitor change over time in preventive behaviour for this population focused on individual behaviours. The omission of multiple behaviours that reduce exposure to ultraviolet radiation (UV) may have led to underestimates of behaviour change, meriting further analysis of long-term trends to contribute to this debate. METHODS AND FINDINGS A population-based survey was conducted in Melbourne in the summer before SunSmart commenced (1987-1988) and across summers in 3 subsequent decades (1988-2017). During summer months, residents (14-69 years) were recruited to cross-sectional weekly telephone interviews assessing their tanning attitudes, sun protection behaviour, and sunburn incidence on the weekend prior to interview. Quotas were used to ensure the sample was proportional to the population by age and sex, while younger respondents were oversampled in some years. The majority of the respondents reported their skin was susceptible to sunburn. Changes in sun protection behaviour were analysed for N = 13,285 respondents in multivariable models, cumulating surveys within decades (1987-1988: N = 1,655; 1990s: N = 5,258; 2000s: N = 3,385; 2010s: N = 2,987) and adjusting for relevant ambient weather conditions and UV levels on weekend dates. We analysed specific and composite behaviours including a novel analysis of the use of maximal sun protection, which considered those people who stayed indoors during peak UV hours together with those people well-protected when outdoors. From a low base, use of sun protection increased rapidly in the decade after SunSmart commenced. The odds of use of at least 1 sun protection behaviours on summer weekends was 3 times higher in the 1990s than pre-SunSmart (adjusted odds ratio [AOR] 3.04, 95% CI 2.52-3.68, p < 0.001). There was a smaller increase in use of maximal sun protection including shade (AOR = 1.68, 95% CI 1.44-1.97, p < 0.001). These improvements were sustained into the 2000s and continued to increase in the 2010s. Inferences about program effects are limited by the self-reported data, the absence of a control population, the cross-sectional study design, and the fact that the survey was not conducted in all years. Other potential confounders may include increasing educational attainment among respondents over time and exposure to other campaigns such as tobacco and obesity prevention. CONCLUSIONS With an estimated 20-year lag between sun exposure and melanoma incidence, our findings are consistent with SunSmart having contributed to the reduction in melanoma among younger cohorts.
Collapse
|
78
|
Kostaki M, Plaka M, Stergiopoulou A, Kypreou K, Chardalia V, Chasapi V, Polydorou D, Stratigos A. Trends in epidemiology of melanoma in situ in Greece: data from a melanoma reference centre during the period 2000-2018. Br J Dermatol 2019; 182:811-813. [PMID: 31549388 DOI: 10.1111/bjd.18551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Kostaki
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - M Plaka
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - A Stergiopoulou
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - K Kypreou
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - V Chardalia
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - V Chasapi
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - D Polydorou
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| | - A Stratigos
- First Department of Dermatology-Venereology of Athens University, Andreas Syggros Hospital, Athens, Greece
| |
Collapse
|
79
|
Duffy D, Lee K, Jagirdar K, Pflugfelder A, Stark M, McMeniman E, Soyer H, Sturm R. High naevus count and
MC
1R
red hair alleles contribute synergistically to increased melanoma risk. Br J Dermatol 2019; 181:1009-1016. [DOI: 10.1111/bjd.17833] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 12/20/2022]
Affiliation(s)
- D.L. Duffy
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
- QIMR Berghofer Medical Research Institute Brisbane Qld Australia
| | - K.J. Lee
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
| | - K. Jagirdar
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
| | - A. Pflugfelder
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
- Department of Dermatology University Medical Center Tübingen Germany
| | - M.S. Stark
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
| | - E.K. McMeniman
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
- Department of Dermatology Princess Alexandra Hospital Brisbane Qld Australia
| | - H.P. Soyer
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
- Department of Dermatology Princess Alexandra Hospital Brisbane Qld Australia
| | - R.A. Sturm
- Dermatology Research Centre The University of Queensland Diamantina Institute The University of Queensland Brisbane Qld Australia
| |
Collapse
|
80
|
Curchin DJ, Forward E, Dickison P, Harris VR, McCormack CJ, Smith SD. The acceleration of melanoma in situ: A population-based study of melanoma incidence trends from Victoria, Australia, 1985-2015. J Am Acad Dermatol 2019; 80:1791-1793. [PMID: 31103160 DOI: 10.1016/j.jaad.2018.12.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/12/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022]
Affiliation(s)
- David J Curchin
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Emily Forward
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Philippa Dickison
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Victoria R Harris
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Saxon D Smith
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
81
|
Olsen CM, Miura K, Dusingize JC, Hosegood I, Brown R, Drane M, Clem P, Marsden J, Tinker R, Karipidis K, Coroneo M, Green AC. Melanoma incidence in Australian commercial pilots, 2011-2016. Occup Environ Med 2019; 76:462-466. [PMID: 31113813 DOI: 10.1136/oemed-2018-105676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Occupational exposure to cosmic and ultraviolet radiation may increase airline pilots' risk of cutaneous melanoma. Meta-analyses of available data show a higher than average incidence of melanoma in airline pilots, but the most recent systematic review revealed that few contemporary data are available. Moreover, all relevant studies have been conducted in Northern Hemisphere populations. We therefore aimed to examine if Australian commercial pilots have a raised incidence of melanoma compared with the general population. METHODS We examined all melanoma histologically diagnosed among Australian-licensed commercial pilots in the period 2011-2016 by manually reviewing de-identified data in the medical records system of the Australian Civil Aviation Safety Authority. We estimated age-specific incidence rates and compared these with corresponding population rates using standardised incidence ratios (SIRs) as measures of relative risk. Expected numbers were calculated by multiplying age- and calendar period-specific person-years (PYs) with corresponding rates from the entire Australian population; 95% CI were calculated assuming a Poisson distribution of the observed cases. RESULTS In this cohort of Australian-licensed commercial pilots observed for 91 370 PYs, 114 developed a melanoma (51 invasive, 63 in situ). More than 50% of melanomas occurred on the trunk, and the predominant subtype was superficial spreading melanoma. The SIR for invasive melanoma was 1.20 (95% CI 0.89 to 1.55) and for melanoma in situ, 1.39 (95% CI 1.08 to 1.78). CONCLUSION Australian-licensed commercial pilots have a modestly raised risk of in situ melanoma but no elevation of invasive melanoma compared with the general population.
Collapse
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kyoko Miura
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jean Claude Dusingize
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Peter Clem
- Civil Aviation Safety Authority, Canberra, Australia
| | | | - Rick Tinker
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia
| | - Ken Karipidis
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia
| | - Minas Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, Australia
| | - Adele C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,CRUK Manchester Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
82
|
Baykal Selcuk L, Aksu Arica D, Ates E, Yayli S, Bahadir S. Sun-protective behaviours of Turkish young adults. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:178-186. [PMID: 30648287 DOI: 10.1111/phpp.12450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/11/2018] [Accepted: 12/23/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The prevalence of skin cancers, including melanoma, has increased significantly in the past five decades. The main environmental factor implicated in their development is excessive sun exposure. Data on sun-protective behaviours in the Turkish population are very limited. OBJECTIVES We aim to assess sun protection behaviours and the prevalence of exposure through broad participation among a young adult population in a national university in Turkey. METHODS A multiple-choice questionnaire including 27 questions to evaluate sun protection behaviours was sent to e-mail addresses of all undergraduates. From 40 000 undergraduates, 17 769 of them were included in the study, with a response rate of 44.4%. RESULTS Sunscreen usage was the most preferred sun protection method, used by 64% of the study population, followed by the use of sunglasses (60%), tending to remain in the shade (49%), the use of a hat (34%) and wearing long-sleeved clothing (23%). Forty-four percentage of the students used at least two methods, whereas 7% did not use any sun protection method. The prevalence rates of the use of sunscreen, sunglasses, wearing long-sleeved clothing and preferring to remain in the shade in the summer were all significantly higher among women. In addition, the prevalence rates of the use of sunscreen and preferring to remain in the shade were higher among students in the faculty of medicine. CONCLUSION We found that when compared to the countries with the highest incidences of skin cancer, such as Australia and the United States, young adults in Turkey are protecting themselves more from the sun. This rate was even higher among women and faculty of medicine undergrads.
Collapse
Affiliation(s)
- Leyla Baykal Selcuk
- Department of Dermatology, School of Medicine, Karadeniz Techinical University, Trabzon, Turkey
| | - Deniz Aksu Arica
- Department of Dermatology, School of Medicine, Karadeniz Techinical University, Trabzon, Turkey
| | - Elif Ates
- Department of Family Medicine, School of Medicine, Karadeniz Techinical University, Trabzon, Turkey
| | - Savaş Yayli
- Department of Dermatology, School of Medicine, Karadeniz Techinical University, Trabzon, Turkey
| | - Sevgi Bahadir
- Department of Dermatology, School of Medicine, Karadeniz Techinical University, Trabzon, Turkey
| |
Collapse
|
83
|
Kimlin MG, Youlden DR, Brodie AM, DiSipio T, Youl P, Nair-Shalliker V, Baade PD. Risk of Second Primary Cancer in Survivors of In Situ Melanoma. J Invest Dermatol 2019; 139:842-847. [PMID: 30423330 DOI: 10.1016/j.jid.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/16/2018] [Accepted: 11/04/2018] [Indexed: 01/12/2023]
Abstract
Survivors of invasive melanoma have an increased risk of developing second primary cancers; however, similar risks associated with in situ melanoma have not been established. We evaluated 39,872 survivors of first primary in situ melanoma diagnosed from 1982 through 2012 in Queensland, Australia. Relative risk of second nonmelanoma primary cancers was estimated from standardized incidence ratios with 95% confidence intervals. A total of 4,823 (12%) in situ melanoma survivors developed a second primary cancer. A small increased risk (6%) compared with the general population was found. In those younger than 50 years, risk was increased by 14% for all cancers combined. In situ melanoma survivors had significantly increased risks of developing lip, thyroid, pancreatic, and brain cancers and decreased risks of head and neck, and lung cancers. Male in situ melanoma survivors had a significantly increased risk of prostate cancer; female survivors had an increased risk of thyroid cancer and lymphoid leukemia. Findings indicate that in situ melanoma may predict the diagnosis of certain second primary cancers. This altered risk may be due to biological, behavioral, or genetic factors or increased medical surveillance, and it requires further investigation, particularly among people younger than 50 years.
Collapse
Affiliation(s)
- Michael G Kimlin
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; Cancer Council Queensland, Spring Hill, Queensland, Australia.
| | - Danny R Youlden
- Cancer Council Queensland, Spring Hill, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Alison M Brodie
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Tracey DiSipio
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Philippa Youl
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Visalini Nair-Shalliker
- Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia; The University of Sydney, Sydney, Australia
| | - Peter D Baade
- Cancer Council Queensland, Spring Hill, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Mathematical Sciences, Queensland University of Technology, Queensland, Australia
| |
Collapse
|
84
|
Venning VL, Abbott LM, Fernandez-Peñas P. Public body consciousness is associated with positive tanning attitudes and behaviours regardless of gender or age. Australas J Dermatol 2018; 60:250-251. [PMID: 30575009 DOI: 10.1111/ajd.12974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Victoria L Venning
- The Skin Hospital (The Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa M Abbott
- The Skin Hospital (The Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Fernandez-Peñas
- The Skin Hospital (The Skin & Cancer Foundation Australia), Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
85
|
Risk factors for development of new skin neoplasms in patients with past history of skin cancer: A survival analysis. Sci Rep 2018; 8:15744. [PMID: 30356134 PMCID: PMC6200724 DOI: 10.1038/s41598-018-33763-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/27/2018] [Indexed: 11/08/2022] Open
Abstract
We conducted a retrospective study aiming to assess the risk, and associated risk factors, of developing subsequent skin cancers after having a first diagnosis of skin cancer. We included all patients with biopsy-proven skin cancer attending a dermatology clinic between July 2007 and July 2017. We assessed the frequency of new skin cancers, as well as potential demographic and clinical factors significantly associated with occurrence of such neoplasms, that were identified by means of a survival analysis. We analyzed 969 patients with a total of 1584 skin neoplasms (1122 basal cell carcinomas (BCC), 310 squamous cell carcinomas (SCC), 143 melanomas and 9 other neoplasms). 165 patients (17.0%) developed subsequent skin neoplasms. Factors identified in multivariable models to be significantly associated with development of new skin cancers included older age (adjusted HR = 1.04 per year; 95%CI = 1.02-1.05; p < 0.001), and presence of synchronous neoplasms (adjusted HR = 2.25; 95%CI = 1.61-3.14; p < 0.001). Having a history of a BCC was significantly associated with development of new BCC (adjusted HR = 1.63; 95%CI = 1.05-2.54; p = 0.030), while having a previous SCC was associated with occurrence of subsequent SCC (adjusted HR = 3.60; 95%CI = 1.93-6.72; p < 0.001). These findings point to the importance of careful follow-up (e.g., skin self-examination and full body examination) of skin cancer patients.
Collapse
|
86
|
Guitera P, Collgros H, Madronio CM, Goumas C, Mann GJ, Watts CG, Pereira AR, Armstrong BK, Drummond M, Morton RL, Scolyer RA, Menzies SW, Thompson JF, Cust AE. The steadily growing problem of lentigo maligna and lentigo maligna melanoma in Australia: Population-based data on diagnosis and management. Australas J Dermatol 2018; 60:118-125. [PMID: 30302753 DOI: 10.1111/ajd.12928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES There are limited population-based data documenting the incidence and management of lentigo maligna (LM) and invasive lentigo maligna melanoma (LMM). We report the data on occurrence and management of LM and LMM in an Australian population. METHODS Prospective collection of incidence and clinician-reported management of melanoma in situ (MIS; n = 450, capped) and localised invasive melanoma (n = 3251) notified to the New South Wales Cancer Registry over 12-months in 2006-2007. RESULTS The estimated annual incidence of all MIS was 27.0 per 100 000 (LM 12.2, non-LM MIS 5.9 and unclassified MIS 9.0). Patients with LM or LMM were on average approximately 10 years older than those with other melanoma subtypes (P < 0.001). The head and neck was the location of 59% of LM, 44% of LMM and <20% of other melanoma subtypes (P < 0.001). The majority of LM and LMM were treated only by specialists. Diagnostic partial biopsies were more frequent for LM and LMM than for other melanoma subtypes, and primary care physicians were more likely than specialists to do a punch partial biopsy than a shave biopsy. The reported median definitive excision margin for LM was 5.0 mm compared with 7.2 mm for non-LM MIS (P = 0.001). CONCLUSIONS In this Australian population, LM was twice as frequent as other types of MIS. Improved strategies for diagnosis and management are required.
Collapse
Affiliation(s)
- Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Helena Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christine M Madronio
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Goumas
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Caroline G Watts
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surveillance, Evaluation & Research Program, Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda R Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Dermatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Bruce K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Drummond
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Scott W Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Discipline of Surgery, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
87
|
Dimitriou F, Krattinger R, Ramelyte E, Barysch MJ, Micaletto S, Dummer R, Goldinger SM. The World of Melanoma: Epidemiologic, Genetic, and Anatomic Differences of Melanoma Across the Globe. Curr Oncol Rep 2018; 20:87. [PMID: 30250984 DOI: 10.1007/s11912-018-0732-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW As cancer remains an increasing problem in industrial countries, the incidence of melanoma has risen rapidly in many populations during the last decades and still continues to rise. Current strategies aiming to control the disease have largely focused on improving the understanding of the interplay of causal factors for this cancer. RECENT FINDINGS Cutaneous melanoma shows clear differences in incidence, mortality, genomic profile, and anatomic presentation, depending on the country of residence, ethnicity, and socioeconomic status. Known risk factors are multiple atypical nevi, positive family and/or personal history, immune suppressive diseases or treatments, and fair skin phenotype. Besides new adjuvant therapeutic options, changed attitude toward leisure and sun exposure, primary prevention, and early detection are major contributors to disease control. Melanoma is a disease of multifactorial causality and heterogeneous presentation. Its subtypes differ in origin, anatomical site, role of UV radiation, and mutational profile. Better understanding of these differences may improve prevention strategies and therapeutic developments.
Collapse
Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Regina Krattinger
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Marjam J Barysch
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Sara Micaletto
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland
| | - Simone M Goldinger
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland.
| |
Collapse
|
88
|
Duarte AF, Sousa-Pinto B, Freitas A, Delgado L, Costa-Pereira A, Correia O. Skin cancer healthcare impact: A nation-wide assessment of an administrative database. Cancer Epidemiol 2018; 56:154-160. [PMID: 30179829 DOI: 10.1016/j.canep.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin cancer is an important health concern, with an increasing incidence worldwide. OBJECTIVE To assess the clinical and economic burden of melanoma (MM) and non-melanoma skin cancer (NMSC) at public hospitals in mainland Portugal. METHODS We used an administrative database containing a registration of all hospitalizations and ambulatory episodes occurred in Portuguese public hospitals between 2011 and 2015. We assessed all episodes with associated diagnoses of MM or NMSC regarding neoplasm location, metastases occurrence, length of stay, in-hospital mortality and hospital costs. RESULTS We assessed 15,913 MM and 72,602 NMSC episodes. 14.3% of MM episodes presented with metastases, compared to 1.9% of NMSC episodes. Patients' median age was lower for MM (66 years) than NMSC (76 years). The trunk was the most common location for MM (32.5%), followed by the lower limbs (26.5%). NMSC presented with higher length of stay than MM (median 5 versus 4 days; p < 0.001), but with lower in-hospital mortality (7.3% versus 11.9%; p < 0.001). MM episodes had higher average hospital costs than NMSC episodes (1197.7 versus 1113.5 €; p < 0.001). Overall, NMSC episodes amounted a total of 80.8 million € in hospital costs versus 19.1 million € for MM episodes. CONCLUSION Skin neoplasms have substantial impact on healthcare services. NMSC is an important contributor to this burden. NMSC underreporting should be tackled and it should not be downplayed in skin cancer preventative strategies.
Collapse
Affiliation(s)
- A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.
| | - B Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - A Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - L Delgado
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| | - A Costa-Pereira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Porto, Portugal; Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Portugal
| |
Collapse
|
89
|
Czarnecki D. Immigration is the most likely reason for the generational change in melanoma incidence in Queensland, Australia. Int J Cancer 2018; 143:720-721. [PMID: 29490432 DOI: 10.1002/ijc.31348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 11/10/2022]
Affiliation(s)
- D Czarnecki
- Doctors' Care Network, 157 Scoresby Rd, Boronia, Australia
| |
Collapse
|
90
|
Aitken JF, Youlden DR, Baade PD, Soyer HP, Green AC, Smithers BM. In response to: Immigration is the most likely reason for the generational change in melanoma incidence in Queensland, Australia. Int J Cancer 2018; 143:722-723. [PMID: 29490433 DOI: 10.1002/ijc.31347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Mathematical Sciences, Queensland University of Technology, QLD, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Adèle C Green
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,CRUK Manchester Institute and Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester, United Kingdom.,Australian Skin and Skin Cancer Research Centre, Brisbane, QLD, Australia
| | - B Mark Smithers
- Princess Alexandra Hospital, Queensland Melanoma Project, Brisbane, QLD, Australia.,Discipline of Surgery, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
91
|
Elwood JM, Kim SJH, Ip KHK, Oakley A, Rademaker M. In situand invasive melanoma in a high-risk, New Zealand, population: A population-based study. Australas J Dermatol 2018; 60:38-44. [DOI: 10.1111/ajd.12884] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- J Mark Elwood
- School of Population Health; University of Auckland; Auckland New Zealand
| | - Stella J-H Kim
- School of Population Health; University of Auckland; Auckland New Zealand
| | - Ken H-K Ip
- Department of Medicine; Middlemore Hospital; Auckland New Zealand
| | - Amanda Oakley
- Waikato Clinical Campus; University of Auckland; Hamilton New Zealand
| | - Marius Rademaker
- Waikato Clinical Campus; University of Auckland; Hamilton New Zealand
| |
Collapse
|
92
|
Rayner JE, Laino AM, Nufer KL, Adams L, Raphael AP, Menzies SW, Soyer HP. Clinical Perspective of 3D Total Body Photography for Early Detection and Screening of Melanoma. Front Med (Lausanne) 2018; 5:152. [PMID: 29911103 PMCID: PMC5992425 DOI: 10.3389/fmed.2018.00152] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/02/2018] [Indexed: 11/28/2022] Open
Abstract
Melanoma incidence continues to increase across many populations globally and there is significant mortality associated with advanced disease. However, if detected early, patients have a very promising prognosis. The methods that have been utilized for early detection include clinician and patient skin examinations, dermoscopy (static and sequential imaging), and total body photography via 2D imaging. Total body photography has recently witnessed an evolution from 2D imaging with the ability to now create a 3D representation of the patient linked with dermoscopy images of individual lesions. 3D total body photography is a particularly beneficial screening tool for patients at high risk due to their personal or family history or those with multiple dysplastic naevi—the latter can make monitoring especially difficult without the assistance of technology. In this perspective, we discuss clinical examples utilizing 3D total body photography, associated advantages and limitations, and future directions of the technology. The optimal system for melanoma screening should improve diagnostic accuracy, be time and cost efficient, and accessible to patients across all demographic and socioeconomic groups. 3D total body photography has the potential to address these criteria and, most importantly, optimize crucial early detection.
Collapse
Affiliation(s)
- Jenna E Rayner
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Antonia M Laino
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kaitlin L Nufer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Laura Adams
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Anthony P Raphael
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
| |
Collapse
|