101
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Aydoğmuş-Öztürk F, Jahan H, Öztürk M, Günaydın K, Choudhary MI. Preclinical study of the medicinal plants for the treatment of malignant melanoma. Mol Biol Rep 2020; 47:5975-5983. [PMID: 32710386 DOI: 10.1007/s11033-020-05671-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Melanoma is the most aggressive type of skin cancer and originates from pigment-containing cells called melanocytes. The incidence of melanoma has been increasing worldwide. In the current study, the cytotoxic and photo-cytotoxic activities of different medicinal plants from Lamiaceae (Salvia cedronella, Salvia chionantha, and Salvia adenophylla), Asteraceae (Klasea kurdica, Klasea bornmuelleri, and Achillea millefolium), Apiaceae (Cuminum cyminum, and Anethum graveolens), and Polygonaceae (Rumex crispus) families were studied against HT 144 (Human malignant melanoma) cancer cell lines. The activities were performed by employing the MTT assay. Moreover, the apoptotic effects of the plant extracts were investigated by flow cytometry with annexin V/PI dual staining technique. The production of intracellular ROS by DCFH-DA technique and the effects of TNF-α secretion on apoptosis were also investigated. All plant extracts exhibited cytotoxic, and photo-cytotoxic effects against HT 144 cancer cells. Salvia species and Klasea species induced apoptosis via intracellular ROS generation secreted by TNF-α. On the other hand, A. millefolium, C. cyminum, A. graveolens, and R. crispus extracts induced apoptosis due to the intracellular generation of ROS, but, via the different pathway. In conclusion, this study indicates that the tested medicinal plant extracts have the potential in the treatment of melanoma.
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Affiliation(s)
- Fatma Aydoğmuş-Öztürk
- Department of Molecular Biology and Genetics, Faculty of Science, Istanbul University, 34134, Istanbul, Turkey.
- Köyceğiz Vocational School, Muğla Sıtkı Koçman University, 48800, Muğla, Turkey.
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
| | - Humera Jahan
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Mehmet Öztürk
- Department of Chemistry, Faculty of Sciences, Muğla Sıtkı Koçman University, 48121, Muğla, Turkey
| | - Keriman Günaydın
- Department of Molecular Biology and Genetics, Faculty of Science, Istanbul University, 34134, Istanbul, Turkey
| | - Muhammad Iqbal Choudhary
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, 21412, Saudi Arabia
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102
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Deinlein T, Michor C, Hofmann-Wellenhof R, Schmid-Zalaudek K, Fink-Puches R. Die Bedeutung von Ganzkörperfotografie und sequenzieller digitaler Dermatoskopie bei der Überwachung von Patienten mit erhöhtem Melanomrisiko. J Dtsch Dermatol Ges 2020; 18:692-698. [PMID: 32713154 DOI: 10.1111/ddg.14158_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Teresa Deinlein
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Carina Michor
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Rainer Hofmann-Wellenhof
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | | | - Regina Fink-Puches
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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103
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Li X, Wu W, Giovannucci E, Stampfer MJ, Gao X, Han J. Cutaneous nevi and internal cancer risk: Results from two large prospective cohorts of US women. Int J Cancer 2020; 147:14-20. [PMID: 31593602 DOI: 10.1002/ijc.32703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/08/2019] [Accepted: 09/11/2019] [Indexed: 12/29/2022]
Abstract
Elevated cutaneous nevus number has been linked to longer telomeres. Recently, a large systematic Mendelian randomization study identified a significant positive association between telomere length and risk of cancer. Here, we hypothesized that higher nevus count, as a phenotypic marker of longer telomere, may be associated with increased risk of internal cancer, and prospectively examined the association between nevus count and total as well as site-specific cancer risk among participants in the Nurses' Health Study (NHS, 1986-2012) and the Nurses' Health Study 2 (NHS2, 1989-2013) using Cox proportional hazards models. During 3,900,264 person-years of follow-up, we documented a total of 23,004 internal cancer cases (15,484 in the NHS and 7,520 in the NHS2). Compared to participants who had no nevi, the multivariate hazard ratios of total cancer (excluding skin cancer) were 1.06 (95% confidence interval [CI], 1.03-1.09) for women with 1-5 nevi, 1.08 (95% CI, 1.03-1.15) for those who had 6-14 nevi and 1.19 (95% CI, 1.05-1.35) for those with 15 or more nevi (p trend <0.0001). Moreover, because nevus count has been associated with risk of breast cancer previously, we conducted a secondary analysis by excluding breast cancer from the outcomes of interest. The results were very similar to those of our primary analysis. For individual cancer, most of the associations with nevus count were positive but not statistically significant. In conclusion, we identified the number of cutaneous nevi as a phenotypic marker associated with internal cancer risk, which may be explained by telomere biology.
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Affiliation(s)
- Xin Li
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN.,Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Wenting Wu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Xiang Gao
- Department of Nutritional Sciences, College of Health and Human Development, Pennsylvania State University, State College, PA
| | - Jiali Han
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN.,Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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104
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Haenssle HA. Hautkrebs‐Vorsorge bei Patienten mit erhöhtem Melanomrisiko. J Dtsch Dermatol Ges 2020; 18:663-664. [DOI: 10.1111/ddg.14144_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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105
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Deinlein T, Michor C, Hofmann-Wellenhof R, Schmid-Zalaudek K, Fink-Puches R. The importance of total-body photography and sequential digital dermatoscopy for monitoring patients at increased melanoma risk. J Dtsch Dermatol Ges 2020; 18:692-697. [PMID: 32597015 PMCID: PMC7496451 DOI: 10.1111/ddg.14158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The incidence of melanoma is rising and prevention plays an important role. Multiple nevi as well as a medical history of melanoma are important risk factors. In affected patients, a two-step algorithm consisting of total-body photography (TBP) and sequential digital dermatoscopy (SDD) is a helpful diagnostic tool. PATIENTS AND METHODS This was a retrospective observational study that lasted six years in order to evaluate the significance of the two-step algorithm. Cases were evaluated based on distinct dermoscopic patterns and statistical analyses were performed with the latest version of SPSS. RESULTS 6020 dermoscopic images of 214 patients were included. TBP was performed at a mean interval of 16.9 months (SD ± 1.43 months), while SDD was performed every 9.9 months (SD ± 1.68 months). The number needed to excise was 4.6 and the number needed to monitor was 548. Excisions were mostly performed because dynamic changes were observed. A total of eleven melanomas were detected and had a mean tumor thickness of 0.44 mm (SD ± 0.15 mm; range 0.2-0.6 mm). CONCLUSIONS Invasive melanomas had a tumor thickness of less than 0.6 mm, thus providing evidence of an effective strategy for early melanoma detection. Excisions of benign nevi were minimized as indicated by a low number needed to excise.
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Affiliation(s)
- Teresa Deinlein
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Carina Michor
- Department of Dermatology, Medical University of Graz, Graz, Austria
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106
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Scope A, Farnetani F, Haupt S, Schechtman E, Longo C, Pellacani G. Dermoscopic and clinical predictors of reflectance confocal microscopy patterns of typical nevi on the back and legs: A cross-sectional study. J Am Acad Dermatol 2020; 85:1240-1247. [PMID: 32534083 DOI: 10.1016/j.jaad.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nevus phenotype is a marker of melanoma risk. In vivo prediction of microscopic pattern is needed to more precisely classify nevi. OBJECTIVE To identify dermoscopic and clinical predictors of microscopic patterns of typical nevi. METHODS We used reflectance confocal microscopy (RCM) to classify microscopic patterns of nevi. We prospectively accrued adults presenting for periodic skin screening and imaged, with dermoscopy and RCM, 3 randomly selected nevi from the upper and lower back and lower extremity. RCM patterns were classified into ring, clod, meshwork, and composite types. Logistic regression was used to identify best predictors of RCM pattern. RESULTS The study included 310 nevi from 112 participants (mean age 44 years; 51 women). Dermoscopic reticular pattern correlated most frequently (59.9%) with RCM ring pattern, dermoscopic globular with RCM composite (56.6%) and RCM clod (35.9%), dermoscopic complex with RCM composite (76.3%), and dermoscopic homogenous with RCM clod (50.8%). Integrating dermoscopic pattern with contour, diameter, color, and anatomic location of nevi improved prediction of microscopic patterns beyond dermoscopy alone. The dermoscopic clinical regression model correctly classified lesions to RCM ring versus RCM clod in 90% and to RCM ring versus RCM composite patterns in 81%. LIMITATIONS The study was restricted to adults, back and lower extremities, and typical nevi. CONCLUSIONS Integrating dermoscopic patterns with clinical attributes may improve prediction of microscopic patterns of nevi.
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Affiliation(s)
- Alon Scope
- Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sara Haupt
- Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edna Schechtman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy; Azienda Unità Sanitaria Locale-Istituto Di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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107
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Trager MH, Geskin LJ, Samie FH, Liu L. Biomarkers in melanoma and non‐melanoma skin cancer prevention and risk stratification. Exp Dermatol 2020; 31:4-12. [DOI: 10.1111/exd.14114] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Megan H. Trager
- Department of Dermatology Columbia University Irving Medical Center New York NYUSA
| | - Larisa J. Geskin
- Department of Dermatology Columbia University Irving Medical Center New York NYUSA
| | - Faramarz H. Samie
- Department of Dermatology Columbia University Irving Medical Center New York NYUSA
| | - Liang Liu
- The Hormel Institute University of Minnesota Austin MNUSA
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108
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Vujic I, Gandini S, Stanganelli I, Fierro MT, Rappersberger K, Sibilia M, Tosti G, Ferrucci PF, Caini S, De Felici MB, Pagliarello C, Quaglino P, Sanlorenzo M. A meta-analysis of melanoma risk in industrial workers. Melanoma Res 2020; 30:286-296. [DOI: 10.1097/cmr.0000000000000531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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109
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Pastor-Tomás N, Martínez-Franco A, Bañuls J, Peñalver JC, Traves V, García-Casado Z, Requena C, Kumar R, Nagore E. Risk factors for the development of a second melanoma in patients with cutaneous melanoma. J Eur Acad Dermatol Venereol 2020; 34:2295-2302. [PMID: 32163215 DOI: 10.1111/jdv.16341] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous melanoma patients have an increased risk of developing other neoplasms, especially cutaneous neoplasms and other melanomas. Identifying factors associated with an increased risk might be useful in the development of melanoma guidelines. OBJECTIVES To identify risk factors related to the development of a second primary melanoma in a series of patients diagnosed with sporadic melanoma and to establish the estimated incidence rate. METHODS A longitudinal study based on prospective follow-up information of patients diagnosed with sporadic cutaneous melanoma at our centre from 2000 to 2015 was performed. Cumulative incidence was estimated based on competing risk models, and the association of characteristics with the risk of a second melanoma was performed by Cox proportional hazard models. RESULTS Out of 1447 patients included in the study, after a median follow-up of 61 months, 55 patients (3.8%) developed a second melanoma. Fair hair colour, more than 100 common melanocytic nevi and the presence of more than 50 cherry angiomas were independently associated with the development of a second melanoma. The site and the histological subtype of the first and second melanomas were not consistent. The second melanomas were thinner than the first ones. CONCLUSIONS Fair-haired and multiple-nevi patients might benefit from more intensive prevention measures. The finding of cherry angiomas as a risk factor suggests that these lesions could be markers of skin sun damage in the setting of certain degree of genetic susceptibility.
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Affiliation(s)
- N Pastor-Tomás
- Department of Dermatology, Hospital General Universitario de Elda, Alicante, Spain.,Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - A Martínez-Franco
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - J Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain.,Departament of Medicina Clínica, Universidad Miguel Hernández. Sant Joan D'Alacant, Alicante, Spain
| | - J C Peñalver
- Department of Thoracic Surgery, Instituto Valenciano de Oncología, València, Spain
| | - V Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Z García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - C Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - R Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - E Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain.,Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
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110
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Fraga-Braghiroli N, Grant-Kels JM, Oliviero M, Rabinovitz H, Ferenczi K, Scope A. The role of reflectance confocal microscopy in differentiating melanoma in situ from dysplastic nevi with severe atypia: A cross-sectional study. J Am Acad Dermatol 2020; 83:1035-1043. [PMID: 32442695 DOI: 10.1016/j.jaad.2020.05.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Melanoma in situ and dysplastic nevi with severe atypia present overlapping histopathologic features. Reflectance confocal microscopy findings can be integrated with the dermatopathology report to improve differentiation between melanoma and dysplastic nevi with severe atypia. OBJECTIVE To compare prevalence of reflectance confocal microscopy findings between melanoma in situ and dysplastic nevi with severe atypia. METHODS This retrospective observational study compared reflectance confocal microscopy findings in dermatopathologically diagnosed dysplastic nevi with severe atypia and melanoma in situ, collected between 2007 and 2017 at a private pigmented-lesion clinic. Concordant pathologic diagnosis was defined as unanimous agreement between 3 dermatopathologists who independently reviewed all cases; all other cases were classified as discordant. RESULTS The study included 112 lesions, 62 concordant melanomas in situ, 28 concordant dysplastic nevi with severe atypia, and 22 discordant lesions. In comparing reflectance confocal microscopy findings in concordant cases, melanoma in situ showed more frequently than dysplastic nevi with severe atypia the presence of epidermal atypical melanocytes as round cells (19/62 vs 0/28; P < .001) and dendritic cells (50/62 vs 6/28; P < .001), as well as a diffuse distribution of epidermal atypical melanocytes (50/54 vs 3/6; P = .002). In contrast, dysplastic nevi with severe atypia showed the presence of dense melanocytic nests more frequently than melanoma in situ did (15/28 vs 14/62; P = .003). LIMITATIONS The study was based on a limited number of lesions originating from a single clinic. CONCLUSIONS Reflectance confocal microscopy findings may help differentiate a subset of dysplastic nevi with severe atypia from melanoma in situ.
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Affiliation(s)
| | - Jane M Grant-Kels
- University of CT Dermatology Department, Farmington, Connecticut; University of Florida Dermatology Department, Gainesville, Florida
| | | | | | - Katalin Ferenczi
- University of CT Dermatology Department, Farmington, Connecticut
| | - Alon Scope
- The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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111
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Vuong K, Armstrong BK, Drummond M, Hopper JL, Barrett JH, Davies JR, Bishop DT, Newton-Bishop J, Aitken JF, Giles GG, Schmid H, Jenkins MA, Mann GJ, McGeechan K, Cust AE. Development and external validation study of a melanoma risk prediction model incorporating clinically assessed naevi and solar lentigines. Br J Dermatol 2020; 182:1262-1268. [PMID: 31378928 PMCID: PMC6997040 DOI: 10.1111/bjd.18411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Melanoma risk prediction models could be useful for matching preventive interventions to patients' risk. OBJECTIVES To develop and validate a model for incident first-primary cutaneous melanoma using clinically assessed risk factors. METHODS We used unconditional logistic regression with backward selection from the Australian Melanoma Family Study (461 cases and 329 controls) in which age, sex and city of recruitment were kept in each step, and we externally validated it using the Leeds Melanoma Case-Control Study (960 cases and 513 controls). Candidate predictors included clinically assessed whole-body naevi and solar lentigines, and self-assessed pigmentation phenotype, sun exposure, family history and history of keratinocyte cancer. We evaluated the predictive strength and discrimination of the model risk factors using odds per age- and sex-adjusted SD (OPERA) and the area under curve (AUC), and calibration using the Hosmer-Lemeshow test. RESULTS The final model included the number of naevi ≥ 2 mm in diameter on the whole body, solar lentigines on the upper back (a six-level scale), hair colour at age 18 years and personal history of keratinocyte cancer. Naevi was the strongest risk factor; the OPERA was 3·51 [95% confidence interval (CI) 2·71-4·54] in the Australian study and 2·56 (95% CI 2·23-2·95) in the Leeds study. The AUC was 0·79 (95% CI 0·76-0·83) in the Australian study and 0·73 (95% CI 0·70-0·75) in the Leeds study. The Hosmer-Lemeshow test P-value was 0·30 in the Australian study and < 0·001 in the Leeds study. CONCLUSIONS This model had good discrimination and could be used by clinicians to stratify patients by melanoma risk for the targeting of preventive interventions. What's already known about this topic? Melanoma risk prediction models may be useful in prevention by tailoring interventions to personalized risk levels. For reasons of feasibility, time and cost many melanoma prediction models use self-assessed risk factors. However, individuals tend to underestimate their naevus numbers. What does this study add? We present a melanoma risk prediction model, which includes clinically-assessed whole-body naevi and solar lentigines, and self-assessed risk factors including pigmentation phenotype and history of keratinocyte cancer. This model performs well on discrimination, the model's ability to distinguish between individuals with and without melanoma, and may assist clinicians to stratify patients by melanoma risk for targeted preventive interventions.
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Affiliation(s)
- K Vuong
- School of Public Health and Community Medicine, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - B K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M Drummond
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - J H Barrett
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J R Davies
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - D T Bishop
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J Newton-Bishop
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - G G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - H Schmid
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
| | - M A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - G J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - K McGeechan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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112
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113
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Stanganelli I, De Felici MB, Mandel VD, Caini S, Raimondi S, Corso F, Bellerba F, Quaglino P, Sanlorenzo M, Ribero S, Medri M, Farnetani F, Feliciani C, Pellacani G, Gandini S. The association between pesticide use and cutaneous melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2020; 34:691-708. [PMID: 31541557 DOI: 10.1111/jdv.15964] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/23/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND The incidence of cutaneous melanoma (CM), the deadliest form of skin cancer, has gradually increased in the last decades among populations of European origin. Epidemiological studies suggested that farmers and agricultural workers are at an increased risk of CM because they were exposed to pesticides. However, little is known about the relationship between pesticides and CM. OBJECTIVES To investigate the association between exposure to pesticides and CM by systematically reviewing the literature. Secondary aim was to determine the categories of pesticides mainly involved in CM development. METHODS A systematic review of the literature was performed up to September 2018 using MEDLINE, Embase and Web of Science. Studies assessing CM risk in licensed pesticide applicators were considered. Strict criteria were established to select independent studies and risk estimates; random effect models, taking into account heterogeneity, were applied. A pooled risk estimate for CM was calculated for the use of each type of pesticide and type of exposure. Between-study and estimate heterogeneity was assessed and publication bias investigated. RESULTS A total of nine studies (two case-controls and seven cohorts) comprising 184 389 unique subjects were included. The summary relative risks for the categories 'herbicides - ever exposure', 'insecticides - ever exposure', 'any pesticide - ever exposure' and 'any pesticide - high exposure' resulted 1.85 [95% confidence interval (CI): 1.01, 3.36], 1.57 (95% CI: 0.58, 4.25), 1.31 (95% CI: 0.85, 2.04) and 2.17 (95% CI: 0.45, 10.36), respectively. Herbicides and insecticides had no between-study heterogeneity (I2 = 0%), while a significant heterogeneity (I2 > 50%) was detected for the high exposure to any pesticide. No indication for publication bias was found. CONCLUSIONS Individuals exposed to herbicides are at an increased risk of CM. Future properly designed observational studies are required to confirm this finding.
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Affiliation(s)
- I Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola, Italy
- Dermatology Department, University of Parma, Parma, Italy
| | - M B De Felici
- Dermatology Department, University of Parma, Parma, Italy
| | - V D Mandel
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola, Italy
| | - S Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - S Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - F Corso
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - F Bellerba
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Sanlorenzo
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - S Ribero
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Medri
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola, Italy
| | - F Farnetani
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - C Feliciani
- Dermatology Department, University of Parma, Parma, Italy
| | - G Pellacani
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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114
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Elder DE, Bastian BC, Cree IA, Massi D, Scolyer RA. The 2018 World Health Organization Classification of Cutaneous, Mucosal, and Uveal Melanoma: Detailed Analysis of 9 Distinct Subtypes Defined by Their Evolutionary Pathway. Arch Pathol Lab Med 2020; 144:500-522. [PMID: 32057276 DOI: 10.5858/arpa.2019-0561-ra] [Citation(s) in RCA: 244] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— There have been major advances in the understanding of melanoma since the last revision of the World Health Organization (WHO) classification in 2006. OBJECTIVE.— To discuss development of the 9 distinct types of melanoma and distinguishing them by their epidemiology, clinical and histologic morphology, and genomic characteristics. Each melanoma subtype is placed at the end of an evolutionary pathway that is rooted in its respective precursor, wherever appropriate and feasible, based on currently known data. Each precursor has a variable risk of progression culminating in its fully evolved, invasive melanoma. DATA SOURCES.— This review is based on the "Melanocytic Tumours" section of the 4th edition of the WHO Classification of Skin Tumours, published in 2018. CONCLUSIONS.— Melanomas were divided into those etiologically related to sun exposure and those that are not, as determined by their mutational signatures, anatomic site, and epidemiology. Melanomas on the sun-exposed skin were further divided by the histopathologic degree of cumulative solar damage (CSD) of the surrounding skin, into low and high CSD, on the basis of degree of associated solar elastosis. Low-CSD melanomas include superficial spreading melanomas and high-CSD melanomas incorporate lentigo maligna and desmoplastic melanomas. The "nonsolar" category includes acral melanomas, some melanomas in congenital nevi, melanomas in blue nevi, Spitz melanomas, mucosal melanomas, and uveal melanomas. The general term melanocytoma is proposed to encompass "intermediate" tumors that have an increased (though still low) probability of disease progression to melanoma.
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Affiliation(s)
- David E Elder
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Boris C Bastian
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Ian A Cree
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Daniela Massi
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
| | - Richard A Scolyer
- From the Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia (Dr Elder); the Department of Dermatology, University of California San Francisco, San Francisco (Dr Bastian); International Agency for Research on Cancer, Lyon, France (Dr Cree); Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy (Dr Massi); and the Department of Pathology and Melanoma Institute Australia, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Scolyer)
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115
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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.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health, International Prevention Research Institute (iPRI), Dardilly, France
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116
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Iranzadasl M, Mansouri P, Kamalinejad M, Gorji N. Review of skin cancers terminology, etiology and treatment from ancient Persian medicine view point. JOURNAL OF MEDICINAL PLANTS 2020; 1:27-36. [DOI: 10.29252/jmp.1.73.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
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117
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Bastholt L, Bataille V, del Marmol V, Dréno B, Fargnoli MC, Grob JJ, Höller C, Kaufmann R, Lallas A, Lebbé C, Malvehy J, Middleton M, Moreno-Ramirez D, Pellacani G, Saiag P, Stratigos AJ, Vieira R, Zalaudek I, Eggermont AM. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics – Update 2019. Eur J Cancer 2020; 126:141-158. [DOI: 10.1016/j.ejca.2019.11.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
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118
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Kiuru M, Urban J, Zhu G, Rybak I, Terrell JR, Qi L, McPherson JD, Marghoob AA, Rauen KA. RAS pathway influences the number of melanocytic nevi in cardiofaciocutaneous and Costello syndromes. J Am Acad Dermatol 2020; 82:1091-1093. [PMID: 32001297 DOI: 10.1016/j.jaad.2020.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/20/2019] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Maija Kiuru
- Department of Dermatology, University of California, Davis, Sacramento; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento.
| | - Jennifer Urban
- Department of Dermatology, University of California, Davis, Sacramento
| | - Guannan Zhu
- Department of Dermatology, University of California, Davis, Sacramento; Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Iryna Rybak
- Department of Dermatology, University of California, Davis, Sacramento
| | - Jessica R Terrell
- Department of Dermatology, University of California, Davis, Sacramento
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, Sacramento
| | - John D McPherson
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York
| | - Katherine A Rauen
- Department of Pediatrics, University of California, Davis, Sacramento
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119
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Ultraviolet Radiation Exposure: Some Observations and Considerations, Focusing on Some Italian Experiences, on Cancer Risk, and Primary Prevention. ENVIRONMENTS 2020. [DOI: 10.3390/environments7020010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Solar ultraviolet radiation may cause acute and chronic health effects on the skin, eyes, and also on the immune system. Actinic keratosis, non-melanoma skin cancers, and malignant melanoma are the main long-term adverse skin effects. In the white population, the most common type of cancer worldwide is skin cancer, and the incidence of this cancer has increased during the last decades. The most important risk factor responsible for this trend seems to be Ultraviolet Radiation (UVR). IARC has classified UVR as being carcinogenic to humans. UV radiation exposure is ubiquitous; to study skin cancer risk, it is important to take into account the fact that UV exposure may occur both for occupational activities but also during vacation or recreational activities. Furthermore, exposure to artificial UVR such as those emitted by artificial devices, classified by IARC as carcinogenic to humans, is also to be considered. Due to the prominent role of UVR, primary prevention of skin cancer is very suitable, because when following specific rules this risk factor can be reduced. The incidence rate of skin cancer is higher in people with fair skin. Outdoor workers exposed to solar UVR are at risk of developing skin cancer, particularly non-melanoma skin cancers, and welders exposed to artificial UVR are at risk of developing ocular melanoma. A specific project on solar UVR risk in outdoor workers in Tuscany, Italy, has shown that outdoor workers had an unsatisfactory sun protection behaviour. The project demonstrates the complexity of studying UVR exposure and recommended the need for prevention programs. Risk increases with increasing ambient solar radiation and with unsafe behaviours in the sun or when using artificial UVR (e.g., sunbeds). Effective prevention strategies have to be adopted both for the outdoor workers and for the general population exposed to UVR. A standardized program of proven efficacy, such as that implemented in Australia, should also be implemented in other countries. All these strategies could contribute to the aim of decreasing the morbidity and mortality of cancers associated with this exposure. The aim of this paper is to provide an overview of UVR exposure risk, particularly occupational risk, and to give some elements to understand the complexity of the relation between UVR exposure and cancer risk, as well as to outline primary prevention measures, focusing also on Italian experiences that could be useful for providing additional elements of knowledge on this topic.
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120
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Abstract
Skin cancer, including melanoma, basal cell carcinoma and cutaneous squamous cell carcinoma, has one of the highest global incidences of any form of cancer. In 2016 more than 16,000 people were diagnosed with melanoma in the UK. Over the last decade the incidence of melanoma has increased by 50% in the UK, and about one in ten melanomas are diagnosed at a late stage. Among the keratinocyte carcinomas (previously known as non-melanoma skin cancers), basal cell carcinoma is the most common cancer amongst Caucasian populations. The main risk factor for all skin cancer is exposure to ultraviolet radiation-more than 80% are considered preventable. Primary care clinicians have a vital role to play in detecting and managing patients with skin lesions suspected to be skin cancer, as timely diagnosis and treatment can improve patient outcomes, particularly for melanoma. However, detecting skin cancer can be challenging, as common non-malignant skin lesions such as seborrhoeic keratoses share features with less common skin cancers. Given that more than 80% of skin cancers are attributed to ultraviolet (UV) exposure, primary care clinicians can also play an important role in skin cancer prevention. This article is one of a series discussing cancer prevention and detection in primary care. Here we focus on the most common types of skin cancer: melanoma, squamous cell carcinoma and basal cell carcinoma. We describe the main risk factors and prevention advice. We summarise key guidance on the symptoms and signs of skin cancers and their management, including their initial assessment and referral. In addition, we review emerging technologies and diagnostic aids which may become available for use in primary care in the near future, to aid the triage of suspicious skin lesions.
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Affiliation(s)
- Owain T Jones
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | | | - Per N Hall
- Addenbrookes Hospital NHS Foundation Trust, Cambridge, UK
| | - Garth Funston
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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121
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Abstract
While melanoma is less common than some other skin cancers, it is responsible for nearly 10,000 deaths in the USA each year alone. For many decades, very limited treatment options were available for patients with metastatic melanoma. However, recent breakthroughs have brought new hopes for patients and providers. While targeted therapy with BRAF and MEK inhibitors represents an important cornerstone in the treatment of metastatic melanoma, this chapter carefully reviews the past and current therapy options available, with a significant focus on immunotherapy-based approaches. In addition, we provide an overview of the results of recent advances in the adjuvant setting for patients with resected stage III and stage IV melanoma, as well as in patients with melanoma brain metastases. Finally, we provide a quick overview over the current research efforts in the field of immuno-oncology and melanoma.
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122
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Nuclear Medicine Imaging Techniques in Melanoma. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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123
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de Oliveira Filho RS, Soares AL, Paschoal FM, Rezze GG, Oliveira E, Macarenco R, Buzaid AC, Ferreira LM. Literature review of Notch melanoma receptors. SURGICAL AND EXPERIMENTAL PATHOLOGY 2019. [DOI: 10.1186/s42047-019-0052-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AbstractDespite the immunotherapeutics and target therapy agents, the survival of patients with advanced melanoma is still low. Notch signaling is able to regulate many aspects of melanomagenesis. Comparative analyses of common melanocytic nevi, dysplastic nevi and melanomas demonstrated increased expression of Notch1, Notch2 and their ligands, indicating that a positive regulation of these components may be related to the progression of melanoma. Some strategies such as gamma-secretase inhibitors (GSI) have been explored in patients with refractory metastatic disease or locally advanced disease of solid tumors. Two major classes of Notch inhibitors are currently in clinical development: GSI and monoclonal antibodies against Notch receptors or their ligands. Inhibition of Notch by GSI has been shown to decrease melanoma growth. GSI RO4929097 co-administered with cisplatin, vinblastine and temozolomide promotes greater elimination of tumor cells. The Notch pathway needs to be explored in the treatment of melanoma.
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124
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Fanconi anemia proteins counteract the implementation of the oncogene-induced senescence program. Sci Rep 2019; 9:17024. [PMID: 31745226 PMCID: PMC6863893 DOI: 10.1038/s41598-019-53502-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/31/2019] [Indexed: 12/27/2022] Open
Abstract
Fanconi Anemia (FA), due to the loss-of-function of the proteins that constitute the FANC pathway involved in DNA replication and genetic stability maintainance, is a rare genetic disease featuring bone marrow failure, developmental abnormalities and cancer predisposition. Similar clinical stigmas have also been associated with alterations in the senescence program, which is activated in physiological or stress situations, including the unscheduled, chronic, activation of an oncogene (oncogene induced senescence, OIS). Here, we wanted to determine the crosstalk, if any, between the FANC pathway and the OIS process. OIS was analyzed in two known cellular models, IMR90-hTERT/ER:RASG12V and WI38-hTERT/ER:GFP:RAF1, harboring 4-hydroxytamoxifen-inducible oncogenes. We observed that oncogene activation induces a transitory increase of both FANCA and FANCD2 as well as FANCD2 monoubiquitination, readout of FANC pathway activation, followed by their degradation. FANCD2 depletion, which leads to a pre-senescent phenotype, anticipates OIS progression. Coherently, FANCD2 overexpression or inhibition of its proteosomal-dependent degradation slightly delays OIS progression. The pro-senescence protease cathepsin L, which activation is anticipated during OIS in FANCD2-depleted cells, also participates to FANCD2 degradation. Our results demonstrate that oncogene activation is first associated with FANCD2 induction and activation, which may support initial cell proliferation, followed by its degradation/downregulation when OIS proceeds.
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125
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Abstract
The incidence of melanoma continues to increase worldwide. In the United States, melanoma is the fifth most common cancer in men and the sixth most common cancer in women. The risk factors contributing to melanoma have largely remained unchanged, but there is a new focus on modifiable risk factors including sun exposure and ultraviolet light. A large public initiative supported by the Centers for Disease Control focuses on educating the public on the risks of sun exposure and indoor tanning. Early detection and resection of melanoma lesions is necessary to prevent metastasis and reduce medical costs.
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Affiliation(s)
- Stephanie Carr
- General Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Christy Smith
- General Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Jessica Wernberg
- General Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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126
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Ribero S. Synergy between
MC
1R
mutations and a high naevus count in increasing melanoma risk in the general population. Br J Dermatol 2019; 181:889-890. [DOI: 10.1111/bjd.18301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Ribero
- Dermatologic Clinic, Department of Medical Sciences University of Torino Torino Italy
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127
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Ozola A, Ruklisa D, Pjanova D. The complementary effect of rs1042522 in TP53 and rs1805007 in MC1R is associated with an elevated risk of cutaneous melanoma in Latvian population. Oncol Lett 2019; 18:5225-5234. [PMID: 31612033 PMCID: PMC6781780 DOI: 10.3892/ol.2019.10906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/30/2019] [Indexed: 11/06/2022] Open
Abstract
Genetic factors serve important roles in melanoma susceptibility. Although much genetic variation has been associated with cutaneous melanoma (CM), little is known about the interactions between genetic variants. The current study investigated the joint effect of rs1042522 in the tumour protein 53 (TP53) gene, rs2279744 in the murine double minute-2 (MDM2) gene and several single nucleotide polymorphisms (SNPs) in the melanocortin 1 receptor (MC1R) gene. All of these genes are interconnected in a single signalling pathway that regulates pigmentation. The current study included 479 individuals, of which, 255 were patients with CM and 224 were controls from the Latvian population. Multifaceted analyses of potential interactions between SNPs were performed, whilst taking into account the pigmentation phenotypes of individuals and tumour characteristics (Breslow thickness and ulceration). Univariate analyses revealed a borderline significant association between rs1042522 in the TP53 gene and CM risk. The results also confirmed a known association with rs1805007 in the MC1R gene. The rs1042522 was also selected as a CM risk factor in multivariate models, suggesting an effect that is independent from and complementary to that of rs1805007. The results indicated that these SNPs need to be taken into account when determining melanoma risk. A strong association between CM and red hair was identified for rs1805007, and rs1805008 in the MC1R gene was mainly associated with red hair. An association was also determined between rs2279744 in the MDM2 gene and brown eye colour. No convincing associations were identified between the analysed SNPs and Breslow thickness of tumours or ulcerations.
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Affiliation(s)
- Aija Ozola
- Latvian Biomedical Research and Study Centre, Riga LV-1067, Latvia
| | - Dace Ruklisa
- Newnham College, University of Cambridge, Cambridge CB3 9DF, United Kingdom
| | - Dace Pjanova
- Latvian Biomedical Research and Study Centre, Riga LV-1067, Latvia
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128
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Mir JF, Estrada-Campmany M, Heredia A, Rodríguez-Caba C, Alcalde M, Espinosa N, Monnier J, Pérez-Anker J, Yélamos O, Puig S, Bosch N, Malvehy J. Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain. Pharm Pract (Granada) 2019; 17:1455. [PMID: 31592287 PMCID: PMC6763307 DOI: 10.18549/pharmpract.2019.3.1455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/28/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Skin cancer incidence is increasing alarmingly, despite current efforts
trying to improve its early detection. Community pharmacists have proven
success in implementing screening protocols for a number of diseases because
of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the
photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a
descriptive cross-sectional study to assess photoprotection habits and skin
cancer risk factors by using a validated questionnaire in 218 community
pharmacies in Barcelona from May 23rd to June 13th
2016. All participants received health education on photoprotection and skin
cancer prevention. Patients with ≥1 skin cancer risk factor were
referred to their physician, as they needed further screening of skin
cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2%
participants had received a total body skin examination for skin cancer
screening in the past by a physician and 57.1% reported using a SPF
50+ sunscreen. 53.9% participants presented ≥1 skin cancer
risk factor: 11.8% participants reported having skin cancer familial
history and 6.2% reported skin cancer personal history; pharmacists
found ≥10 melanocytic nevi in 43.8% participants and
chronically sun-damaged skin in 21.4%. Lesions suspicious for
melanoma were reported in 10.9% of the participants and urgent
dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their
users. This intervention can be considered in multidisciplinary strategies
of skin cancer screening.
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Affiliation(s)
- Joan F Mir
- Consultant Pharmacist in Research and Projects Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Maria Estrada-Campmany
- Consultant Pharmacist in Research and Projects Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Anna Heredia
- Professional Relations Manager. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Cristina Rodríguez-Caba
- Head of Department of Continuous Professional Development. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Marta Alcalde
- Community Pharmacist. Dermopharmacy and Medical Devices Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Natalia Espinosa
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Jilliana Monnier
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Javiera Pérez-Anker
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Oriol Yélamos
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona (Spain).
| | - Susana Puig
- Dermatologist. Melanoma Unit, Dermatology Department, IDIBAPS-Hospital Clinic. Barcelona; & Biomedical Research Networking Centers Consortium, Institute of Health Carlos III (CIBER-ISCIII). Barcelona (Spain).
| | - Núria Bosch
- Community Pharmacist. Dermopharmacy and Medical Devices Area. Barcelona Pharmacists Association (COFB). Barcelona (Spain).
| | - Josep Malvehy
- Dermatologist. Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS).Centro de Investigación Biomédica en Red (CIBER), Instituto Carlos III, Barcelona (Spain).
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129
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Cust A, Drummond M, Bishop D, Azizi L, Schmid H, Jenkins M, Hopper J, Armstrong B, Aitken J, Kefford R, Giles G, Demenais F, Goldstein A, Barrett J, Kanetsky P, Elder D, Mann G, Newton‐Bishop J. Associations of pigmentary and naevus phenotype with melanoma risk in two populations with comparable ancestry but contrasting levels of ambient sun exposure. J Eur Acad Dermatol Venereol 2019; 33:1874-1885. [PMID: 31087403 PMCID: PMC6800761 DOI: 10.1111/jdv.15680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND People at high risk of developing melanoma are usually identified by pigmentary and naevus phenotypes. OBJECTIVE We examined whether associations of these phenotypes with melanoma risk differed by ambient sun exposure or participant characteristics in two population-based, case-control studies with comparable ancestry but different ambient sun exposure. METHODS Data were analysed from 616 cases and 496 controls from the Australian Melanoma Family Study and 2012 cases and 504 controls from the Leeds (UK) case-control study. Questionnaire, interview and dermatological skin examination data were collected using the same measurement protocols. Relative risks were estimated as odds ratios using unconditional logistic regression, adjusted for potential confounders. RESULTS Hair and skin colour were the strongest pigmentary phenotype risk factors. All associations of pigmentary phenotype with melanoma risk were similar across countries. The median number of clinically assessed naevi was approximately three times higher in Australia than Leeds, but the relative risks for melanoma associated with each additional common or dysplastic naevus were higher for Leeds than Australia, especially for naevi on the upper and lower limbs. Higher naevus counts on the head and neck were associated with a stronger relative risk for melanoma for women than men. The two countries had similar relative risks for melanoma based on self-reported naevus density categories, but personal perceptions of naevus number differed by country. There was no consistent evidence of interactions between phenotypes on risk. CONCLUSIONS Classifying people at high risk of melanoma based on their number of naevi should ideally take into account their country of residence, type of counts (clinical or self-reported), body site on which the naevus counts are measured and sex. The presence of naevi may be a stronger indicator of a genetic predisposition in the UK than in Australia based on less opportunity for sun exposure to influence naevus development.
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Affiliation(s)
- A.E. Cust
- Cancer Epidemiology and Prevention ResearchSydney School of Public HealthThe University of SydneySydneyAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
| | - M. Drummond
- Cancer Epidemiology and Prevention ResearchSydney School of Public HealthThe University of SydneySydneyAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
| | - D.T. Bishop
- Section of Epidemiology and BiostatisticsLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
| | - L. Azizi
- School of Mathematics and StatisticsThe University of SydneySydneyAustralia
| | - H. Schmid
- Centre for Cancer ResearchWestmead Institute for Medical ResearchThe University of SydneySydneyAustralia
| | - M.A. Jenkins
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - J.L. Hopper
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - B.K. Armstrong
- Cancer Epidemiology and Prevention ResearchSydney School of Public HealthThe University of SydneySydneyAustralia
| | - J.F. Aitken
- Viertel Centre for Research in Cancer ControlCancer Council QueenslandBrisbaneAustralia
| | - R.F. Kefford
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
- Macquarie University Health Sciences CentreMacquarie UniversitySydneyAustralia
| | - G.G. Giles
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
- Cancer Epidemiology CentreCancer Council VictoriaMelbourneAustralia
| | - F. Demenais
- Genetic Variation and Human Diseases UnitUMR‐946INSERMUniversité Paris DiderotUniversité Sorbonne Paris CitéParisFrance
| | - A.M. Goldstein
- Human Genetics ProgramDivision of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaMDUSA
| | - J.H. Barrett
- Section of Epidemiology and BiostatisticsLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
| | - P.A. Kanetsky
- Cancer Epidemiology ProgramMoffitt Cancer CenterTampaFLUSA
| | - D.E. Elder
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - G.J. Mann
- Melanoma Institute AustraliaThe University of SydneySydneyAustralia
- Centre for Cancer ResearchWestmead Institute for Medical ResearchThe University of SydneySydneyAustralia
| | - J.A. Newton‐Bishop
- Section of Epidemiology and BiostatisticsLeeds Institute of Cancer and PathologyUniversity of LeedsLeedsUK
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130
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Hornberger J, Siegel DM. Economic Analysis of a Noninvasive Molecular Pathologic Assay for Pigmented Skin Lesions. JAMA Dermatol 2019; 154:1025-1031. [PMID: 29998292 DOI: 10.1001/jamadermatol.2018.1764] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A recently described noninvasive gene expression test (the pigmented lesion assay [PLA]) with adhesive patch-based sampling has the potential to rule out melanoma and the need for surgical biopsy of pigmented lesions suggestive of melanoma with a negative predictive value of 99% compared with 83% for the histopathologic standard of care. The cost implications of using this molecular test vs visual assessment followed by biopsy and histopathologic assessment (VAH) have not been evaluated. Objective To determine potential cost savings of PLA use vs the VAH pathway. Design, Setting, and Participants This health economic analysis performed from a US payer perspective was based on consensus treatment guidelines and fee schedules from the Centers for Medicare & Medicaid Services. Data for model input were derived from routine use of the test in US dermatology practices and literature. Participants included patients with primary cutaneous pigmented lesions suggestive of melanoma. Data were analyzed from February 8 to December 1, 2017. Main Outcomes and Measures The primary analysis consisted of the relative reduction in costs of diagnostic surgical procedures for PLA vs VAH management. Additional analyses included stage-related treatment costs associated with delays in diagnosis. Results In the cost analysis for this economic model, the relative reduction in surgical procedure costs (biopsy and subsequent excision), assuming $0 for the PLA to facilitate multiple comparison scenarios, was -$395 compared with VAH. The relative reduction in stage-related treatment costs associated with the PLA was -$433 compared with VAH, primarily associated with avoidance of delays due to false-negative diagnoses. Surveillance costs were reduced by -$119 with the PLA. The total cost of fully adjudicating a lesion suggestive of melanoma by VAH was $947. At a mean selling price reference point for PLA of $500, cost savings of $447 (47%) per lesion tested could be realized. Conclusions and Relevance The results of this analysis suggest that the PLA reduces cost and may improve the care of patients with primary pigmented skin lesions suggestive of melanoma.
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Affiliation(s)
- John Hornberger
- Department of Internal Medicine, Stanford University, Stanford, California.,Cedar Associates, Menlo Park, California
| | - Daniel M Siegel
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn.,Department of Dermatology, Brooklyn Veterans Administration Medical Center, Brooklyn, New York
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131
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Jeong DK, Bae YC, Lee SJ, Kim HS, Choi YJ. A case of malignant melanoma after repeated recurrent dysplastic nevi. Arch Craniofac Surg 2019; 20:260-264. [PMID: 31462019 PMCID: PMC6715558 DOI: 10.7181/acfs.2019.00283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/11/2019] [Indexed: 11/11/2022] Open
Abstract
Dysplastic nevus is common and affects about 10% of the northern European-descendent population. Studies over the past several decades have identified dysplastic nevi as a risk factor for malignant melanoma. Furthermore, in rare cases, they confirmed that dysplastic nevi have progressed to melanoma. Cases in which dysplastic nevi progressed to malignant melanoma in multiple studies are not uncommon. A 35-year-old woman presented with the major symptom of multiple itchy brown nodules (2.0 cm× 1.3 cm) in the left cheek that had first appeared 20 years earlier. Complete excision was performed at the first visit; subsequent biopsy confirmed that they were dysplastic nevi. They recurred three times over 3 years at the same site, all of which were histologically diagnosed as dysplastic nevi. Five years after the final excision, a brownish nodule developed in the left cheek, with others at the left temporal region, right retroauricular region, and left shoulder at the same time. These lesions were histologically diagnosed as malignant melanoma. We experienced a case of malignant melanoma that occurred at the same site after three recurrences of dysplastic nevi. Although rare, the possibility of malignant melanoma should be considered in follow-ups in cases involving repeatedly recurrent dysplastic nevi.
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Affiliation(s)
- Dae Kyun Jeong
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - So Jeong Lee
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Hoon Soo Kim
- Department of Dermatology, Pusan National University School of Medicine, Busan, Korea
| | - Young Jin Choi
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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132
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An 18-year Study of Malignant Melanoma in Childhood and Adolescence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2338. [PMID: 31592003 PMCID: PMC6756637 DOI: 10.1097/gox.0000000000002338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/08/2019] [Indexed: 12/02/2022]
Abstract
Malignant melanoma is rare in childhood and adolescence. Diagnostic uncertainty and misdiagnosis often lead to delayed treatment.
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133
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Visconti A, Ribero S, Sanna M, Spector TD, Bataille V, Falchi M. Body site-specific genetic effects influence naevus count distribution in women. Pigment Cell Melanoma Res 2019; 33:326-333. [PMID: 31403758 DOI: 10.1111/pcmr.12820] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 02/05/2023]
Abstract
Body site is highly relevant for melanoma: it affects prognosis and varies according to the patient's sex. The distribution of naevi, a major risk factor for melanoma, at different body sites also varies according to sex in childhood. Using naevus counts at different body sites in 492 unrelated adults from both sexes, we observed that women have an increased number of naevi on the lower limbs compared to men (p = 8.5 × 10-5 ), showing that a high naevus count on this site persists from childhood throughout life. Then, using data from 3,232 twins, we observed, in women, the lowest naevus count heritability on the trunk (26%), and the highest on the lower limbs (69%). Finally, we showed that, in 2,864 women, six genomic loci previously associated with both naevus count and melanoma risk (IRF4, DOCK8, MTAP, 9q31.2, KITLG and PLA2G6) have an effect on naevus count that is body site-specific, but whose effect sizes are predominantly stronger on the lower limbs. Sex-specific genetic influence on naevus count at different sites may explain differences in site-specific melanoma incidence as well as prognosis between sexes.
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Affiliation(s)
- Alessia Visconti
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Marianna Sanna
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Veronique Bataille
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.,Department of Dermatology, West Herts NHS Trust, Herts, UK
| | - Mario Falchi
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
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134
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Calbet-Llopart N, Potrony M, Tell-Martí G, Carrera C, Barreiro A, Aguilera P, Podlipnik S, Puig S, Malvehy J, Puig-Butillé JA. Detection of cell-free circulating BRAF V 600E by droplet digital polymerase chain reaction in patients with and without melanoma under dermatological surveillance. Br J Dermatol 2019; 182:382-389. [PMID: 31102256 DOI: 10.1111/bjd.18147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The p.V600E mutation in the BRAF protein is the most frequent mutation in cutaneous melanoma and is a recurrent alteration found in common benign naevi. Analysis of the cell-free BRAF c.1799T>A, p.V600E mutation (cfBRAFV 600E ) in plasma has emerged as a biomarker for monitoring prognosis and treatment response in patients with melanoma. OBJECTIVES To quantify cfBRAFV 600E levels in plasma from patients with melanoma and from patients without melanoma undergoing regular follow-up of their melanocytic lesions, in order to assess the clinical significance of the test. METHODS We quantified cfBRAFV 600E by droplet digital polymerase chain reaction in plasma from 146 patients without melanoma undergoing continuous dermatological screening, from 26 stage III and seven stage IV patients with BRAF-mutant melanoma, and from 32 patients with melanoma who were free of disease for 3 or more years. RESULTS Among disease-free patients and individuals without melanoma, 52% presented a high naevus count (> 50) and 49% had clinically atypical naevi. cfBRAFV 600E was detected in 71% of patients with stage IV melanoma and 15% with stage III, and in 1·4% of individuals without melanoma. No cfBRAFV 600E mutation was detected in disease-free patients with melanoma. Individuals without melanoma had lower cfBRAFV 600E levels than patients with melanoma. We established a variant allelic frequency of 0·26% or 5 copies mL-1 of cfBRAFV 600E as the optimal cutoff value for identifying patients with melanoma with > 99% specificity. CONCLUSIONS This study suggests that naevus-related factors do not influence the detection of cfBRAFV 600E in individuals without melanoma, and supports the clinical diagnostic value of plasma cfBRAFV 600E quantification in patients with melanoma. What's already known about this topic? The analysis of the BRAF c.1799T>A (p.V600E) mutation in cell-free (cf)DNA has emerged as a potential biomarker for monitoring prognosis and treatment response in patients with metastatic BRAFV600E melanoma. The BRAFV600E alteration is a common genetic alteration found in benign proliferations such as melanocytic naevi. No information exists about the impact of the number of common acquired naevi or the presence of clinically atypical naevi in cfBRAFV600E detection in an individual. What does this study add? The cfBRAFV600E mutation is detected in plasma from a reduced number of individuals without melanoma undergoing continuous dermatological follow-up. A high number of naevi or the presence of clinically atypical naevi are factors that do not influence cfBRAFV600E detection in an individual. Both total cfBRAF concentration and cfBRAFV600E frequency are effective biomarkers in patients with advanced melanoma but not in patients at early stages or with micrometastases. What is the translational message? Detection of cfBRAFV600E in an individual is not influenced by naevus-related factors. cfBRAFV600E is a robust and reliable biomarker that can be used in dermatological surveillance programmes.
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Affiliation(s)
- N Calbet-Llopart
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M Potrony
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - G Tell-Martí
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - C Carrera
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - A Barreiro
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - P Aguilera
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - S Podlipnik
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - J Malvehy
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - J A Puig-Butillé
- Molecular Biology CORE Laboratory, Biochemistry and Molecular Genetics Department; Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
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135
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Diehl K, Görig T, Osenbrügge N, Schilling L, Greinert R, Schneider S. Optimistisch verzerrte Wahrnehmung des eigenen Hautkrebsrisikos: Ergebnisse einer repräsentativen nationalen Erhebung. J Dtsch Dermatol Ges 2019; 17:786-799. [DOI: 10.1111/ddg.13897_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/23/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Katharina Diehl
- Mannheimer Institut für Public HealthSozial‐ und Präventivmedizin (MIPH)Medizinische Fakultät MannheimUniversität Heidelberg Mannheim
| | - Tatiana Görig
- Mannheimer Institut für Public HealthSozial‐ und Präventivmedizin (MIPH)Medizinische Fakultät MannheimUniversität Heidelberg Mannheim
| | - Nina Osenbrügge
- Mannheimer Institut für Public HealthSozial‐ und Präventivmedizin (MIPH)Medizinische Fakultät MannheimUniversität Heidelberg Mannheim
| | - Laura Schilling
- Mannheimer Institut für Public HealthSozial‐ und Präventivmedizin (MIPH)Medizinische Fakultät MannheimUniversität Heidelberg Mannheim
| | - Rüdiger Greinert
- Arbeitsgemeinschaft Dermatologische Prävention (ADP) Hamburg
- Zentrum für DermatologieElbe Kliniken Buxtehude
| | - Sven Schneider
- Mannheimer Institut für Public HealthSozial‐ und Präventivmedizin (MIPH)Medizinische Fakultät MannheimUniversität Heidelberg Mannheim
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136
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Bendinelli B, Masala G, Garamella G, Palli D, Caini S. Do Thiazide Diuretics Increase the Risk of Skin Cancer? A Critical Review of the Scientific Evidence and Updated Meta-Analysis. Curr Cardiol Rep 2019; 21:92. [PMID: 31352643 DOI: 10.1007/s11886-019-1183-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW We reviewed the hypothesised mechanisms of skin cancerogenesis for thiazide diuretics; conducted an updated meta-analysis of studies focusing on their association with skin cancer risk; critically appraised the quality of available studies and identified knowledge gaps; and discussed implications for health professionals and patients. RECENT FINDINGS Thiazide diuretics possess well-described photosensitizing properties and a causal association with skin cancer is biologically plausible. The epidemiological evidence is stronger for squamous cell cancer; however, diversity in design among studies, methodological concerns potentially affecting the validity of results, and scarcity of data on dose-relation relationship suggest caution in drawing conclusions. Only few, unbalanced, and/or heterogeneous data exist to date for melanoma and basal cell cancer. Patients effectively treated with thiazide diuretics are currently not advised to stop treatment, but encouraged to limit exposure to sunlight and regularly check their skin. While endorsing these recommendations, we believe that well-designed studies are urgently needed to overcome persistent knowledge gaps.
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Affiliation(s)
- Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50141, Florence, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50141, Florence, Italy
| | - Giuseppe Garamella
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50141, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, 50141, Florence, Italy.
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137
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Diehl K, Görig T, Osenbrügge N, Schilling L, Greinert R, Schneider S. Optimistically biased perception of one's own skin cancer risk: Representative nationwide findings. J Dtsch Dermatol Ges 2019; 17:786-798. [PMID: 31334908 DOI: 10.1111/ddg.13897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous research has shown that individuals tend to have unrealistic comparative optimism (UCO) for different diseases and health outcomes. Our aim was to analyze UCO in relation to skin cancer for the first time in a representative nationwide sample. The results will be important for planning future prevention. METHODS The National Cancer Aid Monitoring on Sunbed Use (NCAM, wave 3) is a representative nationwide German survey (n = 3,000, 14-45 years). We assessed UCO in relation to skin cancer and analyzed its association with sociodemographics, tanning and health-related risk behaviors, skin cancer risk, and skin cancer risk awareness. RESULTS Four out of ten (43.3 %) respondents believed themselves to have a lower risk of developing skin cancer than other people of the same age and sex. Younger individuals were more likely to be optimistic. Individuals with an increased risk of skin cancer were more likely to perceive this higher risk. CONCLUSION While it is realistic for those who actually have a higher risk of skin cancer to perceive it that way, the findings for the general population (and specifically for younger individuals) are concerning. It seems important to explain to people that their perception of their own risk of skin cancer is unrealistic, as this may affect their individual screening and prevention behavior.
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Affiliation(s)
- Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tatiana Görig
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina Osenbrügge
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Schilling
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rüdiger Greinert
- Association of Dermatological Prevention (ADP), Hamburg, Germany.,Center of Dermatology, Elbe Clinics, Buxtehude, Germany
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Future reduction of cutaneous malignant melanoma due to improved sun protection habits and decreased common melanocytic nevi density among Swedish children?: A follow-up from 2002 to 2012. Eur J Cancer 2019; 118:149-155. [PMID: 31349135 DOI: 10.1016/j.ejca.2019.06.016] [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: 04/05/2019] [Revised: 05/30/2019] [Accepted: 06/06/2019] [Indexed: 01/07/2023]
Abstract
We have previously demonstrated significant improvements in sun protection regimens and significantly fewer common melanocytic nevi (CMN) among 7-year-old children in southern Sweden when comparing year 2007 with 2002. The aim of this study was to investigate whether the observed decreasing trend also can be observed at age 10 and, in addition, to compare the CMN density change between 7 and 10 years of age during two periods of time. Two open cohorts were used, cohort I with schoolchildren investigated in 2002 at age 7 and in 2005 at age 10 and cohort II with schoolchildren investigated in 2009 at age 7 and in 2012 at age 10. A significant decrease in CMN density (number/m2 BSA) at age 10 from 2005 to 2012 was observed: 15.9 (14.7-17.2) and 11.4 (10.1-12.7), respectively. The density growth rate from 7 to 10 years was 2.8 (2.1-3.5) between 2002 and 2005 and decreased significantly to 0.9 (0.2-1.5) between 2009 and 2012. Significant increases were observed for 'often use of sunscreen', 'often staying in shade' and 'often staying indoors' from cohort I to cohort II: 65 vs 80%, 7.6 vs 13% and 7.3 vs 19%, respectively. The decrease in number of CMN among 10-year-old children confirms a current trend in Sweden. If this persists, a future reduction of cutaneous malignant melanoma incidence in Sweden might be anticipated. The results also indicate that CMN count could be used as an indicator of ultraviolet exposure.
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139
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Dinnes J, Ferrante di Ruffano L, Takwoingi Y, Cheung ST, Nathan P, Matin RN, Chuchu N, Chan SA, Durack A, Bayliss SE, Gulati A, Patel L, Davenport C, Godfrey K, Subesinghe M, Traill Z, Deeks JJ, Williams HC. Ultrasound, CT, MRI, or PET-CT for staging and re-staging of adults with cutaneous melanoma. Cochrane Database Syst Rev 2019; 7:CD012806. [PMID: 31260100 PMCID: PMC6601698 DOI: 10.1002/14651858.cd012806.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Melanoma is one of the most aggressive forms of skin cancer, with the potential to metastasise to other parts of the body via the lymphatic system and the bloodstream. Melanoma accounts for a small percentage of skin cancer cases but is responsible for the majority of skin cancer deaths. Various imaging tests can be used with the aim of detecting metastatic spread of disease following a primary diagnosis of melanoma (primary staging) or on clinical suspicion of disease recurrence (re-staging). Accurate staging is crucial to ensuring that patients are directed to the most appropriate and effective treatment at different points on the clinical pathway. Establishing the comparative accuracy of ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT imaging for detection of nodal or distant metastases, or both, is critical to understanding if, how, and where on the pathway these tests might be used. OBJECTIVES Primary objectivesWe estimated accuracy separately according to the point in the clinical pathway at which imaging tests were used. Our objectives were:• to determine the diagnostic accuracy of ultrasound or PET-CT for detection of nodal metastases before sentinel lymph node biopsy in adults with confirmed cutaneous invasive melanoma; and• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging in adults with cutaneous invasive melanoma:○ for detection of any metastasis in adults with a primary diagnosis of melanoma (i.e. primary staging at presentation); and○ for detection of any metastasis in adults undergoing staging of recurrence of melanoma (i.e. re-staging prompted by findings on routine follow-up).We undertook separate analyses according to whether accuracy data were reported per patient or per lesion.Secondary objectivesWe sought to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for whole body imaging (detection of any metastasis) in mixed or not clearly described populations of adults with cutaneous invasive melanoma.For study participants undergoing primary staging or re-staging (for possible recurrence), and for mixed or unclear populations, our objectives were:• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of nodal metastases;• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases; and• to determine the diagnostic accuracy of ultrasound, CT, MRI, or PET-CT for detection of distant metastases according to metastatic site. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included studies of any design that evaluated ultrasound (with or without the use of fine needle aspiration cytology (FNAC)), CT, MRI, or PET-CT for staging of cutaneous melanoma in adults, compared with a reference standard of histological confirmation or imaging with clinical follow-up of at least three months' duration. We excluded studies reporting multiple applications of the same test in more than 10% of study participants. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2)). We estimated accuracy using the bivariate hierarchical method to produce summary sensitivities and specificities with 95% confidence and prediction regions. We undertook analysis of studies allowing direct and indirect comparison between tests. We examined heterogeneity between studies by visually inspecting the forest plots of sensitivity and specificity and summary receiver operating characteristic (ROC) plots. Numbers of identified studies were insufficient to allow formal investigation of potential sources of heterogeneity. MAIN RESULTS We included a total of 39 publications reporting on 5204 study participants; 34 studies reporting data per patient included 4980 study participants with 1265 cases of metastatic disease, and seven studies reporting data per lesion included 417 study participants with 1846 potentially metastatic lesions, 1061 of which were confirmed metastases. The risk of bias was low or unclear for all domains apart from participant flow. Concerns regarding applicability of the evidence were high or unclear for almost all domains. Participant selection from mixed or not clearly defined populations and poorly described application and interpretation of index tests were particularly problematic.The accuracy of imaging for detection of regional nodal metastases before sentinel lymph node biopsy (SLNB) was evaluated in 18 studies. In 11 studies (2614 participants; 542 cases), the summary sensitivity of ultrasound alone was 35.4% (95% confidence interval (CI) 17.0% to 59.4%) and specificity was 93.9% (95% CI 86.1% to 97.5%). Combining pre-SLNB ultrasound with FNAC revealed summary sensitivity of 18.0% (95% CI 3.58% to 56.5%) and specificity of 99.8% (95% CI 99.1% to 99.9%) (1164 participants; 259 cases). Four studies demonstrated lower sensitivity (10.2%, 95% CI 4.31% to 22.3%) and specificity (96.5%,95% CI 87.1% to 99.1%) for PET-CT before SLNB (170 participants, 49 cases). When these data are translated to a hypothetical cohort of 1000 people eligible for SLNB, 237 of whom have nodal metastases (median prevalence), the combination of ultrasound with FNAC potentially allows 43 people with nodal metastases to be triaged directly to adjuvant therapy rather than having SLNB first, at a cost of two people with false positive results (who are incorrectly managed). Those with a false negative ultrasound will be identified on subsequent SLNB.Limited test accuracy data were available for whole body imaging via PET-CT for primary staging or re-staging for disease recurrence, and none evaluated MRI. Twenty-four studies evaluated whole body imaging. Six of these studies explored primary staging following a confirmed diagnosis of melanoma (492 participants), three evaluated re-staging of disease following some clinical indication of recurrence (589 participants), and 15 included mixed or not clearly described population groups comprising participants at a number of different points on the clinical pathway and at varying stages of disease (1265 participants). Results for whole body imaging could not be translated to a hypothetical cohort of people due to paucity of data.Most of the studies (6/9) of primary disease or re-staging of disease considered PET-CT, two in comparison to CT alone, and three studies examined the use of ultrasound. No eligible evaluations of MRI in these groups were identified. All studies used histological reference standards combined with follow-up, and two included FNAC for some participants. Observed accuracy for detection of any metastases for PET-CT was higher for re-staging of disease (summary sensitivity from two studies: 92.6%, 95% CI 85.3% to 96.4%; specificity: 89.7%, 95% CI 78.8% to 95.3%; 153 participants; 95 cases) compared to primary staging (sensitivities from individual studies ranged from 30% to 47% and specificities from 73% to 88%), and was more sensitive than CT alone in both population groups, but participant numbers were very small.No conclusions can be drawn regarding routine imaging of the brain via MRI or CT. AUTHORS' CONCLUSIONS Review authors found a disappointing lack of evidence on the accuracy of imaging in people with a diagnosis of melanoma at different points on the clinical pathway. Studies were small and often reported data according to the number of lesions rather than the number of study participants. Imaging with ultrasound combined with FNAC before SLNB may identify around one-fifth of those with nodal disease, but confidence intervals are wide and further work is needed to establish cost-effectiveness. Much of the evidence for whole body imaging for primary staging or re-staging of disease is focused on PET-CT, and comparative data with CT or MRI are lacking. Future studies should go beyond diagnostic accuracy and consider the effects of different imaging tests on disease management. The increasing availability of adjuvant therapies for people with melanoma at high risk of disease spread at presentation will have a considerable impact on imaging services, yet evidence for the relative diagnostic accuracy of available tests is limited.
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Affiliation(s)
- Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | | | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Seau Tak Cheung
- Dudley Hospitals Foundation Trust, Corbett HospitalDepartment of DermatologyWicarage RoadStourbridgeUKDY8 4JB
| | - Paul Nathan
- Mount Vernon HospitalMount Vernon Cancer CentreRickmansworth RoadNorthwoodUKHA6 2RN
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Sue Ann Chan
- City HospitalBirmingham Skin CentreDudley RdBirminghamUKB18 7QH
| | - Alana Durack
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustDermatologyHills RoadCambridgeUKCB2 0QQ
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Abha Gulati
- Barts Health NHS TrustDepartment of DermatologyWhitechapelLondonUKE11BB
| | - Lopa Patel
- Royal Stoke HospitalPlastic SurgeryStoke‐on‐TrentStaffordshireUKST4 6QG
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Manil Subesinghe
- King's College LondonCancer Imaging, School of Biomedical Engineering & Imaging SciencesLondonUK
| | - Zoe Traill
- Oxford University Hospitals NHS TrustChurchill Hospital Radiology DepartmentOxfordUK
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Suppa M, Gandini S, Njimi H, Bulliard JL, Correia O, Duarte AF, Peris K, Stratigos AJ, Nagore E, Longo MI, Bylaite-Bucinskiene M, Karls R, Helppikangas H, Del Marmol V. Association of sunbed use with skin cancer risk factors in Europe: an investigation within the Euromelanoma skin cancer prevention campaign. J Eur Acad Dermatol Venereol 2019; 33 Suppl 2:76-88. [PMID: 30811689 DOI: 10.1111/jdv.15307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sunbed use has been significantly associated with increased risk of melanoma and non-melanoma skin cancer (NMSC), but its relationship with melanoma's risk factors such as high nevus count, atypical nevi and lentigines is poorly studied. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants' data, including sunbed use and phenotype, are collected via questionnaires. OBJECTIVES To investigate the association of sunbed use with nevus count, atypical nevi, lentigines and suspicion of skin cancer. METHODS To ensure reliability of the data, we defined inclusion and exclusion criteria for countries' eligibility for the risk analysis. Multivariate logistic regression models (including age, gender, education, skin type, family history of melanoma, personal history of skin cancer, any sun exposure and any sunscreen use) were used to calculate summary odds ratios (SORs) of each clinical endpoint for ever sunbed use. RESULTS Overall, 227 888 individuals from 30 countries completed the Euromelanoma questionnaire. After the data quality check, 16 countries were eligible for the multivariate analysis, for a total of 145 980 participants (64.8% females; median age 43 years; 62.3% highly educated; 28.5% skin type I-II; 11.0% ever sunbed use). Ever sunbed use was independently associated with nevus count >50 [SOR = 1.05 (1.01-1.10)], atypical nevi [SOR = 1.04 (1.00-1.09)], lentigines [SOR = 1.16 (1.04-1.29)] and suspicion of melanoma [SOR = 1.13 (1.00-1.27)]. Conversely, no significant association was found between ever sunbed use and suspicion of NMSC [SOR = 1.00 (0.91-1.10)]. CONCLUSIONS Indoor tanning is significantly associated with well-recognized risk factors for melanoma (including high nevus count, presence of atypical nevi and lentigines) as well as suspicion of melanoma within the Euromelanoma screenees. In order to reduce the prevalence of melanoma risk factors, avoidance/discontinuation of sunbed use should always be encouraged, especially but not exclusively for individuals with high-risk phenotypes.
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Affiliation(s)
- M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - J L Bulliard
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - O Correia
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A F Duarte
- Centro de Dermatologia Epidermis, Instituto CUF, Porto, Portugal.,Portuguese Skin Cancer Association, Lisbon, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - K Peris
- Institute of Dermatology, Catholic University, Rome, Italy
| | - A J Stratigos
- First Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.,Universidad Católica de València San Vicente Ferrer, Valencia, Spain
| | - M I Longo
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Bylaite-Bucinskiene
- Clinic of Infectious, Chest diseases, Dermatovenereology and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Karls
- Department of Infectiology and Dermatology, Riga Stradins University, Riga, Latvia
| | - H Helppikangas
- Dermatology Department, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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141
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Weis E, Vrouwe SQ, LeBaron DB, Parliament MB, Shields J, Shields CL. Changes in Ultraviolet Radiation Exposure to the Ocular Region: A Population-Based Study. Cancers (Basel) 2019; 11:cancers11050719. [PMID: 31137687 PMCID: PMC6562648 DOI: 10.3390/cancers11050719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 11/17/2022] Open
Abstract
In contrast to the well-established association between ultraviolet radiation (UVR) exposure and skin cancers, the relationship between UVR and uveal malignant melanoma (UM) remains controversial. To address this controversy, we evaluated the incidence rates of cutaneous malignancies in the eyelids as a proxy for UVR exposure in the ocular region using a population-based cancer registry. Overall, 74,053 cases of eyelid basal cell carcinoma (BCC) and 7890 cases of melanoma over a 26-year period (1982–2007) were analyzed. The incidence of eyelid basal cell carcinoma and uveal melanoma remained stable, whereas other cutaneous areas demonstrated an increase in the rates. A comparability test demonstrated that BCC incidence trends were significantly different between the eyelid versus both chronically exposed (males p = 0.001; females p = 0.01) and intermittently exposed skin (males and females, p = 0.0002), as well as the skin of the face (males p = 0.002; females p = 0.02). Similarly, melanoma trends were significantly different between the UM group versus both chronically exposed cutaneous melanoma (CM) (males p = 0.001; females p = 0.04) and intermittently exposed CM (males p = 0.005), as well as facial skin CM (males and females p = 0.0002). The discrepancy of cancer incidence between tumors in the peri-ocular region versus the rest of the body suggests that the peri-ocular region might have a different or unique exposure pattern to ultraviolet radiation.
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Affiliation(s)
- Ezekiel Weis
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5H 3V9, Canada.
- Division of Ophthalmology, Department of Surgery, University of Calgary, Calgary, AB T2V 4R6, Canada.
| | - Sebastian Q Vrouwe
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5H 3V9, Canada.
| | - David B LeBaron
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5H 3V9, Canada.
| | - Matthew B Parliament
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada.
| | - Jerry Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Li WQ, Cho E, Weinstock MA, Li S, Stampfer MJ, Qureshi AA. Cutaneous nevi and risk of melanoma death in women and men: A prospective study. J Am Acad Dermatol 2019; 80:1284-1291. [PMID: 30639880 PMCID: PMC6462416 DOI: 10.1016/j.jaad.2018.12.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/05/2018] [Accepted: 12/24/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND It was unclear whether an increased number of common nevi (moles) predicts melanoma death. OBJECTIVE We prospectively examined the association between number of common nevi and risk of melanoma death. METHODS Our study used data from the Nurses' Health Study (n = 77,288 women) and Health Professionals Follow-up Study (n = 32,455 men). In 1986, participants were asked about the number of moles they had with a ≥3-mm diameter on the upper extremity, and we stratified their answers into 3 categories (none, 1-2, or ≥3) on the basis of data distribution. RESULTS During follow-up (1986-2012), 2452 melanoma cases were pathologically confirmed; among these, we identified 196 deaths due to melanoma. Increased number of nevi was associated with melanoma death; the hazard ratio (HR) for ≥3 nevi compared with no nevi was 2.49 (95% confidence interval [CI] 1.50-4.12) for women and 3.97 (95% CI 2.54-6.22) for men. Among melanoma cases, increased number of nevi was associated with melanoma death in men (≥3 nevi, HR 1.89, 95% CI 1.17-3.05) but not in women. Similarly, the number of nevi was positively associated with Breslow thickness in men only (Ptrend = .01). LIMITATIONS This is an epidemiologic study without examination into mechanisms. CONCLUSION Increased number of cutaneous nevi was significantly associated with melanoma death. High nevus count might serve as an independent prognostic factor to predict the risk of melanoma death particularly among male melanoma patients.
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Affiliation(s)
- Wen-Qing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China; Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island.
| | - Eunyoung Cho
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martin A Weinstock
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Center for Dermatoepidemiology, VA Medical Center, Providence, Rhode Island
| | - Suyun Li
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; School of Public Health, Institute for Chemical Carcinogenesis, Guangzhou Medical University, Guangzhou, China
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Abrar A Qureshi
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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143
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Association between risk factors and detection of cutaneous melanoma in the setting of a population-based skin cancer screening. Eur J Cancer Prev 2019; 27:563-569. [PMID: 28692584 DOI: 10.1097/cej.0000000000000392] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Early detection is considered to improve the prognosis of cutaneous melanoma. The value of population-based screening for melanoma, however, is still controversial. The aim of this study was to evaluate the predictive power of established risk factors in the setting of a population-based screening and to provide empirical evidence for potential risk stratifications. We reanalyzed data (including age, sex, risk factors, and screening results) of 354 635 participants in the Skin Cancer Research to provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN)project conducted in the German state of Schleswig-Holstein (2003-2004). In multivariable analysis, atypical nevi [odds ratio (OR): 17.4; 95% confidence interval (CI): 14.4-20.1], personal history of melanoma (OR: 5.3; 95% CI: 3.6-7.6), and multiple (≥40) common nevi (OR: 1.3; 95% CI: 1.1-1.6) were associated with an increased risk of melanoma detection. Family history and congenital nevi were not significantly associated with melanoma detection in the SCREEN. The effects of several risk-adapted screening strategies were evaluated. Hypothesizing a screening of individuals aged more than or equal to 35 years, irrespective of risk factors (age approach), the number needed to screen is 559 (95% CI: 514-612), whereas a screening of adults (aged ≥20) with at least one risk factor (risk approach) leads to a number needed to screen of 178 (95% CI: 163-196). Converted into one screen-detected melanoma, the number of missed melanomas is 0.15 (95% CI: 0.12-0.18) with the age approach and 0.22 (95% CI: 0.19-0.26) with the risk approach. The results indicate that focusing on individuals at high risk for melanoma may improve the cost-effectiveness and the benefit-to-harm balance of melanoma screening programs.
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144
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Rishpon A, Navarrete-Dechent C, Marghoob AA, Dusza SW, Isman G, Kose K, Halpern AC, Marchetti MA. Melanoma risk stratification of individuals with a high-risk naevus phenotype - A pilot study. Australas J Dermatol 2019; 60:e292-e297. [PMID: 30941757 DOI: 10.1111/ajd.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES High a naevus counts and atypical naevi are risk factors for cutaneous melanoma. However, many individuals with a high-risk naevus phenotype do not develop melanoma. In this study, we describe the clinical and dermoscopic attributes of naevi associated with melanoma in a high-risk naevus phenotype population. METHODS This single-centre, hospital-based case-control study included 54 prospectively enrolled adult patients ≥18 years old with a high-risk naevus phenotype (18 cases with a history of melanoma and 36 age- and gender-matched controls without a history of melanoma). We analysed clinical and dermoscopic images of the 20 largest naevi for each participant. RESULTS Cases had a higher mean age than controls (48.2 vs. 39.1 years, P = 0.007) but there was no difference in the male-to-female ratio between groups. Nearly, all participants (97%) were Fitzpatrick skin type II or III. Naevi in cases were more likely to be truncal, (72.6% vs. 53.6%, P = 0.01), particularly anterior truncal, (29.2% vs. 14.4%, P < 0.001) and larger than 8 mm (17.4% vs. 7.8%%, P = 0.01) compared to controls. CASH score of naevi did not differ between groups. Naevi in cases were more likely to have a multicomponent dermoscopic pattern than in controls (18.4% vs. 12.6%, P = 0.02). CONCLUSION Larger naevi, truncal naevi, and naevi, with a multicomponent dermoscopic pattern may be risk factors for melanoma among individuals with a high-risk naevus phenotype. Further studies are needed to validate these findings.
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Affiliation(s)
- Ayelet Rishpon
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cristian Navarrete-Dechent
- Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Dermatology, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Stephen W Dusza
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gila Isman
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kivanc Kose
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allan C Halpern
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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145
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Wróbel S, Przybyło M, Stępień E. The Clinical Trial Landscape for Melanoma Therapies. J Clin Med 2019; 8:E368. [PMID: 30884760 PMCID: PMC6463026 DOI: 10.3390/jcm8030368] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
(1) Despite many years of research, melanoma still remains a big challenge for modern medicine. The purpose of this article is to review publicly available clinical trials to find trends regarding the number of trials, their location, and interventions including the most frequently studied drugs and their combinations. (2) We surveyed clinical trials registered in the International Clinical Trials Registry Platform (ICTRP), one of the largest databases on clinical trials. The search was performed on 30 November 2018 using the term "melanoma". Data have been supplemented with the information obtained from publicly available data repositories including PubMed, World Health Organization, National Cancer Institute, Centers for Disease Control and Prevention, European Cancer Information System, and many others to bring the historical context of this study. (3) Among the total of 2563 clinical trials included in the analysis, most have been registered in the USA (1487), which is 58% of the total. The most commonly studied drug in clinical trials was ipilimumab, described as applied intervention in 251 trials. (4) An increase in the number of melanoma clinical trials using immunomodulating monoclonal antibody therapies, small molecule-targeted therapies (inhibitors of BRAF, MEK, CDK4/6), and combination therapies is recognized. This illustrates the tendency towards precision medicine.
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Affiliation(s)
- Sonia Wróbel
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Krakow, Poland.
| | - Małgorzata Przybyło
- Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, 30-387 Krakow, Poland.
| | - Ewa Stępień
- Department of Medical Physics, Marian Smoluchowski Institute of Physics, Jagiellonian University, 30-348 Krakow, Poland.
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Cho SI, Lee J, Jo G, Kim SW, Minn KW, Hong KY, Jo SJ, Cho KH, Kim BJ, Mun JH. Local recurrence and metastasis in patients with malignant melanomas after surgery: A single-center analysis of 202 patients in South Korea. PLoS One 2019; 14:e0213475. [PMID: 30845184 PMCID: PMC6405088 DOI: 10.1371/journal.pone.0213475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/21/2019] [Indexed: 11/22/2022] Open
Abstract
Malignant melanoma (MM) is a lethal skin cancer in Western countries. Although the incidence is low in Asians compared to that in Caucasians, it is increasing. However, literature regarding risk factors for prognosis of MM patients who have undergone surgical excision in Asian is limited. This study aimed to investigate the predictive factors for local recurrence and metastasis in MM patients who underwent surgical treatment at a single tertiary-level hospital in Korea. Patients who underwent surgery for MM at our institution between January 1998 and December 2014 were analyzed. We retrospectively investigated risk factors for local recurrence and metastasis after surgery. In cases with distant metastasis, tumor thickness (adjusted Hazard Ratio (HR), 6.139; 95% confidence interval (CI), 2.152 to 17.509; P = 0.001) and increased mitotic number [(0-1/mm2 vs 2-6/mm2: adjusted HR, 4.483; 95% CI, 1.233 to 16.303; P = 0.023); (0-1/mm2 vs > 6/mm2: adjusted HR, 10.316; 95% CI, 2.871 to 37.063; P < 0.001)] were associated with risk in multivariate analysis. Regarding local recurrence, tumor thickness (T4 [≥4mm] vs T1) was found to be a significant risk factor (adjusted HR, 8.461; 95% CI, 2.514 to 28.474; P = 0.001). Our data revealed tumor thickness and increased mitotic count were significant risk factors for local recurrence and distant metastasis in Korean patients with MM after surgery.
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Affiliation(s)
- Soo Ick Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jaewon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gwanghyun Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Won Minn
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang Hyun Cho
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (JHM); (BJK)
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (JHM); (BJK)
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147
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Krensel M, Schäfer I, Augustin M. Cost-of-illness of melanoma in Europe - a systematic review of the published literature. J Eur Acad Dermatol Venereol 2019; 33:504-510. [PMID: 30408246 DOI: 10.1111/jdv.15315] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022]
Abstract
Malignant melanoma accounts for the vast majority of skin cancer deaths. Primary prevention is used to increase knowledge about skin cancer and set incentives for a change in behaviour, which leads to a decrease in cases. Primary prevention may be cost-effective or even cost saving. Cost-of-illness (COI) studies provide information on such potential savings. The purpose of this study is to give an overview on COI studies in European countries and to compare the COI in total and by cost categories. The results can be used to model potential cost savings from prevention. We conducted a systematic literature research in PubMed using the PRISMA checklist. All costs were converted into Euro and adjusted for the reference year 2012. For the ranking of countries according to their COI, all costs were adjusted for the purchasing power parity. All studies focusing on stage III-IV melanoma include information on hospital, hospice, and outpatient treatment. Costs for the treatment of advanced melanoma range between € 2972 in Italy and € 17 408 in Sweden after adjusting for purchasing power parity. Most studies on stage I-IV melanoma include costs of hospitalization, outpatient treatment and general practitioner consultation. Direct costs range from € 923 in Sweden to € 9829 in Denmark. Three articles also include information on indirect costs. Mortality costs vary between € 3511 in Sweden and € 20 408 in England, morbidity costs between € 103 in Sweden and € 4550 in England. We showed that costs for the treatment of skin cancer are moderately high in the included countries. Since after publication of the articles new costly drugs were approved in Europe, treatment costs of melanoma in Europe may be expected to have risen in the last few years, which means that there is a high expectable potential for prevention programmes to become cost-effective or even cost saving.
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Affiliation(s)
- M Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - I Schäfer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Abstract
Incidence of malignant melanoma has been increasing since the 1980s. For loco-regional stages, surgery is still the best treatment. Melanoma has a high distant metastatic potential and prognosis of advanced stages was until recently very poor. Since 2011 however, a real revolution has taken place in the treatment of metastatic melanoma. This is based upon considerably improved knowledge of the molecular mechanisms of melanoma and cancer immunology. Thus, two new classes of systemic therapeutic agents are now available: immunotherapies (immunological checkpoint inhibitors), which increase the antitumor immune response, and targeted therapies (BRAF and MEK inhibitors) for patients with BRAF V600-mutant melanoma. Overall survival is now 2 years or above, with hope for a cure in some cases. Unfortunately, the efficacy of these treatments is incomplete and many studies are underway to try to identify predictive biomarkers, and multiple combinations are being evaluated to increase response rates. The efficacy of these treatments has also been shown in the adjuvant setting in high-risk melanoma, they should be available shortly.
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Affiliation(s)
- C Longvert
- Service de dermatologie, EA4340 biomarqueurs en cancérologie et onco-hématologie, UVSQ, université Paris-Saclay, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France.
| | - P Saiag
- Service de dermatologie, EA4340 biomarqueurs en cancérologie et onco-hématologie, UVSQ, université Paris-Saclay, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt cedex, France
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149
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Olsen CM, Pandeya N, Thompson BS, Dusingize JC, Green AC, Neale RE, Whiteman DC. Association between Phenotypic Characteristics and Melanoma in a Large Prospective Cohort Study. J Invest Dermatol 2019; 139:665-672. [DOI: 10.1016/j.jid.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
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150
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Reproductive factors, exogenous hormone use and incidence of melanoma among women in the United States. Br J Cancer 2019; 120:754-760. [PMID: 30814688 PMCID: PMC6461881 DOI: 10.1038/s41416-019-0411-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background Although the photosensitising effects of oestrogens may increase the impact of ultraviolet radiation (UVR) on melanoma risk, few prospective studies have comprehensively assessed the association between oestrogen-related factors and melanoma. Methods We examined the associations between reproductive factors, exogenous oestrogen use and first primary invasive melanoma among 167 503 non-Hispanic white, postmenopausal women in the NIH-AARP Diet and Health Study. Satellite-based ambient UVR estimates were linked to geocoded residential locations of participants at study baseline. Results Increased risk of melanoma was associated with early age at menarche (≤10 vs ≥15 years: HR = 1.25, 95% CI: 0.92, 1.71; P for trend = 0.04) and late age at menopause (≥50 vs <45 years: HR = 1.34, 95% CI: 1.13, 1.59; P for trend = 0.001). The relationship between ambient UVR and melanoma risk was highest among women with age at menarche ≤10 years (HR per UVR quartile increase = 1.29; 95% CI: 1.05, 1.58; P-interaction = 0.02). Melanoma risk was not associated with parity, age at first birth, use of oral contraceptives or use of menopausal hormone therapy. Conclusions Our findings suggest that increased melanoma risk is associated with early age at menarche and late age at menopause. Effect modification findings support the hypothesis that endogenous oestrogen exposure in childhood increases photocarcinogenicity. Future studies should include information on personal UVR exposure and sun sensitivity.
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