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Schuurman M, de Waal A, Thijs E, van Rossum M, Kiemeney L, Aben K. Risk factors for second primary melanoma among Dutch patients with melanoma. Br J Dermatol 2017; 176:971-978. [DOI: 10.1111/bjd.15024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M.S. Schuurman
- Netherlands Comprehensive Cancer Organisation (IKNL); PO Box 19079 3501 DB Utrecht the Netherlands
| | - A.C. de Waal
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - E.J.M. Thijs
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - M.M. van Rossum
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
| | - L.A.L.M. Kiemeney
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Urology; Radboud University Medical Center; Nijmegen the Netherlands
| | - K.K.H. Aben
- Netherlands Comprehensive Cancer Organisation (IKNL); PO Box 19079 3501 DB Utrecht the Netherlands
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
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202
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Pediatric Melanoma: A 35-year Population-based Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1252. [PMID: 28458966 PMCID: PMC5404437 DOI: 10.1097/gox.0000000000001252] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/10/2017] [Indexed: 11/25/2022]
Abstract
Background: Melanoma is a rare neoplasm in the pediatric population. Recent publications suggest a possible increase in incidence over the past few decades. The purpose of this study was to analyze trends in pediatric patients diagnosed with malignant melanoma in British Columbia (BC) in the past 35 years. Methods: A retrospective review was performed. All patients in BC diagnosed with melanoma before 18 years of age from 1979 to 2014 were included. Patient demographics, melanoma description, treatment details, and survival data were collected. Results: Seventy-eight subjects were identified for the study. Patients were equally distributed by sex. Sixty-one (78%) of the subjects were diagnosed in the postpubertal age (≥12 years old). The most common sites of occurrence were the extremities (n = 33) and the trunk (n = 27), with the location on the trunk showing the highest mortality rate (22%). All patients were surgically treated and some had additional chemotherapy (12) and/or radiotherapy (12). Fatal outcome was recorded in 12 of the 78 subjects, 10 of whom had postpubertal diagnosis. The average time from date of diagnosis to date of death was 9.3 years. Conclusions: The incidence of melanoma in the pediatric population remains exceedingly rare: less than 2.5 per million children younger than 18 years. The diagnosis is rarely made before puberty; the incidence is equal in males and females and has not changed over a 35-year time period in BC. Our study shows 85% survival with the majority of patients having had surgical excision only.
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203
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Harrington E, Clyne B, Wesseling N, Sandhu H, Armstrong L, Bennett H, Fahey T. Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules. BMJ Open 2017; 7:e014096. [PMID: 28264830 PMCID: PMC5353325 DOI: 10.1136/bmjopen-2016-014096] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care. DESIGN Systematic review. DATA SOURCES A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms. STUDY SELECTION AND DATA EXTRACTION Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist. RESULTS From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of >4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied. CONCLUSIONS At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice.
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Affiliation(s)
- Emma Harrington
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Harkiran Sandhu
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Laura Armstrong
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Holly Bennett
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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204
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Johnson MM, Leachman SA, Aspinwall LG, Cranmer LD, Curiel-Lewandrowski C, Sondak VK, Stemwedel CE, Swetter SM, Vetto J, Bowles T, Dellavalle RP, Geskin LJ, Grossman D, Grossmann KF, Hawkes JE, Jeter JM, Kim CC, Kirkwood JM, Mangold AR, Meyskens F, Ming ME, Nelson KC, Piepkorn M, Pollack BP, Robinson JK, Sober AJ, Trotter S, Venna SS, Agarwala S, Alani R, Averbook B, Bar A, Becevic M, Box N, E Carson W, Cassidy PB, Chen SC, Chu EY, Ellis DL, Ferris LK, Fisher DE, Kendra K, Lawson DH, Leming PD, Margolin KA, Markovic S, Martini MC, Miller D, Sahni D, Sharfman WH, Stein J, Stratigos AJ, Tarhini A, Taylor MH, Wisco OJ, Wong MK. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Manag 2017; 4:13-37. [PMID: 28758010 PMCID: PMC5480135 DOI: 10.2217/mmt-2016-0022] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023] Open
Abstract
Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.
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Affiliation(s)
- Mariah M Johnson
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.,Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA.,Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave., Portland, OR, USA
| | - Lisa G Aspinwall
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Lee D Cranmer
- University of Washington, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Clara Curiel-Lewandrowski
- University of Arizona Cancer Center, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA
| | - Vernon K Sondak
- Moffitt Cancer Center, Tampa, FL, USA.,Moffitt Cancer Center, Tampa, FL, USA
| | - Clara E Stemwedel
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Susan M Swetter
- Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University Medical Center & VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - John Vetto
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Tawnya Bowles
- Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA.,Intermountain Healthcare & University of Utah, Salt Lake City, UT, USA
| | - Robert P Dellavalle
- University of Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | - Larisa J Geskin
- Columbia University, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Douglas Grossman
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Kenneth F Grossmann
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Jason E Hawkes
- University of Utah, Salt Lake City, UT, USA.,University of Utah, Salt Lake City, UT, USA
| | - Joanne M Jeter
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Caroline C Kim
- Harvard Medical School, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - John M Kirkwood
- University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Aaron R Mangold
- Mayo Clinic Arizona, Scottsdale, AZ, USA.,Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Frank Meyskens
- University of California, Irvine, Orange, CA, USA.,University of California, Irvine, Orange, CA, USA
| | - Michael E Ming
- University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly C Nelson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Piepkorn
- University of Washington, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | - Brian P Pollack
- Emory University & Atlanta VA Medical Center, Atlanta, GA, USA.,Emory University & Atlanta VA Medical Center, Atlanta, GA, USA
| | - June K Robinson
- Northwestern University Feinberg School of Medicine, Chicago, IL USA.,Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Arthur J Sober
- Harvard Medical School, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Shannon Trotter
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Suraj S Venna
- Inova Medical Group, Fairfax, VA, USA.,Inova Medical Group, Fairfax, VA, USA
| | - Sanjiv Agarwala
- St Luke's University Hospital & Temple University, Bethlehem, PA, USA.,St Luke's University Hospital & Temple University, Bethlehem, PA, USA
| | - Rhoda Alani
- Boston University, Boston, MA, USA.,Boston University, Boston, MA, USA
| | - Bruce Averbook
- Case Western Reserve University, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Anna Bar
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Mirna Becevic
- University of Missouri, Columbia, MO, USA.,University of Missouri, Columbia, MO, USA
| | - Neil Box
- University of Colorado, Aurora, CO, USA.,University of Colorado, Aurora, CO, USA
| | - William E Carson
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Pamela B Cassidy
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Suephy C Chen
- Emory University & Atlanta VA Medical Center, Atlanta, GA, USA.,Emory University & Atlanta VA Medical Center, Atlanta, GA, USA
| | - Emily Y Chu
- University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | - Darrel L Ellis
- Vanderbilt University, Nashville, TN, USA.,Vanderbilt University, Nashville, TN, USA
| | - Laura K Ferris
- University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - David E Fisher
- Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School & Massachusetts General Hospital, Charlestown, MA, USA
| | - Kari Kendra
- The Ohio State University, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - David H Lawson
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Philip D Leming
- The Christ Hospital, Cincinnati, OH, USA.,The Christ Hospital, Cincinnati, OH, USA
| | - Kim A Margolin
- City of Hope National Cancer Center, Duarte, CA, USA.,City of Hope National Cancer Center, Duarte, CA, USA
| | | | - Mary C Martini
- Northwestern University Feinberg School of Medicine, Chicago, IL USA.,Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Debbie Miller
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Debjani Sahni
- Boston University, Boston, MA, USA.,Boston University, Boston, MA, USA
| | - William H Sharfman
- Johns Hopkins University, Baltimore, MD.,Johns Hopkins University, Baltimore, MD
| | - Jennifer Stein
- NYU Langone Medical Center, New York, NY, USA.,NYU Langone Medical Center, New York, NY, USA
| | - Alexander J Stratigos
- Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece.,Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Ahmad Tarhini
- University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew H Taylor
- Oregon Health & Science University, Portland, OR, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Oliver J Wisco
- Bend Memorial Clinic, Bend, OR, USA.,Bend Memorial Clinic, Bend, OR, USA
| | - Michael K Wong
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
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205
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Rajská L, Göpfertová D, Hercogová J, Jiráková A, Sečníková Z, Rob F, Šmerhovský Z. Relative Importance of Traditional Risk Factors for Malignant Melanoma in the Czech Population. Cent Eur J Public Health 2017; 24:268-271. [PMID: 28095280 DOI: 10.21101/cejph.a4569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/11/2015] [Indexed: 11/15/2022]
Abstract
AIM The Czech Republic is one of the leading European countries in incident cases of malignant melanoma (MM), which is on the rise. The study objective was to assess the strength of associations between MM and the known generally accepted risk factors for MM in the population of the Czech Republic. METHODS The study was designed as a case-control study where cases were incident cases of MM detected at the Department of Dermatology and Venereology of the Bulovka Hospital. Controls were selected from cancer-free patients admitted to departments other than Dermatology and Venereology. Validated questionnaires were used to collect demographic, epidemiological, and clinical data. RESULTS The binary logistic model shows the main risk factors for MM: male, female (OR=0.292, 95% CI=0.175-0.486), a changed mole (OR=6.371, 95% CI=3.774-10.756), a history of skin cancer (OR=95.704, 95% CI=37.241-10.756), and sunbeds use (OR=3.594, 95% CI=1.288-10.028). Using sunscreen products was considered as a protective factor against MM (OR=0.253, 95% CI=0.137-0.466). CONCLUSION The primary and secondary prevention increasingly emerges as a public health priority in the effort to reverse the negative trend in cases of MM and mortality from this disease in the Czech Republic. A prerequisite for an effective secondary prevention through screening is, among others, the identification of the population groups at highest risk for MM.
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Affiliation(s)
- Lucie Rajská
- Department of Dermatology and Venereology, 2nd Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic.,Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Göpfertová
- Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Hercogová
- Department of Dermatology and Venereology, 2nd Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic
| | - Anna Jiráková
- Department of Dermatology and Venereology, 2nd Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic
| | - Zuzana Sečníková
- Department of Dermatology and Venereology, 2nd Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic.,Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Rob
- Department of Dermatology and Venereology, 2nd Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic
| | - Zdeněk Šmerhovský
- Department of Epidemiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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206
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Hübner J, Waldmann A, Geller AC, Weinstock MA, Eisemann N, Noftz M, Bertram S, Nolte S, Volkmer B, Greinert R, Breitbart E, Katalinic A. Interval cancers after skin cancer screening: incidence, tumour characteristics and risk factors for cutaneous melanoma. Br J Cancer 2017; 116:253-259. [PMID: 27898656 PMCID: PMC5243984 DOI: 10.1038/bjc.2016.390] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The rate of interval cancers is an established indicator for the performance of a cancer-screening programme. METHODS We examined the incidence, tumour characteristics and risk factors of melanoma interval cancers that occurred in participants of the SCREEN project, which was carried out 2003/2004 in Schleswig-Holstein, Germany. Data from 350 306 SCREEN participants, who had been screened negative for melanoma, were linked to data of the state cancer registry. Melanoma interval cancers were defined as melanomas diagnosed within 4-24 months after SCREEN examination. Results were compared with melanomas of the pre-SCREEN era (1999-2002), extracted from the cancer registry. RESULTS The overall relative incidence of melanoma interval cancers in terms of observed/expected ratio was 0.93 (95% CI: 0.82-1.05; in situ: 1.61 (1.32-1.95), invasive: 0.71 (0.60-0.84)). Compared with melanomas of the pre-SCREEN era, the interval melanomas were thinner and had a slightly greater proportion of lentigo maligna melanomas whereas nodular melanomas were less frequent. INTERPRETATION The results indicate a moderate performance of the SCREEN intervention with an excess of in situ melanomas. In part, the findings might be due to specifics of the SCREEN project, in particular a short-term follow-up of patients at high risk for melanoma.
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Affiliation(s)
- J Hübner
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - A Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - M A Weinstock
- Center for Dermatoepidemiology, VA Medical Center—111D, 830 Chalkstone Avenue, Providence, RI 02908, USA
- Department of Dermatology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
- Departments of Dermatology and Epidemiology, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - N Eisemann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - M Noftz
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - S Bertram
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
| | - S Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
- Population Health Strategic Research Centre, Deakin University, 221 Burwood Highway, Melbourne, VIC 3125, Australia
| | - B Volkmer
- Division of Molecular Cell Biology, Dermatology Center, Elbe Clinics Stade-Buxtehude, Am Krankenhaus 1, Buxtehude 21614, Germany
| | - R Greinert
- Division of Molecular Cell Biology, Dermatology Center, Elbe Clinics Stade-Buxtehude, Am Krankenhaus 1, Buxtehude 21614, Germany
| | - E Breitbart
- Association of Dermatological Prevention e.V., Cremon 11, Hamburg 20457, Germany
| | - A Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23562, Germany
- Cancer Registry of Schleswig-Holstein, Ratzeburger Allee 160, Lübeck 23562, Germany
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207
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Watts CG, Cust AE, Menzies SW, Mann GJ, Morton RL. Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma. J Clin Oncol 2017; 35:63-71. [DOI: 10.1200/jco.2016.68.4308] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective. A high-risk standard care cohort was obtained using linked population data, comprising the Sax Institute’s 45 and Up cohort study, linked to Medicare Benefits Schedule claims data, the cancer registry, and hospital admissions data. Benefits were measured in quality-adjusted life-years gained. Sensitivity analyses were undertaken for all model parameters. Results Specialized surveillance through the High Risk Clinic was both less expensive and more effective than standard care. The mean saving was A$6,828 (95% CI, $5,564 to $8,092) per patient, and the mean quality-adjusted life-year gain was 0.31 (95% CI, 0.27 to 0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). The results were robust when tested in sensitivity analyses. Conclusion Specialized surveillance was a cost-effective strategy for the management of individuals at high risk of melanoma. There were also fewer invasive procedures in specialized surveillance compared with standard care in the community.
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Affiliation(s)
- Caroline G. Watts
- Caroline G. Watts, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Sydney School of Public Health, The University of Sydney, and Melanoma Institute Australia, The University of Sydney; Graham J. Mann, Melanoma Institute Australia, The University of Sydney, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney, and Melanoma Institute Australia, The University of
| | - Anne E. Cust
- Caroline G. Watts, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Sydney School of Public Health, The University of Sydney, and Melanoma Institute Australia, The University of Sydney; Graham J. Mann, Melanoma Institute Australia, The University of Sydney, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney, and Melanoma Institute Australia, The University of
| | - Scott W. Menzies
- Caroline G. Watts, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Sydney School of Public Health, The University of Sydney, and Melanoma Institute Australia, The University of Sydney; Graham J. Mann, Melanoma Institute Australia, The University of Sydney, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney, and Melanoma Institute Australia, The University of
| | - Graham J. Mann
- Caroline G. Watts, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Sydney School of Public Health, The University of Sydney, and Melanoma Institute Australia, The University of Sydney; Graham J. Mann, Melanoma Institute Australia, The University of Sydney, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney, and Melanoma Institute Australia, The University of
| | - Rachael L. Morton
- Caroline G. Watts, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Sydney School of Public Health, The University of Sydney, and Melanoma Institute Australia, The University of Sydney; Graham J. Mann, Melanoma Institute Australia, The University of Sydney, and Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney, and Melanoma Institute Australia, The University of
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208
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Dieng M, Butow PN, Costa DS, Morton RL, Menzies SW, Mireskandari S, Tesson S, Mann GJ, Cust AE, Kasparian NA. Psychoeducational Intervention to Reduce Fear of Cancer Recurrence in People at High Risk of Developing Another Primary Melanoma: Results of a Randomized Controlled Trial. J Clin Oncol 2016; 34:4405-4414. [DOI: 10.1200/jco.2016.68.2278] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose People with a history of melanoma commonly report a fear of cancer recurrence (FCR), yet psychologic support is not routinely offered as part of ongoing melanoma care. This randomized controlled trial examined the efficacy of a psychoeducational intervention to reduce FCR and improve psychologic adjustment in this patient group compared with usual care. Methods The intervention comprised a newly developed psychoeducational resource and three telephone-based psychotherapeutic sessions over a 1-month period timed in accordance with dermatologic appointments. Participants were randomly assigned to intervention (n = 80) or usual care (n = 84). Assessments were completed at baseline, 1 month, and 6 months after dermatologic appointments. Linear mixed models were used to examine differences between treatment and control groups for patient-reported outcomes, including FCR, anxiety, stress, depression, melanoma-related knowledge, health behaviors, satisfaction with melanoma care, unmet needs, and health-related quality of life. Results At 6 months, the intervention group reported lower FCR severity, trigger, and distress scores than the control group in the baseline-adjusted models; the between-group mean difference was −1.9 for FCR severity (95% CI, −3.1 to −0.7; P = .002), −2.0 for FCR triggers (95% CI, −3.3 to −0.7; P = .003), and −0.7 for FCR distress (95% CI, −1.3 to −0.1; P = .03). The decrease in FCR severity (but not triggers or distress) remained statistically significant after adjustment for other covariates ( P = .04). At 6 months, the intervention group also reported lower stress (−1.6; 95% CI, −3.1 to −0.2; P = .03) and improved melanoma-related knowledge (1.7; 95% CI, 0.8 to 2.6; P < .001) compared with the control group. No differences were found between groups for other secondary outcomes. Conclusion This newly developed evidence-based psychoeducational intervention was effective in reducing FCR and stress and increasing melanoma-related knowledge in people at high risk for another melanoma.
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Affiliation(s)
- Mbathio Dieng
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Phyllis N. Butow
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Daniel S.J. Costa
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Rachael L. Morton
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Scott W. Menzies
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Shab Mireskandari
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Stephanie Tesson
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Graham J. Mann
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Anne E. Cust
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
| | - Nadine A. Kasparian
- Mbathio Dieng and Anne E. Cust, Sydney School of Public Health, The University of Sydney; Anne E. Cust, Rachael L. Morton, and Graham J. Mann, The Melanoma Institute Australia, The University of Sydney; Phyllis N. Butow and Stephanie Tesson, School of Psychology, The University of Sydney; Daniel S.J. Costa, Pain Management Research Institute, The University of Sydney; Rachael L. Morton, NHMRC Clinical Trials Centre, The University of Sydney; Scott W. Menzies, Sydney Medical School, The University of
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209
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Roos L, Sandling JK, Bell CG, Glass D, Mangino M, Spector TD, Deloukas P, Bataille V, Bell JT. Higher Nevus Count Exhibits a Distinct DNA Methylation Signature in Healthy Human Skin: Implications for Melanoma. J Invest Dermatol 2016; 137:910-920. [PMID: 27993549 PMCID: PMC5754330 DOI: 10.1016/j.jid.2016.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/14/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022]
Abstract
High nevus count is the strongest risk factor for melanoma, and although gene variants have been discovered for both traits, epigenetic variation is unexplored. We investigated 322 healthy human skin DNA methylomes associated with total body nevi count, incorporating genetic and transcriptomic variation. DNA methylation changes were identified at genes involved in melanocyte biology, such as RAF1 (P = 1.2 × 10-6) and CTC1 (region: P = 6.3 × 10-4), and other genes including ARRDC1 (P = 3.1 × 10-7). A subset exhibited coordinated methylation and transcription changes within the same biopsy. The total analysis was also enriched for melanoma-associated DNA methylation variation (P = 6.33 × 10-6). In addition, we show that skin DNA methylation is associated in cis with known genome-wide association study single nucleotide polymorphisms for nevus count, at PLA2G6 (P = 1.7 × 10-49) and NID1 (P = 6.4 × 10-14), as well as melanoma risk, including in or near MC1R, MX2, and TERT/CLPTM1L (P < 1 × 10-10). Our analysis using a uniquely large dataset comprising healthy skin DNA methylomes identified known and additional regulatory loci and pathways in nevi and melanoma biology. This integrative study improves our understanding of predisposition to nevi and their potential contribution to melanoma pathogenesis.
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Affiliation(s)
- Leonie Roos
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; MRC London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Johanna K Sandling
- Department of Medical Sciences, Molecular Medicine and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Christopher G Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Human Development and Health Academic Unit, Institute of Developmental Sciences, University of Southampton, Southampton, UK; Epigenomic Medicine, Centre for Biological Sciences, Faculty of Environmental and Natural Sciences, University of Southampton, Southampton, UK
| | - Daniel Glass
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Panos Deloukas
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Veronique Bataille
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jordana T Bell
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
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210
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Li X, Liang G, Du M, De Vivo I, Nan H. No association between telomere length-related loci and number of cutaneous nevi. Oncotarget 2016; 7:82396-82399. [PMID: 27637081 PMCID: PMC5347699 DOI: 10.18632/oncotarget.12021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/07/2016] [Indexed: 11/25/2022] Open
Abstract
Background Longer telomeres have been associated both with increased melanoma risk and increased nevus counts. Nevus count is one of the strongest risk factors for melanoma. Recent data showed that a genetic score derived by telomere length-related single nucleotide polymorphisms (SNPs) was strongly associated with melanoma risk; however, the relationships between these SNPs and number of cutaneous nevi have not been investigated. Methods We evaluated the associations between telomere length-related SNPs reported by previous genome-wide association study (GWAS) and nevus counts among 15,955 participants of European Ancestry in the Nurses' Health Study and Health Professionals Follow-up Study. Results None of the SNPs was associated with nevus counts, nor was the genetic score combining the dosage of alleles related to increased telomere length. Conclusions The telomere length-related SNPs identified by published GWAS do not appear to play an important role in nevus formation. Genetic determinants of telomere length reported by GWAS do not explain the observed epidemiologic association between telomere length and nevus counts.
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Affiliation(s)
- Xin Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Geyu Liang
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Mengmeng Du
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Hongmei Nan
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
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211
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Belbasis L, Stefanaki I, Stratigos AJ, Evangelou E. Non-genetic risk factors for cutaneous melanoma and keratinocyte skin cancers: An umbrella review of meta-analyses. J Dermatol Sci 2016; 84:330-339. [PMID: 27663092 DOI: 10.1016/j.jdermsci.2016.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Skin cancers have a complex disease mechanism, involving both genetic and non-genetic risk factors. Numerous meta-analyses have been published claiming statistically significant associations between non-genetic risk factors and skin cancers without applying a thorough methodological assessment. OBJECTIVE The present study maps the literature on the non-genetic risk factors of skin cancers, assesses the presence of statistical biases and identifies the associations with robust evidence. METHODS We searched PubMed up to January 20, 2016 to identify systematic reviews and meta-analyses of observational studies that examined associations between non-genetic factors and skin cancers. For each meta-analysis, we estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval and the 95% prediction interval. We also assessed the between-study heterogeneity (I2 metric), evidence for small-study effects and excess significance bias. RESULTS Forty-four eligible papers were identified and included a total of 85 associations. Twenty-one associations were significant at P<10-6. Fifty-two associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in fifteen and thirteen associations, respectively. Overall, thirteen associations (actinic keratosis, serum vitamin D, sunburns, and hair color for basal cell carcinoma and density of freckles, eye color, hair color, history of melanoma, skin type, sunburns, premalignant skin lesions, common and atypical nevi for melanoma) presented high level of credibility. CONCLUSION The majority of meta-analyses on non-genetic risk factors for skin cancers suffered from large between-study heterogeneity and small-study effects or excess significance bias. The associations with convincing and highly suggestive evidence were mainly focused on skin photosensitivity and phenotypic characteristics.
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Affiliation(s)
- Lazaros Belbasis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Irene Stefanaki
- Department of Dermatology, Andreas Sygros Hospital, University of Athens Medical School, Athens, Greece
| | - Alexander J Stratigos
- Department of Dermatology, Andreas Sygros Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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212
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The Pathophysiological Impact of HLA Class Ia and HLA-G Expression and Regulatory T Cells in Malignant Melanoma: A Review. J Immunol Res 2016; 2016:6829283. [PMID: 27999823 PMCID: PMC5141560 DOI: 10.1155/2016/6829283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/16/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022] Open
Abstract
Malignant melanoma, a very common type of cancer, is a rapidly growing cancer of the skin with an increase in incidence among the Caucasian population. The disease is seen through all age groups and is very common in the younger age groups. Several studies have examined the risk factors and pathophysiological mechanisms of malignant melanoma, which have enlightened our understanding of the development of the disease, but we have still to fully understand the complex immunological interactions. The examination of the interaction between the human leucocyte antigen (HLA) system and prognostic outcome has shown interesting results, and a correlation between the down- or upregulation of these antigens and prognosis has been seen through many different types of cancer. In malignant melanoma, HLA class Ia has been seen to influence the effects of pharmaceutical drug treatment as well as the overall prognosis, and the HLA class Ib and regulatory T cells have been correlated with tumor progression. Although there is still no standardized immunological treatment worldwide, the interaction between the human leucocyte antigen (HLA) system and tumor progression seems to be a promising focus in the way of optimizing the treatment of malignant melanoma.
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213
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Sehgal R, Cheung CX, Alradadi R, Healy DA, Landers R, O'Donoghue GT. University Hospital Waterford: 5-year experience of cutaneous melanoma. Ir J Med Sci 2016; 186:309-314. [PMID: 27873142 DOI: 10.1007/s11845-016-1531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The incidence of cutaneous melanoma (CM) continues to rise in Ireland. Despite significant advances in melanoma molecular therapy, surgery remains the mainstay of treatment for CM. The University Hospital Waterford (UHW) prospectively maintained CM registry was established in 2010. AIM To summarize 5-year experience (2010-2015) of primary CM presenting to UHW. METHODS Data were retrospectively obtained from a central electronic pathology and radiology repository augmented by HIPE data and theatre logs. Data collected included patient demographics and clinico-pathological characteristics, specimen number, size, anatomical location, melanoma subtype, Breslow thickness, Clark's level, ulceration, and mitosis. RESULTS 592 CMs were managed in UHW during the study period. Overall, females comprised the majority of cases with mean age at presentation 60.78 ± 18.29 years. The most commonly affected anatomical location was the lower limb (26.7%) followed by the back (15.1%), upper limb (15.07%), and face (14.40%). Superficial spreading and lentigo maligna were the most common histological subtype accounting for 19.8 and 20%, respectively. Overall, the mean Breslow depth was 2.4 ± 3.7 mm with corresponding Clark's Level III. Sentinel lymph node positivity was 39/103 (37.89%) most commonly located in the axilla (53.8%) and groin (30.7%). CONCLUSION There has been a steady increase in the number of cutaneous melanoma presentations over the past 5-years to the South East Cancer Centre. Patients are managed best by prompt surgical excision and multidisciplinary management. Our results are in keeping with international standards and work continues in determining overall 5-year survival and recurrence rates.
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Affiliation(s)
- R Sehgal
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland.
| | - C X Cheung
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - R Alradadi
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - D A Healy
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - R Landers
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
| | - G T O'Donoghue
- Department of Breast and Endocrine Surgery, University Hospital Waterford, Waterford, Ireland
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214
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Campione E, Botta A, Di Prete M, Rastelli E, Gibellini M, Petrucci A, Bernardini S, Novelli G, Bianchi L, Orlandi A, Massa R, Terracciano C. Cutaneous features of myotonic dystrophy types 1 and 2: Implication of premature aging and vitamin D homeostasis. Neuromuscul Disord 2016; 27:163-169. [PMID: 28065683 DOI: 10.1016/j.nmd.2016.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 02/08/2023]
Abstract
Skin changes have been described in myotonic dystrophy type 1 (DM1). However, whether and in which way skin is a target of specific disease alterations in DM1 and DM2 has not been yet clarified. This study aims to explore cutaneous features of DM1 and DM2 patients. Skin examination was performed in 60 DM1, 15 DM2, and 103 control, unselected patients by means of dermoscopy. It revealed quantitative and qualitative abnormalities of nevi and typical signs of premature aging in both DM1 and DM2 patients, with a significantly higher frequency of dysplastic nevi, alopecia, xerosis and seborrheic dermatitis. Twenty-eight nevi were excised in DM patients and none showed histological features of melanoma, although 12 of them were diagnosed as dysplastic and the remaining 16 presented histological irregularity in melanin distribution. In DM1 patients, the number of nevi correlated with CTG expansion size, whereas the presence of dysplastic nevi and xerosis inversely correlated with vitamin D levels. DM1 and DM2 patients display a high frequency of skin abnormalities, the most common of which correlate with genotype severity and serum vitamin D levels. Skin examination is highly informative in these patients and reveals features suggestive of premature aging and impaired vitamin D homeostasis.
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Affiliation(s)
- Elena Campione
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Annalisa Botta
- Department of Biomedicine and Prevention, Division of Medical Genetics, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Monia Di Prete
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Emanuele Rastelli
- Department of Systems Medicine, Division of Neurology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Manuela Gibellini
- Department of Systems Medicine, Division of Neurology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; Department of Experimental Medicine and Surgery, Division of Clinical Biochemistry, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Antonio Petrucci
- Center for Neuromuscular and Neurological Rare Diseases S. Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy
| | - Sergio Bernardini
- Department of Experimental Medicine and Surgery, Division of Clinical Biochemistry, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Novelli
- Department of Biomedicine and Prevention, Division of Medical Genetics, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Luca Bianchi
- Department of Systems Medicine, Division of Dermatology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Augusto Orlandi
- Department of Biomedicine and Prevention, Division of Anatomic Pathology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Roberto Massa
- Department of Systems Medicine, Division of Neurology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Chiara Terracciano
- Department of Systems Medicine, Division of Neurology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; Department of Experimental Medicine and Surgery, Division of Clinical Biochemistry, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
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215
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Castro LGM, Bakos RM, Duprat Neto JP, Bittencourt FV, Di Giacomo THB, Serpa SS, Messina MCDL, Loureiro WR, Macarenco RSES, Stolf HO, Gontijo G. Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II. An Bras Dermatol 2016; 91:49-58. [PMID: 26982779 PMCID: PMC4782647 DOI: 10.1590/abd1806-4841.20164715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/27/2015] [Indexed: 01/04/2023] Open
Abstract
The last Brazilian guidelines on melanoma were published in 2002. Development in
diagnosis and treatment made updating necessary. The coordinators elaborated ten
clinical questions, based on PICO system. A Medline search, according to
specific MeSH terms for each of the 10 questions was performed and articles
selected were classified from A to D according to level of scientific evidence.
Based on the results, recommendations were defined and classified according to
scientific strength. The present Guidelines were divided in two parts for
editorial and publication reasons. In this second part, the following clinical
questions were answered: 1) which patients with primary cutaneous melanoma
benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is
indicated for which patients? 3) Is preventive excision of acral nevi
beneficious to patients? 4) Is preventive excision of giant congenital nevi
beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma
patients be followed?
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Affiliation(s)
| | - Renato Marchiori Bakos
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | | | - Gabriel Gontijo
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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216
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Papageorgiou C, Ioannides D, Apalla Z, Vakirlis E, Lazaridou E, Sotiriou E, Lallas A. Dermoscopy of difficult-to-diagnose Melanomas. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2016. [DOI: 10.1515/sjdv-2016-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Dermoscopy is a non-invasive procedure that allows the evaluation of cutaneous lesions, and is considered to be a useful tool that improves the diagnostic accuracy of melanoma. Many dermoscopic criteria of melanoma have been established and several algorithms have been created for melanoma detection. However, the recognition of some melanomas remains challenging. Melanomas on specific body sites, melanomas in patients with multiple atypical moles, and nodular melanomas represent the most difficult-to-recognize melanoma subtypes, since they typically lack the “classic” melanoma-specific criteria. This paper provides an update on dermoscopy of difficult-to-diagnose melanomas by summarizing the newest data. Lastly, we highlight the importance of digital dermoscopy in the follow-up of melanocytic lesions for the detection of incipient melanomas while maintaining a low excision rate.
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Affiliation(s)
| | | | - Zoe Apalla
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | | | | | - Eleni Sotiriou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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217
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de Vries E, Sierra M, Piñeros M, Loria D, Forman D. The burden of cutaneous melanoma and status of preventive measures in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S100-S109. [PMID: 27034057 DOI: 10.1016/j.canep.2016.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVE Very little is known about the burden of cutaneous melanoma in Central and South America, despite the existence of a reasonable amount of population-based data. We present data on melanoma incidence calculated in a standardized way for Central and South America, as well as an overview of primary and secondary prevention issues in the region. METHODS Cancer registry data on all incident cases reported in the different registries present in Central and South America were combined to provide registry-based country estimates of age-standardized, sex-specific cutaneous melanoma incidence overall, and by histological subtype and anatomical site. A literature search provided additional information. RESULTS Age-standardized incidence rates were between 1 and 5 per 100,000 and tended to be higher further away from the equator. Cutaneous melanomas of the acral type, mostly occurring on the lower limbs, are a distinguishing feature of melanoma in Central and South America in comparison with high-incidence areas. Several preventive measures, both primary and secondary, are in place, albeit largely without evaluation. CONCLUSION Due to incomplete registration and different registration practices, reliable and comparable data on melanoma were difficult to obtain; thus it is likely that the true burden of melanoma in Central and South America has been underestimated. The different characteristics of the cutaneous melanoma patient population in terms of anatomical site and histological type distribution imply a need for adapted primary and secondary prevention measures. The generally high ambient ultraviolet radiation levels require sufficient sun protection measures.
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Affiliation(s)
- Esther de Vries
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France; National Cancer Institute, Directorate of Research, Surveillance, Prevention and Promotion, Colombia; Erasmus MC University Medical Center, Department of Public Health, Rotterdam, The Netherlands.
| | - Mónica Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
| | - Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
| | - Dora Loria
- Argentinian Registry of Cutaneous Melanoma, Argentina
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, Lyon, France
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218
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Ribero S, Osella-Abate S, Reyes-Garcia D, Glass D, Bataille V. Effects of sex on naevus body distribution and melanoma risk in two melanoma case-control studies at different latitudes. Br J Dermatol 2016; 176:1093-1094. [PMID: 27478920 DOI: 10.1111/bjd.14915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Ribero
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, U.K.,Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - S Osella-Abate
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - D Reyes-Garcia
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, U.K.,Faculty of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
| | - D Glass
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, U.K.,Faculty of Medicine, Imperial College London, London, U.K
| | - V Bataille
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Campus, Westminster Bridge Road, London, SE1 7EH, U.K.,Department of Dermatology, West Herts NHS Trust, Hertfordshire, U.K
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Larsen AC, Dahl C, Dahmcke CM, Lade-Keller J, Siersma VD, Toft PB, Coupland SE, Prause JU, Guldberg P, Heegaard S. BRAF mutations in conjunctival melanoma: investigation of incidence, clinicopathological features, prognosis and paired premalignant lesions. Acta Ophthalmol 2016; 94:463-70. [PMID: 27009410 DOI: 10.1111/aos.13007] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/09/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate incidence, clinicopathological features and prognosis of BRAF-mutated conjunctival melanoma in Denmark. Furthermore, to determine BRAF mutations in paired premalignant lesions and evaluate immunohistochemical BRAF V600E oncoprotein detection. METHODS Data from 139 patients with conjunctival melanoma (1960-2012) were collected. Archived conjunctival melanoma samples and premalignant lesions were analysed for BRAF mutations using droplet digital polymerase chain reaction (PCR). Results were associated with clinicopathological features and compared with BRAF V600E oncoprotein stainings. RESULTS The overall incidence of conjunctival melanoma (0.5 cases/1 000 000/year) increased during the study period with 0.13 cases/1 000 000/10 years. The increase comprised a higher proportion of patients aged >65 years, epibulbar tumours and tumours developed from a primary acquired melanosis with atypia. BRAF mutations were identified in 39 of 111 (35%) cases. The rate ratio of BRAF-mutated versus BRAF-wild-type melanoma did not change over time. BRAF mutations were associated with T1 stage (p = 0.007), young age (p = 0.001), male gender (p = 0.02), sun-exposed location (p = 0.01), mixed/non-pigmented tumour colour (p = 0.02) and nevus origin (p = 0.005), but did not associate with prognosis. BRAF status in conjunctival melanoma and paired premalignant lesions corresponded in 19 of 20 cases. Immunohistochemistry detected BRAF V600E mutations with a sensitivity of 0.94 and a specificity of 1.00 in newer conjunctival melanoma samples (2000-2012, n = 47). CONCLUSION The incidence of conjunctival melanoma increased in Denmark over 50 years. The proportion of BRAF-mutated conjunctival melanoma was constant. BRAF mutations were identified as early events in conjunctival melanoma, associated with a distinct clinicopathological profile, similar to BRAF-mutated cutaneous melanoma. Immunohistochemical detection of BRAF can be used to assess BRAF V600E mutations.
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Affiliation(s)
- Ann-Cathrine Larsen
- Department of Neuroscience and Pharmacology; University of Copenhagen; Copenhagen Denmark
- Department of Pathology - Rigshospitalet; Copenhagen Denmark
| | - Christina Dahl
- Danish Cancer Society, Research Center; Copenhagen Denmark
| | | | | | - Volkert D. Siersma
- The Research Unit and Section of General Practice; Institute of Public Health, University of Copenhagen; Copenhagen Denmark
| | - Peter B. Toft
- Department of Ophthalmology; Rigshospitalet - Glostrup Hospital; Copenhagen Denmark
| | - Sarah E. Coupland
- Division of Pathology, Department of Molecular and Clinical Medicine; Royal Liverpool University Hospital; Liverpool UK
| | - Jan U. Prause
- Department of Neuroscience and Pharmacology; University of Copenhagen; Copenhagen Denmark
| | - Per Guldberg
- Danish Cancer Society, Research Center; Copenhagen Denmark
| | - Steffen Heegaard
- Department of Pathology - Rigshospitalet; Copenhagen Denmark
- Department of Ophthalmology; Rigshospitalet - Glostrup Hospital; Copenhagen Denmark
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Abstract
Common moles on the skin, known scientifically as melanocytic nevi, are seen frequently in the pediatric population. They are broadly grouped into two groups: congenital (generally present at birth or in infancy) or acquired. Congenital melanocytic nevi (CMN) are classified based on size and morphologic features. Neurocutaneous melanosis and melanoma represent two important complications, with overall risk affected by nevus size, location, appearance, and number of satellite lesions. Regular lifelong skin surveillance is required for high-risk CMN. Acquired melanocytic nevi (AMN) tend to appear in childhood and increase in number through adolescence. Risk factors for melanoma in children with moles include having more than 50 AMN, clinically atypical AMN, family history of melanoma, excessive ultraviolet light exposure, lightly pigmented skin, and immunosuppression. Children with risk factors should be monitored regularly. The periodic health examination presents an opportunity to perform total body skin examination to screen for concerning lesions and to provide anticipatory guidance about sun protection. [Pediatr Ann. 2016;45(8):e293-e298.].
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221
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Moscarella E, Tion I, Zalaudek I, Lallas A, Kyrgidis A, Longo C, Lombardi M, Raucci M, Satta R, Alfano R, Argenziano G. Both short-term and long-term dermoscopy monitoring is useful in detecting melanoma in patients with multiple atypical nevi. J Eur Acad Dermatol Venereol 2016; 31:247-251. [DOI: 10.1111/jdv.13840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- E. Moscarella
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Reggio Emilia Italy
| | - I. Tion
- Unit of Dermatology; Department of Surgical, Microsurgical and Medical Sciences; University of Sassari; Sassari Italy
| | - I. Zalaudek
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - A. Lallas
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Reggio Emilia Italy
| | - A. Kyrgidis
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Reggio Emilia Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Reggio Emilia Italy
| | - M. Lombardi
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Reggio Emilia Italy
| | - M. Raucci
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova IRCCS; Reggio Emilia Italy
| | - R. Satta
- Unit of Dermatology; Department of Surgical, Microsurgical and Medical Sciences; University of Sassari; Sassari Italy
| | - R. Alfano
- Department of Anesthesiology, Surgery and Emergency; Second University of Naples; Naples Italy
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Naples Italy
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222
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Mitsui H, Kiecker F, Shemer A, Cannizzaro MV, Wang CQF, Gulati N, Ohmatsu H, Shah KR, Gilleaudeau P, Sullivan-Whalen M, Cueto I, McNutt NS, Suárez-Fariñas M, Krueger JG. Discrimination of Dysplastic Nevi from Common Melanocytic Nevi by Cellular and Molecular Criteria. J Invest Dermatol 2016; 136:2030-2040. [PMID: 27377700 DOI: 10.1016/j.jid.2015.11.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/17/2015] [Accepted: 11/02/2015] [Indexed: 12/11/2022]
Abstract
Dysplastic nevi (DNs), also known as Clark's nevi or atypical moles, are distinguished from common melanocytic nevi by variegation in pigmentation and clinical appearance, as well as differences in tissue patterning. However, cellular and molecular differences between DNs and common melanocytic nevi are not completely understood. Using cDNA microarray, quantitative RT-PCR, and immunohistochemistry, we molecularly characterized DNs and analyzed the difference between DNs and common melanocytic nevi. A total of 111 probesets (91 annotated genes, fold change > 2.0 and false discovery rate < 0.25) were differentially expressed between the two lesions. An unexpected finding in DNs was altered differentiation and activation of epidermal keratinocytes with increased expression of hair follicle-related molecules (keratin 25, trichohyalin, ribonuclease, RNase A family, 7) and inflammation-related molecules (S100A7, S100A8) at both genomic and protein levels. The immune microenvironment of DNs was characterized by an increase of T helper type 1 (IFNγ) and T helper type 2 (IL13) cytokines as well as an upregulation of oncostatin M and CXCL1. DUSP3, which regulates cellular senescence, was identified as one of the disease discriminative genes between DNs and common melanocytic nevi by three independent statistical approaches and its altered expression was confirmed by immunohistochemistry. The molecular and cellular changes in which the epidermal-melanin unit undergoes follicular differentiation as well as upregulation of defined cytokines could drive complex immune, epidermal, and pigmentary alterations.
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Affiliation(s)
- Hiroshi Mitsui
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Felix Kiecker
- Department of Dermatology and Allergy, Skin Cancer Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Avner Shemer
- Department of Dermatology, Tel-Hashomer Medical Center, Ramat-Gan, Israel
| | - Maria Vittoria Cannizzaro
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA; Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Claire Q F Wang
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Nicholas Gulati
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Hanako Ohmatsu
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Kejal R Shah
- Texas Dermatology Associates, Baylor University Medical Center, Dallas, Texas, USA
| | - Patricia Gilleaudeau
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Mary Sullivan-Whalen
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Inna Cueto
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Neil Scott McNutt
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Mayte Suárez-Fariñas
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA; Center for Clinical and Translational Science, The Rockefeller University, New York, New York, USA
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA.
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Ransohoff KJ, Jaju PD, Jaju PD, Tang JY, Carbone M, Leachman S, Sarin KY. Familial skin cancer syndromes: Increased melanoma risk. J Am Acad Dermatol 2016; 74:423-34; quiz 435-6. [PMID: 26892652 DOI: 10.1016/j.jaad.2015.09.070] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/01/2015] [Accepted: 09/19/2015] [Indexed: 12/20/2022]
Abstract
Phenotypic traits, such as red hair and freckling, increase melanoma risk by 2- to 3-fold. In addition, approximately 10% of melanomas are caused by inherited germline mutations that increase melanoma risk from 4- to >1000-fold. This review highlights the key genes responsible for inherited melanoma, with an emphasis on when a patient should undergo genetic testing. Many genetic syndromes associated with increased melanoma risk are also associated with an increased risk of other cancers. Identification of these high-risk patients is essential for preventive behavior reinforcement, genetic counseling, and ensuring other required cancer screenings.
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Affiliation(s)
| | | | - Prajaka D Jaju
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University Medical Center, Stanford, California
| | - Michele Carbone
- Department of Thoracic Oncology, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Sancy Leachman
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University Medical Center, Stanford, California.
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224
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Scope A, Marchetti MA, Marghoob AA, Dusza SW, Geller AC, Satagopan JM, Weinstock MA, Berwick M, Halpern AC. The study of nevi in children: Principles learned and implications for melanoma diagnosis. J Am Acad Dermatol 2016; 75:813-823. [PMID: 27320410 PMCID: PMC5030195 DOI: 10.1016/j.jaad.2016.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
Abstract
Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.
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Affiliation(s)
- Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan C Geller
- Harvard School of Public Health, Social and Behavioral Sciences, Boston, Massachusetts
| | - Jaya M Satagopan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin A Weinstock
- Dermatoepidemiology Unit, Veteran's Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | - Marianne Berwick
- Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, New Mexico
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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225
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Le Clair MZ, Cockburn MG. Tanning bed use and melanoma: Establishing risk and improving prevention interventions. Prev Med Rep 2016; 3:139-44. [PMID: 27419006 PMCID: PMC4929140 DOI: 10.1016/j.pmedr.2015.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Exposure to ultraviolet radiation (UVR) from indoor tanning devices is thought to cause melanoma and other negative health consequences. Despite these findings, the practice of indoor tanning in the United States remains prevalent. In this paper we aim to present a clear discussion of the relationship between indoor tanning and melanoma risk, and to identify potential strategies for effective melanoma prevention by addressing indoor tanning device use. BASIC PROCEDURES We reviewed relevant literature on the risks of indoor tanning, current indoor tanning legislation, and trends in indoor tanning and melanoma incidence. Study was conducted at the University of Southern California, Los Angeles, CA between the years of 2014 and 2015. MAIN FINDINGS Our findings reaffirm the relationship between indoor tanning and melanoma risk, and suggest a widespread public misunderstanding of the negative effects of indoor tanning. PRINCIPAL CONCLUSIONS This review argues for an aggressive initiative to reduce indoor tanning in the United States, to design prevention efforts tailored towards specific high risk groups, and the need to better inform the public of the risks of indoor tanning.
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Affiliation(s)
- Marie Z. Le Clair
- Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90089, USA
| | - Myles G. Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA 90089, USA
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226
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Bhatt M, Nabatian A, Kriegel D, Khorasani H. Does an increased number of moles correlate to a higher risk of melanoma? Melanoma Manag 2016; 3:85-87. [PMID: 30190875 DOI: 10.2217/mmt-2016-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mehul Bhatt
- Montefiore Medical Center/Albert Einstein School of Medicine, Department of Medicine, Division of Dermatology, 111 East 210th Street, Bronx, NY 10467, USA.,Montefiore Medical Center/Albert Einstein School of Medicine, Department of Medicine, Division of Dermatology, 111 East 210th Street, Bronx, NY 10467, USA
| | - Adam Nabatian
- Department of Dermatology, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, 5 East 98th Street, NY 10029, USA.,Department of Dermatology, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, 5 East 98th Street, NY 10029, USA
| | - David Kriegel
- Department of Dermatology, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, 5 East 98th Street, NY 10029, USA.,Department of Dermatology, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, 5 East 98th Street, NY 10029, USA
| | - Hooman Khorasani
- Department of Dermatology, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, 5 East 98th Street, NY 10029, USA.,Department of Dermatology, Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, 5 East 98th Street, NY 10029, USA
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227
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Elefanti L, Sacco G, Stagni C, Rastrelli M, Menin C, Russo I, Alaibac M. TLR7 Gln11Leu single nucleotide polymorphism and susceptibility to cutaneous melanoma. Oncol Lett 2016; 12:275-280. [PMID: 27347137 DOI: 10.3892/ol.2016.4584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/17/2016] [Indexed: 01/09/2023] Open
Abstract
Cutaneous melanoma is a life-threatening skin cancer. Its incidence is rapidly increasing, and early diagnosis is the main factor able to improve its poor prognosis. Toll-like receptors (TLRs) are transmembrane glycoproteins that recognize pathogen- and damage-associated molecular patterns, against which TLRs activate the innate immune response and initiate the adaptive immune response. Genetic variations of these receptors may alter the immune system, and are involved in evolution and susceptibility to various diseases, including cancer. The aim of the present study was to evaluate whether the presence of TLR7 glutamine (Gln) 11 leucine (Leu) polymorphism confers an increased susceptibility to cutaneous melanoma. For that purpose, a case-control study was performed with 182 melanoma cases and 89 controls. To highlight the possible association between the aforementioned polymorphism and the susceptibility to melanoma, 93 cases of single melanoma and 89 cases of multiple primary melanoma (MPM) were compared in the present study. Since the TLR7 gene is localized on the chromosome X, the allelic frequency of the Gln11Leu polymorphism was analyzed separately in males and females. The distribution of allele frequencies between melanoma cases and controls (P=0.245) and between single melanoma and MPM cases (P=0.482) was not significant. Therefore, the present results do not suggest an association between TLR7 Gln11Leu polymorphism and susceptibility to cutaneous melanoma. Further studies are required to analyze the influence of other TLR polymorphisms on the susceptibility to malignant melanoma and the involvement of innate immunity in this malignancy.
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Affiliation(s)
- Lisa Elefanti
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, Scientific Institute for Hospitalization, Treatment and Research, Padua I-35128, Italy
| | - Giorgia Sacco
- Department of Medicine, Dermatology Unit, University of Padua, Padua I-35121, Italy
| | - Camilla Stagni
- Department of Surgery, Oncology and Gastroenterology, Oncology and Immunology Unit, University of Padua, Padua I-35100, Italy
| | - Marco Rastrelli
- Melanoma and Soft Tissue Sarcoma Unit, Veneto Institute of Oncology, Scientific Institute for Hospitalization, Treatment and Research, Padua I-35128, Italy
| | - Chiara Menin
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, Scientific Institute for Hospitalization, Treatment and Research, Padua I-35128, Italy
| | - Irene Russo
- Department of Medicine, Dermatology Unit, University of Padua, Padua I-35121, Italy
| | - Mauro Alaibac
- Department of Medicine, Dermatology Unit, University of Padua, Padua I-35121, Italy
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228
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Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomarkers Prev 2016; 23:1080-9. [PMID: 24876226 DOI: 10.1158/1055-9965.epi-13-0821] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Few prospective studies have examined the relationship between sun exposure, other potential risk factors, and risk of different skin cancers [including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma] simultaneously. METHODS We evaluated the association between a number of potential risk factors and skin cancer risk in a cohort of 108,916 US women, the Nurses' Health Study II (1989-2009). RESULTS During 2.05 million years of follow-up, we identified 6,955, 880, and 779 diagnoses of BCC, SCC, and melanoma, respectively. Compared with participants in the lowest quintile of cumulative ultraviolet flux in adulthood, participants in the highest quintile had multivariable-adjusted relative risks (RR) of 2.35 (Ptrend < 0.0001) for BCC, 2.53 (Ptrend = 0.009) for SCC, and 0.68 (Ptrend = 0.38) for melanoma. In contrast, the RRs were 1.68 (95% CI, 1.55-1.82) for BCC, 1.68 (95% CI, 1.34-2.11) for SCC, and 1.80 (95% CI, 1.42-2.28) for melanoma for participants with ≥5 blistering sunburns when compared with participants without sunburn between ages 15 and 20 years. We found significant interactions between family history of melanoma, number of blistering sunburns between ages 15 and 20 years and BCC risk, and between sunburn reaction as a child/adolescent and SCC risk (all Pinteraction < 0.05). CONCLUSION In a cohort of U.S. women, we found that sun exposures in both early life and adulthood were predictive of BCC and SCC risks, whereas melanoma risk was predominantly associated with sun exposure in early life. IMPACT Our results may have potential implications for the prevention of skin cancers. Cancer Epidemiol Biomarkers Prev; 23(6); 1080-9. ©2014 AACR.
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Affiliation(s)
- Shaowei Wu
- Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jiali Han
- Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Br
| | - Francine Laden
- Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abrar A Qureshi
- Authors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode IslandAuthors' Affiliations: Department of Dermatology; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Departments of Epidemiology and Environmental Health, Harvard School of Public Health, Boston, Massachusetts; Department of Epidemiology, Fairbanks School of Public Health, Simon Cancer Center, Indiana University, Indianapolis, Indiana; and Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
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229
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Wu S, Cho E, Li WQ, Weinstock MA, Han J, Qureshi AA. History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies. Am J Epidemiol 2016; 183:824-33. [PMID: 27045074 DOI: 10.1093/aje/kwv282] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 10/12/2015] [Indexed: 12/20/2022] Open
Abstract
Few studies have assessed the relationship between sunburn and risk of different skin cancers (melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC)) in prospective studies simultaneously, and little is known about the association of severe sunburns at different body sites with skin cancer risk. We used data on 87,166 women in the Nurses' Health Study (1982-2010) and 32,959 men in the Health Professionals Follow-up Study (1992-2010) to investigate skin cancer risk associated with history of severe sunburns at different body sites (face/arms, trunk, and lower limbs). After adjustment for other risk factors, overall baseline history of severe sunburn was more apparently associated with risk of melanoma than with risk of SCC and BCC in men (multivariable-adjusted hazard ratios were 2.41 (95% confidence interval (CI): 1.32, 4.41) for melanoma, 1.48 (95% CI: 1.08, 2.03) for SCC, and 1.18 (95% CI: 1.06, 1.32) for BCC) but not in women. Sunburn on the trunk appeared to be more closely associated with melanoma risk, but not risk of SCC and BCC, when compared with sunburns at other body sites (face/arms and lower limbs). These differences were more apparent in men than in women. Pending further investigation, our findings add novel insights to the existing literature on sunburn history and skin cancer risk.
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230
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Recognizing melanoma: Diagnosis and treatment options. Nurse Pract 2016; 41:24-9; quiz 29-30. [PMID: 26974049 DOI: 10.1097/01.npr.0000481508.24736.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Melanoma is a malignant tumor that is usually cutaneous in origin and is associated with significant morbidity and mortality. As one of the most common cancers seen in young adults, melanoma represents a major public health concern in terms of years of lost productivity.
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231
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Fortes C, Mastroeni S, Segatto M M, Hohmann C, Miligi L, Bakos L, Bonamigo R. Occupational Exposure to Pesticides With Occupational Sun Exposure Increases the Risk for Cutaneous Melanoma. J Occup Environ Med 2016; 58:370-5. [PMID: 27058477 DOI: 10.1097/jom.0000000000000665] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of the study was to examine the association between occupational exposure to pesticides and cutaneous melanoma, controlling for all possible confounders. METHODS A pooled analysis of two case-control studies was conducted in two different geographic areas (Italy and Brazil). Detailed pesticides exposure histories were obtained. RESULTS Ever use of any pesticide was associated with a high risk of cutaneous melanoma (odds ratio 2.58; 95% confidence interval 1.18-5.65) in particular exposure to herbicides (glyphosate) and fungicides (mancozeb, maneb), after controlling for confounding factors. When subjects were exposed to both pesticides and occupational sun exposure, the risk increased even more (odds ratio 4.68; 95% confidence interval 1.29-17.0). CONCLUSIONS The study suggests an augmented risk of cutaneous melanoma among subjects with exposure to pesticides, in particular among those exposed to occupational sun exposure.
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Affiliation(s)
- Cristina Fortes
- Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IDI- IRCCS-FLMM, Rome, Italy (Fortes, Mastroeni); Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Brazil (Segatto M, Hohmann B, Bonamigo); Occupational and Environmental Epidemiology Unit, ISPO Cancer Prevention and Research, Institute, Florence, Italy (Miligi); Dermatology Service, Federal University of Health Sciences of Porto Alegre (Bonamigo); and Dermatology Service, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Bakos)
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Kamath S, Miller KA, Cockburn MG. Current Data on Risk Factor Estimates Does Not Explain the Difference in Rates of Melanoma between Hispanics and Non-Hispanic Whites. J Skin Cancer 2016; 2016:2105250. [PMID: 27092276 PMCID: PMC4820624 DOI: 10.1155/2016/2105250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 01/07/2023] Open
Abstract
United States Hispanics have seven times lower melanoma incidence rates than non-Hispanic whites (NHW). It is unclear whether this difference can be explained solely by phenotypic risk factors, like darker skin, or whether modifiable risk factors, like sun exposure, also play a role. The purpose of this paper is to summarize what is currently known about melanoma risk factors among Hispanics and NHWs, and whether or not those differences could explain the difference in melanoma incidence. Through literature review, relative risks and prevalence of melanoma risk factors in Hispanics and NHWs were identified and used to calculate the expected rate in Hispanics and rate ratio compared to NHWs. We found that melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, we found that melanoma incidence rates in the two groups should actually be similar. Sun exposure behavior among Hispanics may contribute to the explanation for the 7-fold difference in melanoma rates. Currently, limited data exist on sun exposure behavior among Hispanics, but possibilities for improving primary prevention by further studying these practices are substantial.
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Affiliation(s)
- Sonia Kamath
- Department of Dermatology, Keck School of Medicine of the University of Southern California (USC), 1200 N State Street, Room 3250, Los Angeles, CA 90033, USA
| | - Kimberly A. Miller
- Department of Preventive Medicine, Keck School of Medicine of USC, 2001 N. Soto Street, Suite 318-A, Los Angeles, CA 90032, USA
| | - Myles G. Cockburn
- Department of Dermatology, Keck School of Medicine of the University of Southern California (USC), 1200 N State Street, Room 3250, Los Angeles, CA 90033, USA
- Department of Preventive Medicine, Keck School of Medicine of USC, 2001 N. Soto Street, Suite 318-A, Los Angeles, CA 90032, USA
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233
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Slimano F, Roessle C, Blanc C, De Maleissye MF, Bauler S. [Updates on prevention and treatment of melanoma: Pharmacist involvements and challenges]. ANNALES PHARMACEUTIQUES FRANÇAISES 2016; 74:335-49. [PMID: 26968263 DOI: 10.1016/j.pharma.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 02/07/2023]
Abstract
Melanoma is a skin cancer that represents an actual public health problem. Its incidence is increasing every year. Environmental risk factors have been clearly identified. Early diagnosis of a suspicious skin lesion should be possible by any health professionals because the prognosis is correlated with the evolution of the disease and the presence of metastases. The advent of new therapies in metastatic forms with the development of immunotherapies and kinases inhibitors has significantly changed the management of this disease. New therapies are available in retail pharmacies and involve health professionals out of the hospital. This article is intended for community and hospital pharmacists and summarizes recommendations for primary and secondary prevention. It updates on new targeted therapies. It wants to give advices to the community pharmacists about the effective use of those treatments for melanoma.
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Affiliation(s)
- F Slimano
- Département de pharmacie clinique, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Laboratoire de pharmacologie et pharmacocinétique, UFR de pharmacie, université de Reims-Champagne-Ardenne, 51, rue Cognacq-Jay, 51100 Reims, France; Unité MEDyC, UMR CNRS/URCA, université de Reims-Champagne-Ardenne, 51, rue Cognacq-Jay, 51100 Reims, France.
| | - C Roessle
- Département de pharmacie clinique, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - C Blanc
- Service de pharmacie, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - M-F De Maleissye
- Service de dermatologie, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - S Bauler
- Service de pharmacie, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
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234
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Barbaric J, Sekerija M, Agius D, Coza D, Dimitrova N, Demetriou A, Safaei Diba C, Eser S, Gavric Z, Primic-Zakelj M, Zivkovic S, Zvolsky M, Bray F, Coebergh JW, Znaor A. Disparities in melanoma incidence and mortality in South-Eastern Europe: Increasing incidence and divergent mortality patterns. Is progress around the corner? Eur J Cancer 2016; 55:47-55. [PMID: 26773419 DOI: 10.1016/j.ejca.2015.11.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/23/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Most countries in South-Eastern Europe (SEE) have lower incidence, but higher mortality rates of malignant melanoma (MM) of the skin compared to North-Western Europe (NWE). We explored trends in MM incidence and mortality in SEE countries by sex and age and compared them with the trends in NWE. METHODS We obtained data on incident cases and deaths from MM (ICD-10 code C43) from 11 population-based cancer registries in Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Malta, Romania, Serbia, Slovakia, Slovenia and Turkey. We calculated age-specific rates for 25-49 ('young'), 50-69 ('middle aged') and 70+ years ('older') and estimated the average annual percent of change in incidence and mortality trends 2000-2010 according to age group and sex, using joinpoint regression analysis. FINDINGS The incidence rates of MM across the region were uniformly increasing. Significant increases in mortality rates were observed in middle aged men in Serbia and Bulgaria, middle aged women in Slovenia, older men in the Czech Republic, Serbia and Turkey, and older women in Slovenia and Serbia. INTERPRETATION While MM incidence rates were still increasing across SEE, mortality trends diverged and were less favourable than in NWE. Empowering cancer registration and improving the quality of incidence and mortality data will be essential for monitoring progress in MM control. In the context of prevention of melanoma, disparities in early detection appear to be widening the gap between SEE and NWE, while the provision of care to patients with advanced disease is likely to prove a challenge for regional healthcare budgets.
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Affiliation(s)
- Jelena Barbaric
- Agency for Quality and Accreditation in Health Care and Social Welfare, Department for Development, Research and Health Technology Assessment, Planinska 13, 10000 Zagreb, Croatia.
| | - Mario Sekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia.
| | - Dominic Agius
- Malta National Cancer Registry, Department for Health Information and Research, 95, G'Mangia Hill, Pieta, PTA 1313, Malta.
| | - Daniela Coza
- Regional Cancer Registry of Cluj, Oncological Institute 'Ion Chiricuta', Republicii Street 34-36, 400015 Cluj-Napoca, Romania.
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, 6, Plovdivsko Pole Street, 1756 Sofia, Bulgaria.
| | - Anna Demetriou
- Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, 1 Prodromou Street & 17 Chilonos Street, 1448 Lefkosia, Cyprus.
| | - Chakameh Safaei Diba
- National Cancer Registry of Slovakia, National Health Information Center, Lazaretska 26, 81109 Bratislava, Slovakia.
| | - Sultan Eser
- Hacettepe University, Public Health Institute, Sıhhıye Campus, Sıhhıye, 06100 Ankara, Turkey; Izmir Cancer Registry, Izmir Public Health Directorate, Zubeyde Hanim Caddesi No:100, 35067 Karsiyaka, Izmir, Turkey.
| | - Zivana Gavric
- Cancer Registry of Republic of Srpska, The Public Health Institute Banja Luka, Jovan Ducic 1, 78 000 Banja Luka, Bosnia and Herzegovina.
| | - Maja Primic-Zakelj
- Cancer Registry of Republic of Slovenia, Oncology Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia.
| | - Snezana Zivkovic
- Cancer Registry of Central Serbia, Institute of Public Health of Serbia, Dr Subotica 5, 11000 Belgrade, Serbia.
| | - Miroslav Zvolsky
- Czech National Cancer Registry, Institute of Health Information and Statistics of the Czech Republic, Palackého nám. 4, PO Box 60, 128 01 Praha 2, Czech Republic.
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 CEDEX 08 Lyon, France.
| | - Jan Willem Coebergh
- Department of Public Health, Erasmus University Medical Center, PO Box 2040 3000 CA Rotterdam, The Netherlands.
| | - Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 CEDEX 08 Lyon, France.
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235
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Eleven Primary Melanomas, Colon Cancer, and Atypical Nevi in the Same Patient: A Case Report and Literature Review. Case Rep Dermatol Med 2016; 2016:3145986. [PMID: 27022491 PMCID: PMC4789033 DOI: 10.1155/2016/3145986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/17/2022] Open
Abstract
Background. As the incidence of cutaneous malignant melanoma increases in the Caucasian population, an increasing population of melanoma survivors is at risk of developing multiple primary melanomas (MPM) as well as secondary primary cancers. Objective. To present a case of a patient with atypical nevi, 11 primary melanomas over 33 years, and colon cancer and to review the literature on multiple primary melanomas, atypical nevi, and correlation of nonmelanoma cancers. Conclusion. The literature indicates that patients with MPM are not uncommon, although 11 primary melanomas are rarely described, that patients with MPM may have a better survival than patients with single primary melanoma, that atypical nevi are a risk marker of not only melanoma in general but also MPM, and that melanoma patients have a significantly increased risk of developing nonmelanoma skin and other cancers, which may be even higher for patients with MPM.
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236
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Berwick M, Buller DB, Cust A, Gallagher R, Lee TK, Meyskens F, Pandey S, Thomas NE, Veierød MB, Ward S. Melanoma Epidemiology and Prevention. Cancer Treat Res 2016; 167:17-49. [PMID: 26601858 DOI: 10.1007/978-3-319-22539-5_2] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The epidemiology of melanoma is complex, and individual risk depends on sun exposure, host factors, and genetic factors, and in their interactions as well. Sun exposure can be classified as intermittent, chronic, or cumulative (overall) exposure, and each appears to have a different effect on type of melanoma. Other environmental factors, such as chemical exposures-either through occupation, atmosphere, or food-may increase risk for melanoma, and this area warrants further study. Host factors that are well known to be important are the numbers and types of nevi and the skin phenotype. Genetic factors are classified as high-penetrant genes, moderate-risk genes, or low-risk genetic polymorphisms. Subtypes of tumors, such as BRAF-mutated tumors, have different risk factors as well as different therapies. Prevention of melanoma has been attempted using various strategies in specific subpopulations, but to date optimal interventions to reduce incidence have not emerged.
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Affiliation(s)
- Marianne Berwick
- Department of Internal Medicine, University of New Mexico, MSC10-5550, Albuquerque, NM, 87131-0001, USA.
| | - David B Buller
- Klein Buendel, Inc., 1667 Cole Boulevard, Suite 225, Golden, CO, 80401, USA.
| | - Anne Cust
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Level 6, 119-143 Missenden Road, Camperdown, NSW, 2050, Australia.
| | - Richard Gallagher
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Tim K Lee
- Cancer Control Research Program, BC Cancer Agency, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Frank Meyskens
- Public Health and Epidemiology, University of California, Irvine, USA.
| | - Shaily Pandey
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Nancy E Thomas
- University of North Carolina, 413 Mary Ellen Jones Bldg. CB#7287, Chapel Hill, NC, 275992, USA.
| | - Marit B Veierød
- Department of Biostatistics, Institute of Basic Medical Sciences, P.O. Box 1122 Blindern, 0317, Oslo, Norway.
| | - Sarah Ward
- Centre for Genetic Origins of Health and Disease (GOHaD), The University of Western Australia, M409, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
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237
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Harland M, Petljak M, Robles-Espinoza CD, Ding Z, Gruis NA, van Doorn R, Pooley KA, Dunning AM, Aoude LG, Wadt KAW, Gerdes AM, Brown KM, Hayward NK, Newton-Bishop JA, Adams DJ, Bishop DT. Germline TERT promoter mutations are rare in familial melanoma. Fam Cancer 2016; 15:139-44. [PMID: 26433962 PMCID: PMC4698275 DOI: 10.1007/s10689-015-9841-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Germline CDKN2A mutations occur in 40 % of 3-or-more case melanoma families while mutations of CDK4, BAP1, and genes involved in telomere function (ACD, TERF2IP, POT1), have also been implicated in melanomagenesis. Mutation of the promoter of the telomerase reverse transcriptase (TERT) gene (c.-57 T>G variant) has been reported in one family. We tested for the TERT promoter variant in 675 multicase families wild-type for the known high penetrance familial melanoma genes, 1863 UK population-based melanoma cases and 529 controls. Germline lymphocyte telomere length was estimated in carriers. The c.-57 T>G TERT promoter variant was identified in one 7-case family with multiple primaries and early age of onset (earliest, 15 years) but not among population cases or controls. One family member had multiple primary melanomas, basal cell carcinomas and a bladder tumour. The blood leukocyte telomere length of a carrier was similar to wild-type cases. We provide evidence confirming that a rare promoter variant of TERT (c.-57 T>G) is associated with high penetrance, early onset melanoma and potentially other cancers, and explains <1 % of UK melanoma multicase families. The identification of POT1 and TERT germline mutations highlights the importance of telomere integrity in melanoma biology.
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Affiliation(s)
- Mark Harland
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS9 7TF, UK.
| | - Mia Petljak
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | | | - Zhihao Ding
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - Nelleke A Gruis
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karen A Pooley
- Strangeways Research Laboratory, Departments of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, 2, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Alison M Dunning
- Strangeways Research Laboratory, Departments of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, 2, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Lauren G Aoude
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Karin A W Wadt
- Department of Clinical Genetics, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anne-Marie Gerdes
- Department of Clinical Genetics, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kevin M Brown
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Nicholas K Hayward
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Herston, Brisbane, QLD, Australia
| | - Julia A Newton-Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS9 7TF, UK
| | - David J Adams
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, Cambridge, CB10 1SA, UK
| | - D Timothy Bishop
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, LS9 7TF, UK.
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238
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Roach REJ, Plasmeijer EI, van Doorn R, Bergman W, Kukutsch NA. The value of clinical characteristics for the diagnosis of melanoma in patients presenting at a pigmented lesion clinic. Br J Dermatol 2015; 174:1401-3. [PMID: 26708210 DOI: 10.1111/bjd.14375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R E J Roach
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
| | - E I Plasmeijer
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
| | - R van Doorn
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
| | - W Bergman
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
| | - N A Kukutsch
- Department of Dermatology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands
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239
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Arbesman H. Hypothesis: Is frequent, commercial jet travel by the general public a risk factor for developing cutaneous melanoma? F1000Res 2015; 4:620. [PMID: 26672515 PMCID: PMC4670002 DOI: 10.12688/f1000research.6962.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/21/2022] Open
Abstract
Melanoma incidence has been increasing worldwide over the past 50 years and various risk factors have been identified. Interestingly, multiple studies have shown a multifold increased risk of developing melanoma in jet pilots and airline crew. There has also been a dramatic increase in the availability and frequency of jet travel by the general population during this time period.. Therefore, it is hypothesized that frequent commercial jet travel may represent an additional risk factor for the development of cutaneous melanoma in susceptible individuals of the general public.
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Affiliation(s)
- Harvey Arbesman
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, 14214-8001, USA ; Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, 14263, USA ; Department of Dermatology, Clinical and Translational Research Center, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, 14203, USA
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240
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Ribero S, Zugna D, Osella-Abate S, Glass D, Nathan P, Spector T, Bataille V. Prediction of high naevus count in a healthy U.K. population to estimate melanoma risk. Br J Dermatol 2015; 174:312-8. [DOI: 10.1111/bjd.14216] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- S. Ribero
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
- Section of Dermatology; Department of Medical Sciences; University of Turin; Torino Italy
- Imperial College London; London U.K
- Department of Dermatology; London North West Healthcare NHS Trust; London U.K
| | - D. Zugna
- Unit of Cancer Epidemiology - CERMS; Department of Medical Sciences; University of Turin; Torino Italy
| | - S. Osella-Abate
- Section of Dermatology; Department of Medical Sciences; University of Turin; Torino Italy
| | - D. Glass
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
- Imperial College London; London U.K
- Department of Dermatology; London North West Healthcare NHS Trust; London U.K
| | - P. Nathan
- Mount Vernon Cancer Network; West Herts NHS Trust; Herts U.K
| | - T. Spector
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
| | - V. Bataille
- Department of Twin Research and Genetic Epidemiology; King's College London; St Thomas' Campus, Westminster Bridge Road London SE1 7EH U.K
- Department of Dermatology; West Herts NHS Trust; Herts U.K
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241
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Knowledge, attitudes, and behaviors regarding sun protection, effects of the sun, and skin cancer among Turkish high school students and teachers. DERMATOL SIN 2015. [DOI: 10.1016/j.dsi.2015.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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242
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Detert H, Hedlund S, Anderson CD, Rodvall Y, Festin K, Whiteman DC, Falk M. Validation of sun exposure and protection index (SEPI) for estimation of sun habits. Cancer Epidemiol 2015; 39:986-93. [PMID: 26547793 DOI: 10.1016/j.canep.2015.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND In both Sweden and Australia high incidence rates of skin cancer have become a major health problem. In prevention and risk communication, it is important to have reliable ways for identifying people with risky sun habits. In this study the validity and reliability of the questionnaire Sun Exposure Protection Index (SEPI), developed to assess individual's sun habits and their propensity to increase sun protection during routine, often brief, clinical encounters, has been evaluated. The aim of our study was to evaluate validity and reliability of the proposed SEPI scoring instrument, in two countries with markedly different ultraviolet radiation environments (Sweden and Australia). METHOD Two subpopulations in Sweden and Australia respectively were asked to fill out the SEPI together with the previously evaluated Readiness to Alter Sun Protective Behaviour questionnaire (RASP-B) and the associated Sun-protective Behaviours Questionnaire. To test reliability, the SEPI was again filled out by the subjects one month later. RESULTS Comparison between SEPI and the questions in the Sun-protective Behaviours Questionnaire, analyzed with Spearman's Rho, showed good correlations regarding sun habits. Comparison between SEPI and RASP-B regarding propensity to increase sun protection showed concurrently lower SEPI mean scores for action stage, but no difference between precontemplation and contemplation stages. The SEPI test-retest analysis indicated stability over time. Internal consistency of the SEPI, assessed with Cronbach's alpha estimation showed values marginally lower than the desired >0.70 coefficient value generally recommended, and was somewhat negatively affected by the question on sunscreen use, likely related to the classic "sunscreen paradox". There were some differences in the performance of the SEPI between the Swedish and Australian samples, possibly due to the influence of "available" sunlight and differing attitudes to behaviour and protection "at home" and on vacation. CONCLUSIONS SEPI appears to be a stable instrument with an overall acceptable validity and reliability, applicable for use in populations exposed to different UVR environments, in order to evaluate individual sun exposure and protection.
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Affiliation(s)
- H Detert
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - S Hedlund
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - C D Anderson
- Division of Dermatology, Department of Clinical and Experimental Medicine, Linköping University, S-581 83 Linköping, Sweden.
| | - Y Rodvall
- Department of Public Health Sciences, Karolinska Institutet, S-171 77 Stockholm, Sweden.
| | - K Festin
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Qld 4029 Herston, Australia.
| | - M Falk
- Division of Community Medicine, Primary Care, Department of Medicine and Health Sciences, Linköping University, S-581 83 Linköping, Sweden.
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Abstract
Although the signs and symptoms of the 3 most common skin malignancies are well known to physicians, any new or changing lesions should be monitored and worked up to rule out varying forms of cutaneous malignancy. Classic presenting features of each condition exist, but patients may present with overlapping or atypical features, and a biopsy is almost always required to definitively determine the true nature of each disorder. Given the intense psychosocial ramifications of skin cancer diagnosis and treatment, early detection remains the hallmark in producing favorable outcomes.
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Affiliation(s)
- Sumul Ashok Gandhi
- Division of Dermatology, University of Washington School of Medicine, Seattle, WA 98105, USA
| | - Jeremy Kampp
- Division of Dermatology, University of Washington School of Medicine, Seattle, WA 98105, USA.
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244
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Damanpour S, Grichnik JM. Conceptual approach to early melanoma detection: models, tools, issues and challenges. Melanoma Manag 2015; 2:327-337. [PMID: 30190861 PMCID: PMC6094681 DOI: 10.2217/mmt.15.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Identification and removal of melanoma early in its development remains the most effective treatment. However, identification of early melanoma remains challenging and may result in unnecessary morbidity due to the excess excision of benign melanocytic nevi. Herein, we present a conceptual model of benign and malignant melanocytic growths. The potential differences in the location of the cell of origin as well as considerations for neoplasm progression are also reviewed. Several of the clinical tools currently available, the integration of information from those different sources, and approaches to set an optimum biopsy threshold are discussed. While early detection remains a challenge, significant progress has been made. Insight into melanoma growth processes and appropriate use of available tools can result in the detection of thinner melanomas while also decreasing overall biopsy rates.
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Affiliation(s)
- Shadi Damanpour
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James M Grichnik
- Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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245
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Fonseca M, Marchetti MA, Chung E, Dusza SW, Burnett ME, Marghoob AA, Geller AC, Bishop M, Scope A, Halpern AC. Cross-sectional analysis of the dermoscopic patterns and structures of melanocytic naevi on the back and legs of adolescents. Br J Dermatol 2015; 173:1486-1493. [PMID: 26189624 DOI: 10.1111/bjd.14035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Junctional (flat) naevi predominate on the extremities, whereas dermal (raised) naevi are found primarily on the head, neck and trunk. Few studies have investigated the anatomical site prevalence of melanocytic naevi categorized using dermoscopy. OBJECTIVES To identify the prevalence of dermoscopic patterns and structures of naevi from the back and legs of adolescents. METHODS Dermoscopic images of acquired melanocytic naevi were obtained from the back and legs of students from a population-based cohort in Framingham, Massachusetts. Naevi were classified into reticular, globular, homogeneous or complex dermoscopic patterns. Multinomial logistic regression modelling assessed the associations between dermoscopic pattern and anatomical location. RESULTS In total 509 participants (mean age 14 years) contributed 2320 back naevi and 637 leg naevi. Compared with homogeneous naevi, globular and complex naevi were more commonly observed on the back than the legs [odds ratio (OR) 29·39, 95% confidence interval (CI) 9·53-90·65, P < 0·001 and OR 6·8, 95% CI 2·7-17·14, P < 0·001, respectively], whereas reticular lesions were less likely to be observed on the back than on the legs (OR 0·67, 95% CI 0·54-0·84, P = 0·001). Naevi containing any globules were more prevalent on the back than on the legs (25% vs. 3·6%, P < 0·001). Naevi containing any network were more prevalent on the legs than on the back (56% vs. 40·6%, P < 0·001). CONCLUSIONS These findings add to a robust body of literature suggesting that dermoscopically defined globular and reticular naevi represent biologically distinct naevus subsets that differ in histopathological growth pattern, age- and anatomical-site-related prevalence, molecular phenotype and aetiological pathways.
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Affiliation(s)
- M Fonseca
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - M A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - E Chung
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - S W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - M E Burnett
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - A A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - A C Geller
- Harvard School of Public Health, Social and Behavioral Sciences, Boston, MA, U.S.A
| | - M Bishop
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - A Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A.,Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 52621, Israel
| | - A C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
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246
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Potrony M, Badenas C, Aguilera P, Puig-Butille JA, Carrera C, Malvehy J, Puig S. Update in genetic susceptibility in melanoma. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:210. [PMID: 26488006 DOI: 10.3978/j.issn.2305-5839.2015.08.11] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Melanoma is the most deadly of the common skin cancers and its incidence is rapidly increasing. Approximately 10% of cases occur in a familial context. To date, cyclin-dependent kinase inhibitor 2A (CDKN2A), which was identified as the first melanoma susceptibility gene more than 20 years ago, is the main high-risk gene for melanoma. A few years later cyclin-dependent kinase 4 (CDK4) was also identified as a melanoma susceptibility gene. The technologic advances have allowed the identification of new genes involved in melanoma susceptibility: Breast cancer 1 (BRCA1) associated protein 1 (BAP1), CXC genes, telomerase reverse transcriptase (TERT), protection of telomeres 1 (POT1), ACD and TERF2IP, the latter four being involved in telomere maintenance. Furthermore variants in melanocortin 1 receptor (MC1R) and microphthalmia-associated transcription factor (MITF) give a moderately increased risk to develop melanoma. Melanoma genetic counseling is offered to families in order to better understand the disease and the genetic susceptibility of developing it. Genetic counseling often implies genetic testing, although patients can benefit from genetic counseling even when they do not fulfill the criteria for these tests. Genetic testing for melanoma predisposition mutations can be used in clinical practice under adequate selection criteria and giving a valid test interpretation and genetic counseling to the individual.
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Affiliation(s)
- Miriam Potrony
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Celia Badenas
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Paula Aguilera
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joan Anton Puig-Butille
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Cristina Carrera
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Malvehy
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Susana Puig
- 1 Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain ; 2 Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Valencia, Spain ; 3 Molecular Biology and Genetics Department, Melanoma Unit, Hospital Clínic de Barcelona, Barcelona, Spain
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247
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Dinnes J, Matin RN, Moreau JF, Patel L, Chan SA, Chuchu N, Bayliss SE, Grainge M, Takwoingi Y, Davenport C, Walter FM, Fleming C, Schofield J, Shroff N, Godfrey K, O'Sullivan C, Deeks JJ, Williams HC. Tests to assist in the diagnosis of cutaneous melanoma in adults: a generic protocol. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011902] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jac Dinnes
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Rubeta N Matin
- Churchill Hospital; Department of Dermatology; Old Road Headington Oxford UK OX3 7LJ
| | - Jacqueline F Moreau
- University of Pittsburgh Medical Center; Internal Medicine; Department of Medicine, Office of Education UPMC Montefiore Hospital, N715 Pittsburgh USA PA, 15213
| | - Lopa Patel
- Royal Stoke Hospital; Plastic Surgery; Stoke-on-Trent Staffordshire UK ST4 6QG
| | - Sue Ann Chan
- NHS; Dermatology; 104 Times Square Avenue Brierley Hill Dudley UK DY5 1SX
| | - Naomi Chuchu
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Susan E Bayliss
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Matthew Grainge
- School of Community Health Sciences; Division of Epidemiology and Public Health; University of Nottingham Nottingham UK NG7 2UH
| | - Yemisi Takwoingi
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Clare Davenport
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Fiona M Walter
- University of Cambridge; Public Health & Primary Care; Strangeways Research Laboratory, Worts Causeway Cambridge UK CB1 8RN
| | - Colin Fleming
- NHS Tayside, Ninewells Hospital; Dermatology; Ninewells Drive Dundee UK DD1 9SY
| | - Julia Schofield
- United Lincolnshire Hospitals NHS Trust; Dermatology; Greetwell Street Lincoln UK LN2 5QY
| | - Neil Shroff
- Keyworth Medical Practice; Bunny Lane Keyworth Nottingham UK NG12 5JU
| | - Kathie Godfrey
- The University of Nottingham; c/o Cochrane Skin Group; Nottingham UK
| | | | - Jonathan J Deeks
- University of Birmingham; Public Health, Epidemiology and Biostatistics; Birmingham UK B15 2TT
| | - Hywel C Williams
- The University of Nottingham; Centre of Evidence Based Dermatology; Queen's Medical Centre Derby Road Nottingham UK NG7 2UH
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248
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Ribero S, Davies JR, Requena C, Carrera C, Glass D, Rull R, Vidal‐Sicart S, Vilalta A, Alos L, Soriano V, Quaglino P, Traves V, Newton‐Bishop JA, Nagore E, Malvehy J, Puig S, Bataille V. High nevus counts confer a favorable prognosis in melanoma patients. Int J Cancer 2015; 137:1691-8. [PMID: 25809795 PMCID: PMC4503475 DOI: 10.1002/ijc.29525] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/06/2015] [Indexed: 01/31/2023]
Abstract
A high number of nevi is the most significant phenotypic risk factor for melanoma and is in part genetically determined. The number of nevi decreases from middle age onward but this senescence can be delayed in patients with melanoma. We investigated the effects of nevus number count on sentinel node status and melanoma survival in a large cohort of melanoma cases. Out of 2,184 melanoma cases, 684 (31.3%) had a high nevus count (>50). High nevus counts were associated with favorable prognostic factors such as lower Breslow thickness, less ulceration and lower mitotic rate, despite adjustment for age. Nevus count was not predictive of sentinel node status. The crude 5- and 10-year melanoma-specific survival rate was higher in melanomas cases with a high nevus count compared to those with a low nevus count (91.2 vs. 86.4% and 87.2 vs. 79%, respectively). The difference in survival remained significant after adjusting for all known melanoma prognostic factors (hazard ratio [HR] = 0.43, confidence interval [CI] = 0.21-0.89). The favorable prognostic value of a high nevus count was also seen within the positive sentinel node subgroup of patients (HR = 0.22, CI = 0.08-0.60). High nevus count is associated with a better melanoma survival, even in the subgroup of patients with positive sentinel lymph node. This suggests a different biological behavior of melanoma tumors in patients with an excess of nevi.
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Affiliation(s)
- Simone Ribero
- Department of Twin Research & Genetic EpidemiologyKing's College LondonLondonUnited Kingdom
- Department of Medical Sciences, Section of DermatologyUniversity of TurinTurinItaly
- Department of DermatologyLondon North West Healthcare NHS Trust Northwick Park HospitalLondonUnited Kingdom
- Imperial College LondonLondonUnited Kingdom
| | - John R. Davies
- Section of Epidemiology and BiostatisticsLICAP, University of LeedsLeedsUnited Kingdom
| | - Celia Requena
- Department of DermatologyInstituto Valenciano De OncologıaValenciaSpain
| | - Cristina Carrera
- Department of DermatologyMelanoma Unit, Hospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Daniel Glass
- Department of Twin Research & Genetic EpidemiologyKing's College LondonLondonUnited Kingdom
- Department of DermatologyLondon North West Healthcare NHS Trust Northwick Park HospitalLondonUnited Kingdom
- Imperial College LondonLondonUnited Kingdom
| | - Ramon Rull
- Department of SurgeryMelanoma UnitHospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Sergi Vidal‐Sicart
- Department of Nuclear Medicine ServiceMelanoma Unit, Hospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Antonio Vilalta
- Department of DermatologyMelanoma Unit, Hospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Lucia Alos
- Department of Pathology ServiceMelanoma Unit, Hospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
| | - Virtudes Soriano
- Department of OncologyInstituto Valenciano De OncologıaValenciaSpain
| | - Pietro Quaglino
- Department of Medical Sciences, Section of DermatologyUniversity of TurinTurinItaly
| | - Victor Traves
- Department of PathologyInstituto Valenciano De OncologıaValenciaSpain
| | | | - Eduardo Nagore
- Department of DermatologyInstituto Valenciano De OncologıaValenciaSpain
| | - Josep Malvehy
- Department of DermatologyMelanoma Unit, Hospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
- Instituto de Salud Carlos IIICIBER on Rare DiseasesBarcelonaSpain
| | - Susana Puig
- Department of DermatologyMelanoma Unit, Hospital Clinic & IDIBAPS, University of BarcelonaBarcelonaSpain
- Instituto de Salud Carlos IIICIBER on Rare DiseasesBarcelonaSpain
| | - Veronique Bataille
- Department of Twin Research & Genetic EpidemiologyKing's College LondonLondonUnited Kingdom
- Department of DermatologyWest Herts NHS TrustHertfordshireUnited Kingdom
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249
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Robert C, Lebbe C, Ricard S, Saiag P, Grange F, Mortier L, Lhomel C, Sassolas B. Personal vs. intrinsic melanoma risk awareness: results of the EDIFICE Melanoma survey. J Eur Acad Dermatol Venereol 2015; 29 Suppl 2:31-4. [PMID: 25639931 DOI: 10.1111/jdv.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The efficiency of skin cancer prevention programmes is strongly correlated with the information dispensed, and with the level of risk awareness, of the overall population on one hand, and on the other, of specific sub-populations, according to their risk profiles. OBJECTIVES The primary objective of this analysis was to establish a correlation between individual perceptions of the risk of developing a melanoma, and the recognized intrinsic risk factors for a given individual. Secondary objectives were to assess factors that are potentially associated with acceptable, high or low perception of melanoma risk. METHODS The EDIFICE Melanoma survey was conducted in 2011 via telephone interviews of a representative sample of 1502 individuals aged 18 and older in the French population. RESULTS Although most respondents (73%) had a true estimation of their intrinsic risk for melanoma, those who did not (underestimation, 17%; overestimation, 10%) had an attitude towards environmental risk factors (sun exposure, sun protection, sunbed use) that did not compensate for this misplaced perception. CONCLUSIONS Skin cancer prevention messages need to be reinforced, new methods of evaluating understanding of the messages need to be implemented, and both need to be included into personal risk assessment.
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Affiliation(s)
- C Robert
- Department of Dermatology, Institut Gustave Roussy, Villejuif, France
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250
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Melanoma density and relationship with the distribution of melanocytic naevi in an Italian population: a GIPMe study--the Italian multidisciplinary group on melanoma. Melanoma Res 2015; 25:80-7. [PMID: 25171087 DOI: 10.1097/cmr.0000000000000113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most frequent site for melanoma is the back in men and the lower limbs in women, where intermittent sun exposure has been reported to be an environmental agent, although studies on age-specific incidence have suggested that melanoma in chronically sun-exposed areas, such as the face, increases with age. To identify the preferential development of melanoma in chronically or intermittently sun-exposed areas and the relationship between body site distribution and parameters such as sex, age, distribution of melanocytic naevi, atypical naevi and actinic keratoses, a prospective epidemiological multicentre study was carried out on all the consecutive melanoma cases diagnosed in a 2-year period from 27 Italian GIPMe centres (GIPMe: the Italian Multidisciplinary Group on Melanoma). Both the relative density of melanoma (RDM), defined as the ratio between observed and expected melanoma for a specific body site, and the average nevi density were identified. The most common melanoma site was the back, a factor that was not affected by either age or sex, even if men had higher density values. Statistically significant higher RDM values were observed in women aged more than 50 years for leg lesions and in the anterior thighs for young women (<50 years), whereas the lowest values were observed in the posterior thighs in women of any age. Facial RDM was statistically significantly higher than expected in both male and female patients more than 50 years of age. Melanoma was associated with a significantly higher atypical naevi density only for the back, chest and thighs. Indeed, facial melanoma was related to the presence of more than four actinic keratoses and not naevi density. To the best of our knowledge, the RDM method was applied for the first time together with naevus density calculation to obtain these data, which strongly substantiate the 'divergent pathway' hypothesis for the development of melanoma, but not find a direct correlation between melanoma and nevi for each anatomical site.
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