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Farberg AS, Heysek RV, Haber R, Agha R, Crawford KM, Xinge J, Stricker JB. Freedom from Recurrence across Age in Non-Melanoma Skin Cancer Treated with Image-Guided Superficial Radiation Therapy. Geriatrics (Basel) 2024; 9:114. [PMID: 39311239 PMCID: PMC11417751 DOI: 10.3390/geriatrics9050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 09/26/2024] Open
Abstract
Non-melanoma skin cancers (NMSCs) are a significant cause of morbidity and mortality; their incidence is increasing most in older patients. NMSCs have traditionally been treated with surgical excision, curettage, Mohs micrographic surgery (MMS), and superficial radiotherapy (SRT). Image-guided SRT (IGSRT) is a treatment option for poor surgical candidates or patients with low- or high-risk, early-stage NMSC who prefer to avoid surgery. This large retrospective cohort study compared 2-, 4-, and 6-year freedom from recurrence in biopsy-proven NMSC lesions treated with IGSRT (n = 20,069 lesions) between patients aged < 65 years (n = 3158 lesions) and ≥65 years (n = 16,911 lesions). Overall freedom from recurrence rates were 99.68% at 2 years, 99.57% at 4 years, and 99.57% at 6 years. Rates did not differ significantly by age (p = 0.8) nor by sex among the two age groups (p > 0.9). There was a significant difference in recurrence among older patients when analyzed by stage (p = 0.032), but no difference by stage in younger patients (p = 0.7). For early-stage NMSCs, IGSRT is a clinically equivalent alternative to MMS and statistically significant in superiority to non-image-guided SRT. This study demonstrates that there is no significant effect of age on 2-, 4-, or 6-year freedom from recurrence in patients with IGSRT-treated NMSC.
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Affiliation(s)
- Aaron S. Farberg
- Bare Dermatology, Dallas, TX 75235, USA;
- University of North Texas Health Science Center, University of North Texas, Fort Worth, TX 76107, USA
| | | | - Robert Haber
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
| | - Rania Agha
- Department of Dermatology, The University of Illinois at Chicago, Chicago, IL 60607, USA;
- Jesse Brown VA Medical Center, Chicago, IL 60612, USA
- Department of Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
| | - Kevin M. Crawford
- Department of Dermatology, Marian University College of Osteopathic Medicine, Indianapolis, IN 46222, USA
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ji Xinge
- Independent Researcher, Champaign, IL 61822, USA;
| | - Jeffrey Blake Stricker
- Dermatology Specialists of Alabama, Dothan, AL 36303, USA
- Alabama College of Osteopathic Medicine, Dothan, AL 36303, USA
- Southeast Health Internal Medicine Residency, Dothan, AL 36301, USA
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Lesage C, Habib-Hadef S, Trétarre B, Lesage FX, Bessaoud F, Varey E, Guillot B, Satgé D. Melanoma and intellectual disability: do prognostic factors at diagnosis differ from general population? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:392-398. [PMID: 35137477 DOI: 10.1111/jir.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/21/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Few melanoma cases are reported in individuals with intellectual disability (ID), and prognostic factors at diagnosis are unknown in this population. This work was designed to investigate whether prognostic factors at diagnostic are different in patients with ID compared with a general population. METHODS Melanoma cases retrieved from Hérault's Tumour Registry (HTR) from 1995 to 2015 were cross-referenced against a list of adult patients with ID, living in Hérault. Major prognostic factors were compared with those in non-ID melanoma patients included in HTR and in patients followed by Montpellier University Hospital and included in the Réseau pour la Recherche et l'Investigation Clinique sur le Mélanome (RIC-Mel) database. RESULTS Ten melanoma cases in individuals with ID were identified and compared with 3804 non-ID melanoma cases in HTR and 1024 non-ID melanoma cases included in RIC-Mel. Mean Breslow thickness at diagnosis was 4.6 mm in melanoma cases among those with ID versus 1.89 mm in HTR (P = 0.109) and 2.36 mm in RIC-Mel (P = 0.156). Stage at diagnosis was superior to stage IIB in 42.9% of ID cases versus 11.4% of non-ID cases in HTR (P < 0.05) and 8.5% in RIC-Mel (P < 0.05). CONCLUSIONS Melanomas in patients with ID had less favourable prognostic factors at diagnosis, including higher Breslow thickness and more advanced stage, than melanomas in non-ID patients. These adverse prognostic factors indicate a later diagnosis in this population, leading to a poorer prognosis. This work underlines the need to improve melanoma screening among individuals with ID.
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Affiliation(s)
- C Lesage
- Department of Dermatology, University Hospital, Montpellier, France
| | | | - B Trétarre
- Registre des Tumeurs de l'Hérault, Montpellier, France
| | - F-X Lesage
- Department of Professional pathologies, University of Montpellier, University Hospital Montpellier, Montpellier, France
| | | | - E Varey
- Réseau pour la Recherche et l'Investigation Clinique sur le Mélanome, Nantes University Hospital, Nantes, France
| | - B Guillot
- Department of Dermatology, University Hospital, Montpellier, France
| | - D Satgé
- ONCODEFI, Montpellier, France
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM Univ. Montpellier, Montpellier, France
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Legrand A, Quintard B, Garrouteigt C, Beylot-Barry M, Broc G. From neglect to earlier diagnosis: a qualitative meta-synthesis of psycho-social factors associated with consultation delay in advanced basal cell carcinoma. PSYCHOL HEALTH MED 2021; 27:1793-1804. [PMID: 34251919 DOI: 10.1080/13548506.2021.1952281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Local malignant potential of basal cell carcinoma (BCC) can lead at advanced stages to the destruction of underlying tissues and significant morbidity. The primary risk factor for progression of advanced basal cell carcinoma (aBCC) is the long duration of the tumour, which results from delay in seeking medical care. To assess the implication of psycho-social factors in the delay before the first medical consultation among patients with aBCC, in order to identify potentially targetable factors enabling earlier diagnosis. Three-step qualitative meta-synthesis: (1) systematic review of the literature; (2) structured qualitative analysis of these documents; (3) construction of a logical model. After screening, 81 articles were included. Self-neglect and denial in patients are roundly put forward as the main obstacles to consultation. We found that avoidance behaviour, mistaken interpretation and banalisation of symptoms, and fear of treatment all played a role. The strongest motivation to seek help comes from the realisation that new symptoms may be dangerous; the role of interpersonal surroundings is highlighted as helpful. Patient delay has multifactorial origins in aBCC, especially self-neglect ranging from denial of tumours to conscious refusal of treatment.
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Affiliation(s)
- A Legrand
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - B Quintard
- INSERM U1219, Bordeaux Population Health Research Centre, Team: Handicap, Activity, Cognition, Health, Bordeaux, France
| | - C Garrouteigt
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - M Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France.,INSERM U1053, UMR Bariton, Oncogenesis of Cutaneous Lymphoma, University of Bordeaux, Bordeaux, France
| | - G Broc
- Department of Psychology, Paul Valéry Montpellier 3, University of Montpellier, Montpellier, France
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Garrouteigt C, Broc G, Legrand A, Quintard B, Beylot-Barry M. Facilitators of and obstacles to consultation in patients with advanced basal cell carcinoma: a French pilot study. Arch Dermatol Res 2021; 313:829-835. [PMID: 33433714 DOI: 10.1007/s00403-020-02175-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Basal cell carcinoma is the most common skin cancer for which surgery is usually the unique and definitive treatment. Advanced basal cell carcinoma is not eligible to surgery when underlying structures are destroyed. Delayed consultation is the principal cause of advanced basal cell carcinoma. It is questionable why some patients seek care only when the tumour is advanced. The objective of this study was to identify the psychosocial factors involved in delayed consultation. We used a qualitative approach, conducting semi-structured interviews with advanced basal cell carcinoma patients and the healthcare staff of a dermatology unit to explore why some patients consult only when basal cell carcinoma is advanced. We then put our findings into perspective and created a logical model for change. We interviewed 14 patients and 12 healthcare staff. The first lesion was associated with banalization. Then, denial and fear of diagnosis or treatment were post common. Finally, the advanced basal cell carcinoma's symptoms, along with social pressure, created the intention to seek medical help and improved disease awareness. We developed a logical model that summarizes these findings. In this pilot study, we modelled factors that delayed consultation. This will aid future research and targeted interventions reducing delay, in particular by improving knowledge and by using social pressure as facilitators. Trial registration: NCT04124796.
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Affiliation(s)
- Constance Garrouteigt
- Department of Dermatology, University Hospital of Bordeaux, 1, rue Jean Burguet, 33000, Bordeaux, France
| | - Guillaume Broc
- Paul Valéry Montpellier 3, University of Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Adeline Legrand
- Department of Dermatology, University Hospital of Bordeaux, 1, rue Jean Burguet, 33000, Bordeaux, France
| | - Bruno Quintard
- INSERM UMR 1219, Bordeaux Population Health Research Center, Team: Handicap, Activity, Cognition, Health, University of Bordeaux, Bordeaux, France
| | - Marie Beylot-Barry
- Department of Dermatology, University Hospital of Bordeaux, 1, rue Jean Burguet, 33000, Bordeaux, France.
- INSERM U1053, UMR Bariton, Oncogenesis of Cutaneous Lymphoma, University of Bordeaux, Bordeaux, France.
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Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, Bernabei R, Peris K. Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology. Aging Dis 2017; 8:643-661. [PMID: 28966807 PMCID: PMC5614327 DOI: 10.14336/ad.2017.0503] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/03/2017] [Indexed: 12/16/2022] Open
Abstract
Skin cancer is a worldwide, emerging clinical need in the elderly white population, with a steady increase in incidence rates, morbidity and related medical costs. Skin cancer is a heterogeneous group of cancers comprising cutaneous melanoma and non-melanoma skin cancers (NMSC), which predominantly affect elderly patients, aged older than 65 years. Melanoma has distinct clinical presentations in the elderly patient and represents a challenging question in terms of clinical management. NMSC includes the basal cell carcinoma and cutaneous squamous cell carcinoma and presents a wide disease spectrum in the elderly population, ranging from low-risk to high-risk tumours, advanced and inoperable disease. Treatment decisions for NMSC are preferentially based on tumour characteristics, patient’s chronological age and physician’s preferences and operational settings. Several treatment options are available for NMSC, from surgery to non-invasive/medical therapies, but patient-based factors, such as geriatric comorbidities and patient’s life expectancy, do not frequently modulate treatment goals. In melanoma, age-related variations in clinical management are significant and may frequently lead to under-treatment, limiting access to advanced surgical and medical treatments. Clinical decision-making in the care of elderly skin cancer patient should ideally implement a geriatric assessment, prioritizing patient-based factors and efficiently differentiating fit from frail cancer patients. Current clinical practice guidelines for NMSC and melanoma only partially address geriatric aspects of cancer care, such as frailty, limited life-expectancy, geriatric comorbidities and treatment compliance. We review the recent evidence on the scope and problem of skin cancer in the elderly population as well as age-related variations in its clinical management, highlighting the potential role of a geriatric approach in optimizing dermato-oncological care.
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Affiliation(s)
- Simone Garcovich
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Colloca
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Sollena
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Bellieni Andrea
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Lodovico Balducci
- 3Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - William C Cho
- 4Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Roberto Bernabei
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Ketty Peris
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
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Grosshans E. [Chronically neglected malignant skin tumours]. Ann Dermatol Venereol 2012; 139:180-2. [PMID: 22401681 DOI: 10.1016/j.annder.2012.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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