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Vikström S, Mikiver R, Lapins J, Nielsen K, Vassilaki I, Lyth J, Isaksson K, Eriksson H. Increasing melanoma incidence and survival trend shifts with improved melanoma-specific survival between 1990 and 2020 in Sweden. Br J Dermatol 2023; 189:702-709. [PMID: 37463416 DOI: 10.1093/bjd/ljad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Melanoma-specific survival (MSS) is heterogenous between stages and is highly dependent on the T stage for primary localized disease. New systemic therapies for metastatic cutaneous melanoma (CM) have been introduced since 2012 in Sweden. OBJECTIVES To analyse the incidence and MSS time trends between 1990 and 2020 in Sweden. METHODS Nationwide, population-based and prospectively collected clinico-pathological data on invasive CM from the Swedish Melanoma Registry (SweMR) were analysed for survival trends between 1990 and 2020 using Kaplan-Meier curves and Cox proportional hazard ratios (HRs). RESULTS In total, 77 036 primary invasive CMs were diagnosed in 70 511 patients in Sweden between 1990 and 2020. The 5-year MSS [95% confidence interval (CI)] was 88.9% (88.3-89.4) for 1990-2000, 89.2% (88.7-89.6) for 2001-2010 and 93.0% (92.7-93.9) for 2011-2020. The odds ratios for being diagnosed with nodular melanoma (vs. superficial spreading melanoma) was significantly reduced by 20% (2001-2010) and by 46% (2011-2020) vs. the reference period 1990-2000. Overall, the MSS improved over both diagnostic periods (2001-2010 and 2011-2020) vs. the reference period 1990-2000 among men and women, respectively [HRmen: 2001-2010: 0.89 (95% CI 0.82-0.96) and 2011-2020: 0.62 (95% CI 0.56-0.67); HRwomen: 2001-2010: 0.82 (95% CI 0.74-0.91) and 2011-2020: 0.62 (95% CI 0.56-0.70)]. The risk of death from CM was significantly lower in all age groups for both men and women in the most recent diagnostic period (2011-2020 vs.1990-2000). CONCLUSIONS The results emphasize the improved MSS among men and women in Sweden. The MSS improvements, specifically for the period 2011-2020, may be correlated to the introduction of new systemic therapies and are here shown for the first time in detail for Sweden.
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Affiliation(s)
- Sofi Vikström
- Department of Oncology-Pathology
- Department of Pathology and Cancer Diagnostics, Radiumhemmet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rasmus Mikiver
- Department of Clinical and Experimental Medicine
- Regional Cancer Centre Southeast Sweden, Linköping, Sweden
| | - Jan Lapins
- Department of Medicine, Unit of Dermatology, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology
| | - Kari Nielsen
- Dermatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ismini Vassilaki
- Department of Pathology and Cancer Diagnostics, Radiumhemmet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Johan Lyth
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Karolin Isaksson
- Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Hanna Eriksson
- Department of Oncology-Pathology
- Cancer Theme, Unit of Head-Neck-, Lung-, and Skin Cancer, Skin Cancer Centre, Karolinska University Hospital, Stockholm, Sweden
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Pedersen AB, Johnsen SP, Horváth-Puhó E. Long-Term Temporal Trends in Survival Among Danish Patients with Advanced Cutaneous Melanoma: A Nationwide Follow-Up Study. Clin Epidemiol 2023; 15:733-742. [PMID: 37342868 PMCID: PMC10278652 DOI: 10.2147/clep.s407060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Population-based data on survival trends over time among patients with advanced cutaneous melanoma are lacking. We examined changes in mortality for patients diagnosed from 1980 to 2011 in a nationwide historical follow-up study using population-based medical registries from Denmark. Material and Methods The study population included all Danish patients with an incident diagnosis of advanced (metastatic or unresectable stage IIIA, IIIB, IIIC, or IV) cutaneous melanoma (ie, initial diagnosis for melanoma at stage III/IV) between 1980-2011 and who were followed-up until 2013. For each patient, we randomly matched 100 individuals from the general population on sex and year of birth. Age-standardized mortality rates were calculated by calendar year of diagnosis overall, 30 days after diagnosis, and during 31 to 364 days and 0-10 years after diagnosis. Stratified Cox's proportional hazards regression was used to compute hazard ratios. Results We identified a total of 1236 patients and 123,600 comparison cohort members. We observed that the standardized mortality rates of patients with advanced melanoma dropped from the 1980s onwards, but remain high (eg, 74.3 and 248.4 per 1000 person-years in 0-30 days and 31-364 days after diagnosis, respectively, for patients diagnosed during 2008-2011). Compared with the general population, patients with advanced melanoma had a 10.4-fold increased hazard of death during 0-10 years of follow-up. The highest relative mortality was found for the first year following melanoma diagnosis. No improvements in survival compared to the general population were observed in the most recent years of the study period, thus in 2004-2007 and 2008-2011. Discussion and Conclusion Survival of patients with advanced cutaneous melanoma in Denmark improved between 1980 and 2013 but appears to have leveled off in the years leading up to more widespread introduction of newer immuno-oncology therapies.
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Affiliation(s)
- Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Søren P Johnsen
- Center for Clinical Health Services Research, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Tichanek F, Försti A, Hemminki A, Hemminki O, Hemminki K. SURVIVAL IN MELANOMA IN THE NORDIC COUNTRIES INTO THE ERA OF TARGETED AND IMMUNOLOGICAL THERAPIES. Eur J Cancer 2023; 186:133-141. [PMID: 37068406 DOI: 10.1016/j.ejca.2023.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Survival in melanoma has been increasing and the most recent interest is to observe the population-level impact of novel targeted therapies and immunotherapy. We analysed survival in melanoma from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE) over a 50-years period (1971-2020). METHODS Relative 1-5/1- and 5-year survival data were obtained from the NORDCAN database for the years 1971-2020. We estimated annual changes in survival rates and determined significant breaking points for trends. RESULTS Survival in melanoma has reached the point where 1-year survival is approaching 100% (men 97.5-98.6%, women 98.4-99.3%, depending on the country) and 5-year survival is 93% for men (91.5-95.2%) and 96% for women (95.3-97.2%). The highest survival figures were for DK. Significant increases in both 1- and 5-year survival were observed in most countries even towards the end of the follow-up (from 2006 to 2010-2011-2015 and further to 2016-2020). CONCLUSIONS The main increase in melanoma survival took place up to year 1990, which was probably largely achieved through successful population campaigns for sun protection and programmes for early detection of lesions. Survival increased again after year 2000 up to the last period 2016-2020. This late development coincided with the introduction of targeted therapies using BRAF and BRAF/MEK inhibitors, and towards the end of the time period availability of checkpoint inhibitors. The success of melanoma treatment in DK was mostly likely due to the efficient use of modern therapies and to the centralised treatment for metastatic disease.
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Affiliation(s)
- Filip Tichanek
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic; Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Finland; Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Finland; Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany.
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4
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Sun J, Zhou JS, Wang YC, Dai HY, Sun MY, Lv C. Prognostic significance of age on superficial spreading melanoma after resection: lessons from SEER database involving 12 536 patients. ANZ J Surg 2023; 93:227-234. [PMID: 36368699 DOI: 10.1111/ans.18135] [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: 03/18/2022] [Revised: 08/15/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study sought to analyse the impact of elderly age on long-term prognosis of superficial spreading melanoma (SSM) after surgery. METHODS A population-based cohort of patients undergoing resection for SSM from 2004 to 2015 was collected, using data from National Cancer Institute' Surveillance, Epidemiology, and End Results (SEER)* Stat software. Patients were divided into the non-elderly group (≤70 years) and elderly group (>70 years). Baseline characteristics and long-term survivals were compared between the two groups. A 1:1 propensity score matching (PSM) was used to reduce the risk of bias. The impact of the elderly age on overall survival (OS) and cause-specific mortality (CSM) was estimated by Cox-regression and competing-risk regression models. RESULTS Among 12 536 patients with SSM after resection included into the cohort, 8664 patients were ≤70 years, and 3872 were >70 years. Patients in the elderly group had higher incidences of multiple tumours, worse tumour stage and infiltration degree, lymphatic metastasis, and larger size of primary lesions. Using PSM, 3581 pairs of patients were created. On matched analysis, the elderly group was associated with worse OS and CSM. On multivariable Cox-regression and competing-risk regression analyses, elderly age was identified as an independent risk factor of OS and CSM after adjusting for other prognostic variables. CONCLUSIONS The elderly age of patients was independently associated with worse OS and CSM after resection of SSM when baseline and tumour characteristics were balanced. Adjuvant therapy and individualized strategy on follow-up should be made for elderly patients after resection of SSM.
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Affiliation(s)
- Jie Sun
- Department of Plastic Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Jie-Song Zhou
- Department of Plastic Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yu-Chong Wang
- Department of Plastic Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Hai-Ying Dai
- Department of Plastic Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Meng-Yan Sun
- Department of Plastic Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Chuan Lv
- Department of Plastic Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
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Kiuru M, Li Q, Zhu G, Terrell JR, Beroukhim K, Maverakis E, Keegan THM. Melanoma in women of childbearing age and in pregnancy in California, 1994-2015: a population-based cohort study. J Eur Acad Dermatol Venereol 2022; 36:2025-2035. [PMID: 35870141 PMCID: PMC9560982 DOI: 10.1111/jdv.18458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma is one of the most common malignancies during pregnancy. There is debate regarding the impact of pregnancy on the prognosis of melanoma. Recent large population-based studies from the United States are lacking. OBJECTIVES To determine the characteristics and survival of women with pregnancy-associated melanoma. METHODS This population-based, retrospective cohort study used California Cancer Registry data linked with state-wide hospitalization and ambulatory surgery data to identify 15-44-year-old female patients diagnosed with melanoma in 1994-2015, including pregnant patients. Multivariable logistic regression compared demographic and clinical characteristics between pregnant and non-pregnant women with melanoma. Multivariable cox proportional hazards regression models assessed melanoma-specific and overall survival. RESULTS We identified 13 108 patients, of which 1406 were pregnant. Pregnancy-associated melanoma was more frequent in Hispanic compared to non-Hispanic White women. Melanoma occurring post-partum was associated with greater tumour thickness (2.01-4.00 vs. 0.01-1.00 mm, odds ratio 1.75, 95% confidence interval: 1.03-2.98). There were otherwise no significant differences between pregnant and non-pregnant women. Worse survival was associated with Asian, Black and Native American race/ethnicity (vs. non-Hispanic White), lower neighbourhood socio-economic status, public insurance, tumour site, greater tumour thickness and lymph node involvement, but not pregnancy. CONCLUSIONS Melanoma occurring post-partum was associated with greater tumour thickness, but pregnancy status did not affect survival after melanoma. Race/ethnicity, socio-economic status and health insurance impacted survival, emphasizing the importance of reducing health disparities.
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Affiliation(s)
- M Kiuru
- Department of Dermatology, University of California Davis, Sacramento, California, USA
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Q Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
| | - G Zhu
- Department of Dermatology, University of California Davis, Sacramento, California, USA
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - J R Terrell
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - K Beroukhim
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - E Maverakis
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - T H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
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6
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Rodríguez-Betancourt JD, Arias-Ortiz N. Cutaneous melanoma incidence, mortality, and survival in Manizales, Colombia: a population-based study. J Int Med Res 2022; 50:3000605221106706. [PMID: 35722901 PMCID: PMC9344176 DOI: 10.1177/03000605221106706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We estimated the cutaneous melanoma (CM) incidence, mortality, and survival in Manizales, Colombia to establish predictors for survival. METHODS This analytical cohort study used CM incident cases during 2006 to 2015 in the Manizales Cancer Registry (n = 132). Incidence and mortality rates were standardized using the direct method. Patients were followed up until 30 November 2020. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the log-rank test for differences. Cox multivariate regression models were fitted. RESULTS Incidence (per 100,000) increased from 1.6 to 3.0 in men and 2.6 to 2.8 in women during 2006-2010 to 2011-2015, respectively. Mortality was low and stable. Five-year survival was 68.7%, with significant differences according to age (hazard ratio [HR] >70 vs. ≤70 years: 3.37); histological subtype (HR for melanoma not otherwise specified and HR for nodular melanoma vs lentigo malignant melanoma and superficial spreading melanoma: 17.39 and 10.16, respectively); and clinical stage (HR stages III-IV vs. stages I-II: 5.94). CONCLUSION CM is characterized by increasing incidence and unfavorable prognosis, particularly in patients aged >70 years, with melanoma not otherwise specified and nodular melanoma, and advanced stages. Promoting photoprotection and early detection and management of suspicious skin lesions is crucial.
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Affiliation(s)
- Juan David Rodríguez-Betancourt
- Young Researchers Program, Ministerio de Ciencia, Tecnología e
Innovación, Bogotá, Colombia
- Population-based Manizales Cancer Registry, Instituto de
Investigaciones en Salud, Universidad de Caldas, Manizales, Colombia
- Departamento de Salud Pública, Universidad de Caldas, Manizales,
Colombia
| | - Nelson Arias-Ortiz
- Population-based Manizales Cancer Registry, Instituto de
Investigaciones en Salud, Universidad de Caldas, Manizales, Colombia
- Departamento de Salud Pública, Universidad de Caldas, Manizales,
Colombia
- Grupo de Investigación Promoción de la Salud y Prevención de la
Enfermedad, Universidad de Caldas, Manizales, Colombia
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7
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Mancipe JMA, Lobianco FA, Dias ML, da Silva Moreira Thiré RM. Electrospinning: New Strategies for the Treatment of Skin Melanoma. Mini Rev Med Chem 2022; 22:564-578. [PMID: 34254914 DOI: 10.2174/1389557521666210712111809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/25/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022]
Abstract
Recent studies have shown a significant growth of skin cancer cases in northern regions of the world, in which its presence was not common. Skin cancer is one of the cancers that mostly affects the world's population, ranking fifth in studies conducted in the United States (USA). Melanoma is cancer that has the highest number of deaths worldwide since it is the most resistant skin cancer to current treatments. This is why alternatives for its treatment has been investigated considering nanomedicine concepts. This study approaches the role of this field in the creation of promising electrospun devices, composed of nanoparticles and nanofibers, among other structures, capable of directing and/or loading active drugs and/or materials with the objective of inhibiting the growth of melanoma cells or even eliminating those cells.
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Affiliation(s)
- Javier Mauricio Anaya Mancipe
- Programa de Engenharia Metalúrgica e de Materiais, Universidade Federal do Rio de Janeiro - PEMM/COPPE/ UFRJ, Rio de Janeiro, RJ. Brazil
- Instituto de Macromolécula Professora Eloisa Mano, Universidade Federal do Rio de Janeiro - IMA/UFRJ, Rio de Janeiro, RJ. Brazil
| | - Franz Acker Lobianco
- Programa de Engenharia Metalúrgica e de Materiais, Universidade Federal do Rio de Janeiro - PEMM/COPPE/ UFRJ, Rio de Janeiro, RJ. Brazil
| | - Marcos Lopes Dias
- Instituto de Macromolécula Professora Eloisa Mano, Universidade Federal do Rio de Janeiro - IMA/UFRJ, Rio de Janeiro, RJ. Brazil
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8
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Akhtar S, Levin A, Rajabi-Estarabadi A, Nouri K. Cells to Surgery Quiz: August 2021. J Invest Dermatol 2021. [PMID: 34303471 DOI: 10.1016/j.jid.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shifa Akhtar
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adam Levin
- Island Dermatology, Newport Beach, California, USA
| | - Ali Rajabi-Estarabadi
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Keyvan Nouri
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
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Dessinioti C, Geller AC, Whiteman DC, Garbe C, Grob JJ, Kelly JW, Scolyer RA, Rawson RV, Lallas A, Pellacani G, Stratigos AJ. Not all melanomas are created equal: a review and call for more research into nodular melanoma. Br J Dermatol 2021; 185:700-710. [PMID: 33864261 DOI: 10.1111/bjd.20388] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/23/2022]
Abstract
Among the histogenic subtypes of melanoma, nodular melanoma (NM) is the major contributor for thicker and fatal melanomas and it has been associated with melanoma-specific death in thin tumours, highlighting an important subgroup of 'aggressive thin' melanomas. This review provides a synthesis of the distinct characteristics of NM, with respect to epidemiology and risk factors, clinical presentation, histopathology, molecular and dermoscopic aspects, and screening practices. The real challenges are to find better biomarkers of aggressiveness and to know whether the control of such aggressive melanomas can be influenced by targeted interventions such as early detection, drug interventions and preventive strategies.
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Affiliation(s)
- C Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - D C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - J J Grob
- Department of Dermatology and Skin Cancers, APHM Timone Hospital Aix-Marseille University, Marseille, France
| | - J W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
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Krensel M, Petersen J, Stephan B, Katalinic A, Augustin J. Vergleich der Patientenpfade bei der Früherkennungsuntersuchung auf Hautkrebs – eine Sekundärdatenanalyse. J Dtsch Dermatol Ges 2021; 19:389-399. [PMID: 33709581 DOI: 10.1111/ddg.14318_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Magdalene Krensel
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Jana Petersen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Brigitte Stephan
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Alexander Katalinic
- Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Lübeck (UKSH), Lübeck
| | - Jobst Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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11
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Krensel M, Petersen J, Stephan B, Katalinic A, Augustin J. Comparison of patient pathways in the early detection of skin cancer – a claims data analysis. J Dtsch Dermatol Ges 2021; 19:389-398. [DOI: 10.1111/ddg.14318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Magdalene Krensel
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology University Medical Center Lübeck (UKSH) Lübeck Germany
| | - Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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12
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Di Carlo V, Estève J, Johnson C, Girardi F, Weir HK, Wilson RJ, Minicozzi P, Cress RD, Lynch CF, Pawlish KS, Rees JR, Coleman MP, Allemani C. Trends in short-term survival from distant-stage cutaneous melanoma in the United States, 2001-2013 (CONCORD-3). JNCI Cancer Spectr 2021; 4:pkaa078. [PMID: 33409455 PMCID: PMC7771008 DOI: 10.1093/jncics/pkaa078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease. Methods Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race. Results Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks. Conclusions One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacques Estève
- Université Claude Bernard, Hospices Civils de Lyon, Service de Biostatistique, Lyon Cedex 03, France
| | | | - Fabio Girardi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reda J Wilson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pamela Minicozzi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemary D Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | | | - Judith R Rees
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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13
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Gambichler T, Tsagoudis K, Kiecker F, Reinhold U, Stockfleth E, Hamscho R, Egberts F, Hauschild A, Amaral T, Garbe C. Prognostic significance of an 11-gene RNA assay in archival tissue of cutaneous melanoma stage I-III patients. Eur J Cancer 2021; 143:11-18. [PMID: 33278769 DOI: 10.1016/j.ejca.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to validate the results of an 11-gene expression profiling (GEP) assay which aims to improve the precision of individual prognosis beyond conventional American Joint Committee on Cancer staging for patients with cutaneous melanoma. METHODS The reverse transcriptase polymerase chain reaction test of 11 prospectively selected genes was performed on 291 formalin-fixed, paraffin-embedded primary tumours of patients with stage I-III cutaneous melanoma. The expression levels of eight prognostic and three reference genes were used in a predefined algorithm to calculate a numerical score (-0.84 to 3.53) and then assign each patient to a preselected risk group (low versus high score) for melanoma-specific survival (MSS). RESULTS One hundred twenty-seven patients were allocated to the low-score group, with a corresponding five-year disease-free survival (DFS) and MSS of 95% and 99%, respectively. 164 patients were allocated to the high-score group, with a corresponding five-year DFS and MSS of 78% and 88%. Continuous regression analysis demonstrated decreasing MSS probabilities with increasing scores. In a multivariate cox regression, only the 11-GEP, tumour thickness and age were statistically associated with MSS (p = 0.0068, 0.002 and 0.0159). CONCLUSIONS The 11-GEP has been validated as an independent predictor of outcome for melanoma patients. More specifically, using an 11-GEP score cut-off of ≤0, the assay can identify patient cohorts with 10-year survival probabilities well above 90%. This information may be used in the decision-making for a potential adjuvant therapy.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | | | - Felix Kiecker
- Skin Cancer Center, Department of Dermatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Reinhold
- Dermatological Centre Bonn Friedensplatz, Bonn, Germany
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Rami Hamscho
- Department of Dermatology and Allergology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Friederike Egberts
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Axel Hauschild
- Department of Dermatology and Venerology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
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14
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Bianconi F, Crocetti E, Grisci C, Primieri C, Stracci F. What has changed in the epidemiology of skin melanoma in central Italy during the past 20 years? Melanoma Res 2020; 30:396-401. [PMID: 30480621 DOI: 10.1097/cmr.0000000000000551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim was to evaluate changes in skin melanoma incidence and mortality at a population level in central Italy over the past two decades. Skin melanoma incidence rate from 1994 to 2014, were retrieved from the Umbrian Cancer Registry (about 900 000 inhabitants). Changes from 1994-1999 to 2010-2014 in tumour and patient characteristics - sex, age (0-44, 45-64, ≥ 65 years), site (head and neck, trunk, limbs), morphology (superficial spreading, nodular, other), thickness (≤ 1, 1-2, 2-4, > 4) and stage I-II, III-IV - were evaluated. Trends in age-standardized incidence and mortality rates were evaluated as annual percent change. During the past two decades, melanoma incidence significantly increased in both sexes (+6%/year among men and +4%/year among women) and in all ages (0-44 years: + 4.7 and + 4.3; 45-64 years: + 6.1 and + 4.4; ≥65 years: + 6.6 and + 1.7), morphologies, except nodular, and stages. Mortality was stable among men and women. In the area, incidence increased for thin and thick melanoma, showing a true increase, whereas mortality did not increase. Therefore, although improvements in treatment and downstaging effect of early diagnosis have to be considered, a certain degree of overdiagnosis cannot be ruled out.
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Affiliation(s)
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto scientifico romagnolo per lo studio e la cura dei tumori (IRST), Meldola, Forlì-Cesena
| | - Chiara Grisci
- School of Specialization in Hygiene and Preventive Medicine
| | | | - Fabrizio Stracci
- Umbria Cancer Registry, Umbria
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
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15
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Babcock B, Rodrigues M, Kearns D, Solomon N, Reeves ME, Senthil M, Garberoglio CA, Namm JP. Improved Survival with Immunotherapy but Lack of Synergistic Effect with Radiation for Stage IV Melanoma of the Head and Neck. Am Surg 2020. [DOI: 10.1177/000313481908501009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prospective randomized studies have demonstrated a survival benefit of immunotherapy in stage IV cutaneous melanoma. Some retrospective studies have hypothesized a synergistic effect of radiation and immunotherapy. Our objective was to identify whether there is a survival benefit for patients treated with radiation and immunotherapy in stage IV cutaneous melanoma of the head and neck (CMHN). The National Cancer Database was used to identify patients with stage IV CMHN between 2012 and 2014. These patients were stratified based on receipt of radiation and immunotherapy. Adjusted Cox regression was used to analyze overall survival. A total of 542 patients were identified with stage IV CMHN, of whom 153 (28%) patients received immunotherapy. Receipt of immunotherapy (hazard ratio [HR] 0.69, P = 0.02) and negative LNs (HR 0.50, P = 0.002) were independently associated with improved survival, whereas radiation conferred no survival benefit (HR 1.17, P = 0.26). Patients who received immunotherapy without radiation were associated with significantly improved survival compared with those who received immunotherapy with radiation ( P < 0.0001). However, of patients who received radiation, the addition of immunotherapy did not seem to improve survival ( P = 0.979). In stage IV CMHN, immunotherapy confers a 32 per cent survival benefit. The use of immunotherapy in patients who require radiation, however, is not associated with improved survival.
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Affiliation(s)
- Blake Babcock
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Medora Rodrigues
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Donovan Kearns
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Naveenraj Solomon
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Mark E. Reeves
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Maheswari Senthil
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | | | - Jukes P. Namm
- Department of Surgery, Loma Linda University Health, Loma Linda, California
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16
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Herbert A, Koo MM, Barclay ME, Greenberg DC, Abel GA, Levell NJ, Lyratzopoulos G. Stage-specific incidence trends of melanoma in an English region, 1996-2015: longitudinal analyses of population-based data. Melanoma Res 2020; 30:279-285. [PMID: 30106842 PMCID: PMC6330074 DOI: 10.1097/cmr.0000000000000489] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine temporal trends in overall and stage-specific incidence of melanoma. Using population-based data on patients diagnosed with melanoma in East Anglia, England, 1996-2015, we estimated age-standardized time trends in annual incidence rates for each stage at diagnosis. Negative binomial regression was used to model trends over time adjusted for sex, age group and deprivation, and to subsequently examine variation in stage-specific trends by sex and age group. The age-standardized incidence increased from 14 to 29 cases/100 000 persons (i.e. 4% annually). Increasing incidence was apparent across all stages but was steepest for stage I [adjusted annual increase: 5%, 95% confidence interval (CI): 5-6%, and more gradual for stage II-IV disease (stage II: 3%, 95% CI: 2-4%; stage III/IV: 2%, 95% CI: 1-3%)]. Stage II-IV increase was apparent in men across age groups and in women aged 50 years or older. Increases in incidence were steeper in those aged 70 years or older, and in men. The findings suggest that both a genuine increase in the incidence of consequential illness and a degree of overdiagnosis may be responsible for the observed increasing incidence trends in melanoma in our population during the study period. They also suggest the potentially lower effectiveness of public health awareness campaigns in men and older people.
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Affiliation(s)
- Annie Herbert
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
| | - Minjoung M. Koo
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
| | - Matthew E. Barclay
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| | - David C. Greenberg
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| | | | - Nick J. Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
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Using Media to Promote Public Awareness of Early Detection of Kaposi's Sarcoma in Africa. JOURNAL OF ONCOLOGY 2020; 2020:3254820. [PMID: 32280342 PMCID: PMC7115145 DOI: 10.1155/2020/3254820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/20/2020] [Accepted: 02/06/2020] [Indexed: 01/17/2023]
Abstract
Background Despite its hallmark cutaneous presentation, most Kaposi's sarcoma (KS) in Africa is diagnosed too late for effective treatment. Early diagnosis will only be achievable if patients with KS present earlier for care. We hypothesized that public awareness about KS can be enhanced through exposure to common media. Methods We developed educational messages regarding early detection of KS for the general African public portraying a three-part theme: “Look” (regularly examine one's skin/mouth), “Show” (bring to the attention of a healthcare provider any skin/mouth changes), and “Test” (ask for a biopsy for definitive diagnosis). We packaged the messages in three common media forms (comic strips, radio, and video) and tested their effect on increasing KS awareness among adults attending markets in Uganda. Participants were randomized to a single exposure to one of the media and evaluated for change in KS-related knowledge and attitudes. Results Among 420 participants, media exposure resulted in increased ability to identify KS (from 0.95% pretest to 46% posttest); awareness that anyone is at risk for KS (29% to 50%); belief that they may be at risk (63% to 76%); and knowledge that definitive diagnosis requires biopsy (23% to 51%) (all p < 0.001). Most participants (96%) found the media culturally appropriate. Conclusion Exposure to media featuring a theme of “Look,” “Show,” and “Test” resulted in changes in knowledge and attitudes concerning KS among the general public in Uganda. High incidence and poor survival of KS in Africa are an impetus to further evaluate these media, which are freely available online.
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18
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Miller R, Walker S, Shui I, Brandtmüller A, Cadwell K, Scherrer E. Epidemiology and survival outcomes in stages II and III cutaneous melanoma: a systematic review. Melanoma Manag 2020; 7:MMT39. [PMID: 32399177 PMCID: PMC7212505 DOI: 10.2217/mmt-2019-0022] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim Management of cutaneous melanoma (CM) is continually evolving with adjuvant treatment of earlier stage disease. The aim of this review was to identify published epidemiological data for stages II-III CM. Materials & methods Systematic searches of Medline and Embase were conducted to identify literature reporting country/region-specific incidence, prevalence, survival or mortality outcomes in stage II and/or III CM. Screening was carried out by two independent reviewers. Results & conclusion Of 41 publications, 14 described incidence outcomes (incidence rates per stage were only reported for US and Swedish studies), 33 reported survival or mortality outcomes and none reported prevalence data. This review summarizes relevant data from published literature and highlights an overall paucity of epidemiological data in stages II and III CM.
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Affiliation(s)
- Rachael Miller
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Sophie Walker
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
| | - Irene Shui
- Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | | | - Kevin Cadwell
- PHMR Ltd, Berkeley Works, Berkley Grove, Camden Town, London, UK
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Abstract
Melanoma and keratinocyte skin cancer (KSC) are the most common types of cancer in White-skinned populations. Both tumor entities showed increasing incidence rates worldwide but stable or decreasing mortality rates. Rising incidence rates of cutaneous melanoma (CM) and KSC are largely attributed to increasing exposure to ultraviolet (UV) radiation, the main causal risk factor for skin cancer.Incidence rates of KSC, comprising of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are much higher than that of melanoma. BCC development is mainly the cause of an intensive UV exposure in childhood and adolescence, while SCC development is related to chronic, cumulative UV exposure over decades. Although mortality is relatively low, KSC is an increasing problem for health care services causing significant morbidity.Cutaneous melanoma is rapidly increasing in White populations, with an estimated annual increase of around 3-7% over the past decades. In contrast to SCC, melanoma risk is associated with intermittent and chronic exposure to sunlight. The frequency of its occurrence is closely associated with the constitutive color of the skin and the geographical zone. Changes in outdoor activities and exposure to sunlight during the past 70 years are an important factor for the increasing incidence of melanoma. Mortality rates of melanoma show stabilization in the USA, Australia, and in European countries. In the USA even dropping numbers of death cases were recently reported, probably reflecting efficacy of the new systemic treatments.Among younger cohorts in some populations (e.g., Australia and New Zealand,), stabilizing or declining incidence rates of CM are observed, potentially caused by primary prevention campaigns aimed at reducing UV exposure. In contrast, incidence rates of CM are still rising in most European countries and in the USA. Ongoing trends towards thinner melanoma are largely ascribed to earlier detection.
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20
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Hicks BM, Kristensen KB, Pedersen SA, Hölmich LR, Pottegård A. Hormone replacement therapy and the risk of melanoma in post-menopausal women. Hum Reprod 2019; 34:2418-2429. [PMID: 31803923 DOI: 10.1093/humrep/dez222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/02/2019] [Accepted: 09/11/2019] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Is hormone replacement therapy (HRT) associated with an increased risk of melanoma skin cancer or prognostic outcomes amongst post-menopausal women? SUMMARY ANSWER Whilst we found evidence of an association with melanoma risk, the lack of dose-response and associations observed with recent use, localised disease and intravaginal oestrogens suggests this is a non-causal association. WHAT IS KNOWN ALREADY Evidence on HRT and melanoma risk remains inconclusive, with studies providing conflicting results. Furthermore, evidence on melanoma survival is sparse, with only one previous study reporting protective associations with HRT use, likely attributable to immortal time bias. STUDY DESIGN, SIZE, DURATION We conducted a nation-wide population-based case-control study and a retrospective cohort study utilising the Danish healthcare registries. Case-control analyses included 8279 women aged 45-85 with a first-ever diagnosis of malignant melanoma between 2000 and 2015, matched by age and calendar time to 165 580 population controls. A cohort of 6575 patients with a diagnosis of primary malignant melanoma between 2000 and 2013 and followed through 2015 was examined to determine if HRT use had an impact on melanoma survival outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on prescriptions dispensed since 1995, ever-use of HRT was defined as having filled at least one prescription for HRT prior to the index date. In total, 2629 cases (31.8%) and 47 026 controls (28.4%) used HRT. Conditional logistic regression was used to calculate odds ratios (ORs) for melanoma risk according to HRT use, compared with non-use, adjusting for potential confounders. For cohort analyses, Cox proportional hazards models was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for second melanoma incidence and all-cause mortality associated with HRT. MAIN RESULTS AND THE ROLE OF CHANCE High use of HRT was associated with an OR of 1.21 (95% CI 1.13-1.29) for melanoma risk, with no evidence of a dose-response pattern. Results were most pronounced amongst recent high users (OR, 1.28; 95% CI 1.17-1.41), for localised disease (OR, 1.25; 95% CI 1.15-1.36) and for intravaginal oestrogen therapy (OR, 1.38; 95% CI 1.13-1.68). Compared with non-use, there was no evidence of an association for secondary melanoma for post-diagnostic new-use (fully adjusted HR, 1.56; 95% CI 0.64-3.80) or continuous HRT use (fully adjusted HR, 1.26; 95% CI 0.89-1.78). Similar associations were observed for all-cause mortality. LIMITATIONS, REASONS FOR CAUTION Despite the large sample size and the use of robust population-based registries with almost complete coverage, we lacked information on some important confounders including sun exposure. WIDER IMPLICATIONS OF THE FINDINGS Whilst we cannot rule out an association between HRT use and melanoma risk, the associations observed are also compatible with increased healthcare utilisation and thus increased melanoma detection amongst HRT users. No association between HRT use and melanoma survival outcomes was observed. This should provide some reassurance to patients and clinicians, particularly concerning the use of HRT in patients with a history of melanoma. STUDY FUNDING/COMPETING INTEREST(S) B.M.H. is funded by a Cancer Research UK Population Research Postdoctoral Fellowship. The funding source had no influence on the design or conduct of this study. A.P. reports participation in research projects funded by Alcon, Almirall, Astellas, Astra-Zeneca, Boehringer-Ingelheim, Servier, Novo Nordisk and LEO Pharma, all with funds paid to the institution where he was employed (no personal fees) and with no relation to the work reported in this article. The other authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B M Hicks
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, Northern Ireland
| | - K B Kristensen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - S A Pedersen
- Department of Clinical Biochemistry and Clinical Pharmacology, Odense University Hospital, Odense, Denmark
| | - L R Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - A Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Rieckmann A, Meyle KD, Rod NH, Baker JL, Benn CS, Aaby P, Sørup S. Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years. Vaccine 2019; 37:6730-6736. [PMID: 31537447 DOI: 10.1016/j.vaccine.2019.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/30/2019] [Accepted: 09/06/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Early smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with reduced risk of cutaneous malignant melanoma (CMM). We assessed the association between pre-school smallpox vaccination and early-school BCG vaccination and CMM in a young Danish population. METHODS We conducted a register-based case-cohort study of individuals growing up during the phase-out period of smallpox and BCG vaccination in Denmark (born 1965-1976) utilising the decrease in vaccination during this period. Information on childhood vaccinations and potential confounders from Copenhagen school health records were linked with nationwide registers on cancer (CMM diagnoses), migrations and deaths by personal identification numbers. RESULTS The individuals were followed from age 18 until 31/12/2014 (maximum age at end of follow-up, 49 years). 188 cases of CMM occurred in the background population of 46,239 individuals; 172 CMM cases (91%) had full information and were analysed. The adjusted hazard ratio (HR) for CMM by BCG and/or smallpox vaccination compared with neither vaccine was 1.29 (95% confidence interval (CI) 0.72-2.31). For smallpox vaccination only, HR = 1.23 (95% CI 0.53-2.86) for BCG vaccination only, HR = 1.13 (95% CI 0.61-2.09) and for both smallpox and BCG vaccination, HR = 1.75 (95% CI 0.87-3.48) compared with none of these. Vaccination below the age of one year gave similar results. CONCLUSIONS We found no strong beneficial effect of smallpox and BCG vaccination against CMM among young adult Danes and with broad confidence intervals our data alone could be compatible with both modest preventive effects, no effects, and modest harmful effects. Our estimates do not contradict a potential modest beneficial effect of neonatal vaccination.
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Affiliation(s)
- Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Kathrine Damm Meyle
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer Lyn Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christine Stabell Benn
- OPEN, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
| | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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22
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Sondermeijer L, Lamboo LGE, de Waal AC, Galesloot TE, Kiemeney LALM, van Rossum M, Aben KH. Cigarette Smoking and the Risk of Cutaneous Melanoma: A Case-Control Study. Dermatology 2019; 236:228-236. [PMID: 31505496 PMCID: PMC7257256 DOI: 10.1159/000502129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Previous studies regarding cigarette smoking causing a lower risk of melanoma are inconclusive. Here, we re-examined melanoma risk in relation to cigarette smoking in a large, case-control study. METHODS In total 1,157 patients with melanoma diagnosed between 2003 and 2011 in the Netherlands and 5,595 controls from the Nijmegen Biomedical Study were included. Information concerning smoking habits and known risk factors for melanoma were obtained through self-administered questionnaires. Logistic regression analyses stratified by gender were performed to study the risk of cigarette smoking on melanoma risk, adjusted for age, marital status, highest level of education, skin type, sun vacation, use of solarium, time spent outdoors, and sun protective measures. RESULTS Among men, current and former smokers did not have a higher risk of melanoma compared to never smokers: adjusted odds ratio (OR) = 0.56 (95% confidence interval [CI]: 0.40-0.79) and adjusted OR = 0.50 (95% CI: 0.39-0.64), respectively. With an increasing number of years smoked the risk of melanoma decreased: <20 years: OR = 0.61 (95% CI: 0.46-0.80); 21-40 years: OR = 0.50 (95% CI: 0.37-0.68); >40 years: OR = 0.26 (95% CI: 0.15-0.44). No clear trend was found for the number of cigarettes smoked. Results for females were less clear and not statistically significant (current smoker: adjusted OR = 0.96, 95% CI: 0.74-1.26, former smoker: adjusted OR = 0.89, 95% CI: 0.73-1.08). CONCLUSION This study shows a strong inverse association between cigarette smoking and melanoma risk in men. Fundamental laboratory research is necessary to investigate the biological relation between smoking cigarettes and melanoma.
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Affiliation(s)
- Liesbeth Sondermeijer
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Dermatology, Nijmegen, The Netherlands,
| | - Lieke G E Lamboo
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Dermatology, Nijmegen, The Netherlands
| | - Anne C de Waal
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Dermatology, Nijmegen, The Netherlands
| | - Tessel E Galesloot
- Radboud university medical center, Radboud Institute for Health Sciences, Department for Health Evidence Nijmegen, Nijmegen, The Netherlands
| | - Lambertus A L M Kiemeney
- Radboud university medical center, Radboud Institute for Health Sciences, Department for Health Evidence Nijmegen, Nijmegen, The Netherlands
| | - Michelle van Rossum
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Dermatology, Nijmegen, The Netherlands
| | - Katja H Aben
- Radboud university medical center, Radboud Institute for Health Sciences, Department for Health Evidence Nijmegen, Nijmegen, The Netherlands
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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23
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Pérez-Aldrete BM, Matildes-Mariscal JB, Gómez-Padilla F, Guevara-Gutiérrez E, Barrientos-García JG, Hernández-Peralta SL, Tlacuilo-Parra A. Cutaneous melanoma in patients from western Mexico: Clinical pathology characteristics and their relationship to prognosis. Australas J Dermatol 2019; 60:e298-e303. [PMID: 31016713 DOI: 10.1111/ajd.13054] [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: 09/17/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Melanoma is the third most frequent malignant neoplasm in skin. The majority of information available comes from studies performed in Caucasian populations. Our objective was to investigate the clinico-pathological characteristics in Mexican patients with cutaneous melanoma and the relationship these characteristics had to prognosis. METHODS A retrospective study included patients with a histopathological diagnosis of melanoma who were attended at a tertiary level Dermatology Institute over a 10-year period. Age, gender, anatomical location; histopathological subtype, Breslow thickness, Clark level; presence of ulceration, metastasis, anatomical-pathological stage and survival were investigated. To assess the data, descriptive statistics, chi-squared or the Fisher exact test and Kaplan-Meier curves were used. RESULTS There were 323 patients included. The overall survival rate was 77% with an average follow-up of 7 years. The lowest survival was statistically related to the following: higher age (>65 years), localisation in palms/soles, histopathological nodular subtype, presence of ulceration, Breslow thickness >4.0 mm, Clark level V, the presence of metastasis and stage IV disease. CONCLUSIONS Our results relay the characteristics and prognosis of patients with the diagnosis of cutaneous melanoma in western Mexico.
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Affiliation(s)
| | | | | | - Elizabeth Guevara-Gutiérrez
- Instituto Dermatologico de Jalisco "Dr. José Barba Rubio", Secretaria de Salud Jalisco, Zapopan, Jalisco, Mexico
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Garbe C, Keim U, Eigentler TK, Amaral T, Katalinic A, Holleczek B, Martus P, Leiter U. Time trends in incidence and mortality of cutaneous melanoma in Germany. J Eur Acad Dermatol Venereol 2019; 33:1272-1280. [DOI: 10.1111/jdv.15322] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023]
Affiliation(s)
- C. Garbe
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - U. Keim
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - T. K. Eigentler
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
| | - T. Amaral
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
- Portuguese Air Force Health Care Direction Lisbon Portugal
| | - A. Katalinic
- Institute of Social Medicine and Epidemiology University Hospital Schleswig‐Holstein Luebeck Germany
| | | | - P. Martus
- Institute for Clinical Epidemiology und Applied Biostatistics Eberhard‐Karls University Tuebingen Germany
| | - U. Leiter
- Centre for Dermato‐Oncology Department of Dermatology Eberhard‐Karls University Tuebingen Germany
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Gartrell RD, Marks DK, Rizk EM, Bogardus M, Gérard CL, Barker LW, Fu Y, Esancy CL, Li G, Ji J, Rui S, Ernstoff MS, Taback B, Pabla S, Chang R, Lee SJ, Krolewski JJ, Morrison C, Horst BA, Saenger YM. Validation of Melanoma Immune Profile (MIP), a Prognostic Immune Gene Prediction Score for Stage II-III Melanoma. Clin Cancer Res 2019; 25:2494-2502. [PMID: 30647081 PMCID: PMC6594682 DOI: 10.1158/1078-0432.ccr-18-2847] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/14/2018] [Accepted: 01/11/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Biomarkers are needed to stratify patients with stage II-III melanoma for clinical trials of adjuvant therapy because, while immunotherapy is protective, it also confers the risk of severe toxicity. We previously defined and validated a 53-immune gene melanoma immune profile (MIP) predictive both of distant metastatic recurrence and of disease-specific survival (DSS). Here, we test MIP on a third independent population. EXPERIMENTAL DESIGN A retrospective cohort of 78 patients with stage II-III primary melanoma was analyzed using the NanoString assay to measure expression of 53 target genes, and MIP score was calculated. Statistical analysis correlating MIP with DSS, overall survival, distant metastatic recurrence, and distant metastasis-free interval was performed using ROC curves, Kaplan-Meier curves, and standard univariable and multivariable Cox proportional hazards models. RESULTS MIP significantly distinguished patients with distant metastatic recurrence from those without distant metastatic recurrence using ROC curve analysis (AUC = 0.695; P = 0.008). We defined high- and low-risk groups based on the cutoff defined by this ROC curve and find that MIP correlates with both DSS and overall survival by ROC curve analysis (AUC = 0.719; P = 0.004 and AUC = 0.698; P = 0.004, respectively). Univariable Cox regression reveals that a high-risk MIP score correlates with DSS (P = 0.015; HR = 3.2). CONCLUSIONS MIP identifies patients with low risk of death from melanoma and may constitute a clinical tool to stratify patients with stage II-III melanoma for enrollment in clinical trials.
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Affiliation(s)
| | - Douglas K Marks
- Columbia University Irving Medical Center, New York, New York
| | | | - Margaret Bogardus
- College of Physician and Surgeons, Columbia University, New York, New York
| | | | - Luke W Barker
- College of Physician and Surgeons, Columbia University, New York, New York
| | - Yichun Fu
- College of Physician and Surgeons, Columbia University, New York, New York
| | - Camden L Esancy
- Columbia University Irving Medical Center, New York, New York
| | - Gen Li
- Mailman School of Public Health, Columbia University, New York, New York
| | - Jiayi Ji
- Mailman School of Public Health, Columbia University, New York, New York
| | - Shumin Rui
- Mailman School of Public Health, Columbia University, New York, New York
| | | | - Bret Taback
- Columbia University Irving Medical Center, New York, New York
| | | | - Rui Chang
- University of Arizona, Tucson, Arizona
| | - Sandra J Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Køster B, Meyer MKH, Andersson TML, Engholm G, Dalum P. Skin cancer projections and cost savings 2014-2045 of improvements to the Danish sunbed legislation of 2014. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:78-86. [PMID: 30198585 PMCID: PMC7379953 DOI: 10.1111/phpp.12424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Sunbed use increases the risk of skin cancer. The Danish sunbed legislation (2014) did not include an age limit. AIM To model skin cancer incidences and saved costs from potential effects of structural interventions on prevalence of sunbed use. MATERIALS AND METHODS Survey data from 2015 were collected for 3999 Danes, representative for the Danish population in regards to age, gender and region. Skin cancer incidences were modelled in the Prevent program, using population projections, historic cancer incidence, sunbed use exposure and relative risk of sunbed use on melanoma. RESULTS If structural interventions like an age limit of 18 years for sunbed use or complete ban had been included in the Danish sunbed legislation in 2014, it would have reduced the annual number of skin cancer cases with 455 or 4177, respectively, while for the entire period, 2014-2045 the total reductions would be 3730 or 81 887 fewer cases, respectively. The cost savings from an age limit or ban, respectively, are 9 and 129 millions € during 2014-2045. CONCLUSION Legislative restrictive measures which could reduce the sunbed use exists. Danish politicians have the opportunity, supported by the population, to reduce the skin cancer incidence and thereby to reduce the future costs of skin cancer.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Maria K H Meyer
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Therese M-L Andersson
- Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
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Lucas RM, Yazar S, Young AR, Norval M, de Gruijl FR, Takizawa Y, Rhodes LE, Sinclair CA, Neale RE. Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate. Photochem Photobiol Sci 2019; 18:641-680. [PMID: 30810559 DOI: 10.1039/c8pp90060d] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.
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Affiliation(s)
- R M Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia. and Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
| | - S Yazar
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia and MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - M Norval
- Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK
| | - F R de Gruijl
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Y Takizawa
- Akita University School of Medicine, National Institute for Minamata Disease, Nakadai, Itabashiku, Tokyo, Japan
| | - L E Rhodes
- Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - R E Neale
- QIMR Berghofer Institute of Medical Research, Herston, Brisbane, Australia and School of Public Health, University of Queensland, Australia
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Rubió-Casadevall J, Puig-Vives M, Puigdemont M, Vilardell L, Carbó-Bagué A, Marcos-Gragera R, Vilar-Coromina N. Patterns of increased incidence and survival of cutaneous melanoma in Girona (Spain) 1994-2013: a population-based study. Clin Transl Oncol 2018; 20:1617-1625. [PMID: 29873027 DOI: 10.1007/s12094-018-1900-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/21/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION We conducted a population-based study on the Girona Cancer Registry (Spain) for the period 1994-2013 to determine patterns of change in the incidence of melanoma, which is increasing in many countries, and patient survival in our geographical area. MATERIALS AND METHODS Using the standard registration rules for cancer registries, we calculated crude and standardized incidence rates as well as their trends. We also analysed the observed survival, 1-year conditioned survival and relative survival at 3, 5 and 10 years. RESULTS Our crude incidence rate was 9.13 cases/100,000 inhabitants for invasive and 2.59 for "in situ" melanomas. A statistically significant increase in incidence was found for melanomas of less than 1 mm in Breslow index and in males. 10-year observed and relative survival rates were 64.1 and 83.1%, respectively. CONCLUSIONS We found an increasing trend in the incidence of low-risk melanoma and a survival rate similar to that reported elsewhere in Europe.
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Affiliation(s)
- J Rubió-Casadevall
- Medical Oncology Department, Hospital Josep Trueta, Catalan Institute of Oncology of Girona, Av. França s/n, 17005, Girona, Spain.
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.
- School of Medicine, University of Girona (UdG), Girona, Spain.
| | - M Puig-Vives
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - M Puigdemont
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- University Hospital Josep Trueta Cancer Registry Coordinator, Catalan Institute of Oncology of Girona, Girona, Spain
- School of Nursery, University of Girona (UdG), Girona, Spain
| | - L Vilardell
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - A Carbó-Bagué
- Medical Oncology Department, Hospital Josep Trueta, Catalan Institute of Oncology of Girona, Av. França s/n, 17005, Girona, Spain
| | - R Marcos-Gragera
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- School of Medicine, University of Girona (UdG), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - N Vilar-Coromina
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- School of Medicine, University of Girona (UdG), Girona, Spain
- Dermatology Department, University Hospital Josep Trueta, Catalan Institute of Health, Girona, Spain
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Makady A, Kalf RRJ, Ryll B, Spurrier G, de Boer A, Hillege H, Klungel OH, Goettsch W. Social media as a tool for assessing patient perspectives on quality of life in metastatic melanoma: a feasibility study. Health Qual Life Outcomes 2018; 16:222. [PMID: 30497502 PMCID: PMC6267816 DOI: 10.1186/s12955-018-1047-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/13/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose Development of innovative drugs for melanoma is occurring rapidly. Incremental gains in overall survival amongst innovative products may be difficult to measure in clinical trials, and their use may be associated with increased toxicity profiles. Therefore, HTA agencies increasingly require information on HRQoL for the assessment of such drugs. This study explored the feasibility of social media to assess patient perspectives on HRQoL in melanoma, and whether current cancer- and melanoma-specific HRQoL questionnaires represent these perspectives. Methods A survey was distributed on the social media channels of Melanoma Patient Network Europe to assess melanoma patients’ perspectives regarding HRQoL. Two researchers independently conducted content analysis to identify key themes, which were subsequently compared to questions from one current cancer-specific and two melanoma-specific HRQoL questionnaires (i.e. EORTC QLQ-C30, EORTC QLQ-MEL38, FACT-M). Results In total, 72 patients and 17 carers completed the survey. Patients indicated that family, having a normal life, and enjoying life were the three most important aspects of HRQoL for them. Carers indicated that being capable, having manageable adverse events, and being pain-free were the three most important aspects of HRQoL for patients. Respondents seem to find some questions from HRQoL questionnaires relevant (e.g. ‘Have you felt able to carry on with things as normal?’) and others less relevant (e.g. ‘Have you had swelling near your melanoma site?’). Additionally, wording may differ between patients and HRQoL questionnaires, whereby patients generally use a more positive tone. Conclusions Social media may provide a valuable tool in assessing patient perspectives regarding HRQoL. However, differences seem to emerge between patient and carer perspectives. Additionally, patient perspectives did not seem to fully correlate to questions posed in cancer- (i.e. EORTC QLQ-C30) and melanoma-specific (i.e. EORTC QLQ-MEL38, FACT-M) HRQoL questionnaires examined. Electronic supplementary material The online version of this article (10.1186/s12955-018-1047-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amr Makady
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, The Netherlands. .,Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands.
| | - Rachel R J Kalf
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, The Netherlands
| | - Bettina Ryll
- Melanoma Patient Network Europe, Uppsala, Sweden.,Uppsala University, Uppsala, Sweden
| | | | - Anthonius de Boer
- Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands
| | - Hans Hillege
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Olaf H Klungel
- Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands
| | - Wim Goettsch
- Zorginstituut Nederland, Eekholt 4, 1112 XH, Diemen, The Netherlands.,Department of Pharmacoepidemiology and Clinical Pharmacology, Universiteit Utrecht, Utrecht, The Netherlands
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Weitemeyer MB, Bramsen P, Klausen TW, Hölmich LR, Gjorup CA. Patient-and observer-reported long-term scar quality of wide local excision scars in melanoma patients. J Plast Surg Hand Surg 2018; 52:319-324. [PMID: 30380964 DOI: 10.1080/2000656x.2018.1493388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Wide local excision of the primary tumour is the mainstay of treatment for melanoma patients. The aims of this study were to assess the patient- and observer-reported long-term scar quality after surgery using the patient and observer scar assessment scale (POSAS) in melanoma patients, to assess the reliability and validity of POSAS, and to identify factors influencing the scar assessment. This cross-sectional clinical study included 320 melanoma patients with primary tumours on the trunk and limbs. Data regarding patients, treatment, scar characteristics and functional outcomes was analysed. Internal consistency, inter-rater reliability, and convergent validity were examined. Factors influencing the patient- and observer-reported scar quality were tested using regression analyses. Results of the POSAS showed an overall good scar quality. The internal consistency of POSAS was good, and the convergent validity was strong. The inter-rater reliability was only moderate. The patients were influenced by the POSAS sub-items: colour, irregularity, thickness and pain. The observer was influenced by the POSAS sub-items: vascularity, surface area, thickness, relief and pliability. Both patient- and observer-reported scar qualities were influenced by age, location, type of superficial suture, keloids and widened scars. Moreover, the patients were influenced by the scar tightness while the observer was influenced by postoperative complications, hypertrophic scars, suture marks and dog ears. In conclusion POSAS is a reliable and valid scar assessment tool. The factors influencing patient- and observer-reported scar quality differed, and better understanding of this may improve treatment and hence patient-reported scar quality.
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Affiliation(s)
- Marie B Weitemeyer
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Pernille Bramsen
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Tobias W Klausen
- b Department of Haematology , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Lisbet R Hölmich
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
| | - Caroline A Gjorup
- a Department of Plastic and Reconstructive Surgery , Herlev and Gentofte Hospital, University of Copenhagen , Denmark
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Køster B, Meyer MKH, Andersson TML, Engholm G, Dalum P. Sunbed use 2007-2015 and skin cancer projections of campaign results 2007-2040 in the Danish population: repeated cross-sectional surveys. BMJ Open 2018; 8:e022094. [PMID: 30158228 PMCID: PMC6119446 DOI: 10.1136/bmjopen-2018-022094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the effect of the Danish Sun Safety Campaign 2007-2015 on the prevalence of sunbed use and to model future effects on the skin cancer incidences 2007-2040. DESIGN The study has a repeated, cross-sectional design. SETTING Exposure to ultraviolet radiation is the main risk factor for skin cancer. Denmark has the highest prevalence of sunbed use reported and one of the highest incidences of skin cancer worldwide. PARTICIPANTS During 2007-2015, survey data were collected for 37 766 Danes, representative of the Danish population with regards to age, gender and region. INTERVENTIONS In 2007, an ongoing long-term antisunbed campaign was launched in Denmark. PRIMARY AND SECONDARY OUTCOME MEASURES Sunbed use was evaluated by annual cross-sectional surveys. Skin cancer incidence was modelled in the Prevent programme, using population projections, historic cancer incidence, sunbed use exposure and relative risk of sunbed use on melanoma. RESULTS The prevalence of recent sunbed use in Denmark was reduced from 32% and 18% to 13% and 8% for women and men, respectively. The campaigns results during 2007-2015 are estimated to reduce the number of skin cancer cases from more than 5000 (746malignant melanoma, 1562 SCC, 2673 BCC) totally during 2007-2040. Keeping the 2015 level of sunbed use constant by continued campaign pressure or introduction of structural interventions would potentially prevent more than 750 skin cancer cases annually in 2040 and 16 000 skin cancer cases in total during 2007-2040. CONCLUSION We have shown the value of prevention and of long-term planning in prevention campaigning. Sunbed use was reduced significantly during 2007-2015 and further reductions are possible by structural interventions. Consequently, significantly fewer skin cancer cases are anticipated during 2007-2040. The Danish Parliament has population support to enforce structural interventions to avoid a large burden of this disease.
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Affiliation(s)
- Brian Køster
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Maria KH Meyer
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Therese M-L Andersson
- Department of Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Peter Dalum
- Department of Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
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Robsahm TE, Helsing P, Nilssen Y, Vos L, Rizvi SMH, Akslen LA, Veierød MB. High mortality due to cutaneous melanoma in Norway: a study of prognostic factors in a nationwide cancer registry. Clin Epidemiol 2018; 10:537-548. [PMID: 29780262 PMCID: PMC5951132 DOI: 10.2147/clep.s151246] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to examine why Norway has the highest rate of mortality due to cutaneous melanoma (CM) in Europe. The Norwegian Malignant Melanoma Registry (NMMR) enables the study of clinical and histopathological characteristics of patients who die due to CM. Results The NMMR and the Norwegian Cause of Death Registry provided data on the clinical and histopathological factors as well as the date and cause of death, through June 2015 for all first invasive CMs diagnosed in 2008–2012 (n=8087). Cox regression was used to estimate associations between clinical and pathological factors and CM-specific death. Multiple imputation was used to handle missing data. Results The CMs were equally distributed between men (49.9%) and women (50.1%), and the median follow-up was 4.0 years (range: 0.08–7.5 years). Trunk was the most common anatomic site (48%), superficial spreading melanoma was the dominant melanoma subtype (68.2%), median Breslow thickness was 1.0 mm, ulceration was present in 23% of CMs, and 91.8% of cases were in a local clinical stage at diagnosis. Compared to women, men were diagnosed at a higher age, with thicker and more-often-ulcerated tumor, and more often were in advanced clinical stages. During follow-up, 1015 patients died due to CM, representing 52.8% of all deaths. The nodular subtype made up the dominant proportion of fatal CM cases (55.3% in women, 64.6% in men). Sex, age, anatomic site (trunk), T-stage, ulceration, clinical stage, and having a second primary CM were associated with increased risk of CM-specific death. Conclusion Our data suggest that the high rate of mortality due to CM observed in Norway is attributable to the more advanced stage of the disease at diagnosis. Most high-risk cases occurred in male patients ≥70 years of age. Efforts to improve awareness and secondary prevention of CM, including warning signs of all melanoma subtypes, are required urgently and should be targeted toward men in particular.
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Affiliation(s)
| | - Per Helsing
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Linda Vos
- Cancer Registry of Norway, Oslo, Norway
| | - Syed Mohammad H Rizvi
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars A Akslen
- Centre for Cancer Biomarkers, Department of Clinical Medicine, Section for Pathology, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Eggen C, Durgaram V, van Doorn R, Mooi W, Pardo L, Pasmans S, Hollestein L. Incidence and relative survival of melanoma in children and adolescents in the Netherlands, 1989-2013. J Eur Acad Dermatol Venereol 2018; 32:956-961. [DOI: 10.1111/jdv.14665] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- C.A.M. Eggen
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - V.V.L. Durgaram
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - R. van Doorn
- Department of Dermatology; Leiden University Medical Centre; Leiden The Netherlands
| | - W.J. Mooi
- Department of Pathology; VU University medical center; Amsterdam The Netherlands
| | - L.M. Pardo
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - S.G.M.A. Pasmans
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - L.M. Hollestein
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Research; Netherlands Comprehensive Cancer Center; Utrecht The Netherlands
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Sacchetto L, Zanetti R, Comber H, Bouchardy C, Brewster DH, Broganelli P, Chirlaque MD, Coza D, Galceran J, Gavin A, Hackl M, Katalinic A, Larønningen S, Louwman MWJ, Morgan E, Robsahm TE, Sanchez MJ, Tryggvadóttir L, Tumino R, Van Eycken E, Vernon S, Zadnik V, Rosso S. Trends in incidence of thick, thin and in situ melanoma in Europe. Eur J Cancer 2018; 92:108-118. [PMID: 29395684 DOI: 10.1016/j.ejca.2017.12.024] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND We analysed trends in incidence for in situ and invasive melanoma in some European countries during the period 1995-2012, stratifying for lesion thickness. MATERIAL AND METHODS Individual anonymised data from population-based European cancer registries (CRs) were collected and combined in a common database, including information on age, sex, year of diagnosis, histological type, tumour location, behaviour (invasive, in situ) and lesion thickness. Mortality data were retrieved from the publicly available World Health Organization database. RESULTS Our database covered a population of over 117 million inhabitants and included about 415,000 skin lesions, recorded by 18 European CRs (7 of them with national coverage). During the 1995-2012 period, we observed a statistically significant increase in incidence for both invasive (average annual percent change (AAPC) 4.0% men; 3.0% women) and in situ (AAPC 7.7% men; 6.2% women) cases. DISCUSSION The increase in invasive lesions seemed mainly driven by thin melanomas (AAPC 10% men; 8.3% women). The incidence of thick melanomas also increased, although more slowly in recent years. Correction for lesions of unknown thickness enhanced the differences between thin and thick cases and flattened the trends. Incidence trends varied considerably across registries, but only Netherlands presented a marked increase above the boundaries of a funnel plot that weighted estimates by their precision. Mortality from invasive melanoma has continued to increase in Norway, Iceland (but only for elder people), the Netherlands and Slovenia.
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Affiliation(s)
- L Sacchetto
- Piedmont Cancer Registry, A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy; Politecnico di Torino, Turin, Italy; Università degli Studi di Torino, Turin, Italy.
| | - R Zanetti
- Piedmont Cancer Registry, A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - H Comber
- National Cancer Registry Ireland, Ireland
| | | | | | - P Broganelli
- A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - M D Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, CIBERESP, Spain
| | - D Coza
- Cluj Regional Cancer Registry, Oncology Institute Cluj, Romania
| | - J Galceran
- Tarragona Cancer Registry, Foundation Society for Cancer Research and Prevention, (FUNCA), Pere Virgili Health Research Institute (IISPV), Reus, Spain
| | - A Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - M Hackl
- Austrian National Cancer Registry, Wien, Austria
| | - A Katalinic
- Institute for Social Medicine and Epidemiology, University Lübeck, Lubeck, Germany
| | - S Larønningen
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - M W J Louwman
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - E Morgan
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - T E Robsahm
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - M J Sanchez
- Escuela Andaluza de Salud Pública, CIBER de Epidemiología y Salud Pública, (CIBERESP), Ibs, Granada, Spain
| | - L Tryggvadóttir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
| | - R Tumino
- Cancer Registry and Histopathology Department, "Civic - M.P.Arezzo" Hospital, ASP, Ragusa, Italy
| | | | - S Vernon
- National Cancer Registration Service - Public Health England, Cambridge, UK
| | - V Zadnik
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - S Rosso
- Piedmont Cancer Registry, A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
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Dugonik B, Dugonik A, Horvat D, Žalik B, Špelič D. e-Derma - a Novel Wireless Dermatoscopy System. J Med Syst 2017; 41:205. [PMID: 29128996 DOI: 10.1007/s10916-017-0849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
Cutaneous Melanoma (CM) is a malignant tumour, and is one of the most rapidly growing cancers. Discovering a melanoma in the early stages of the disease is extremely difficult and, as such, only an invasive disease stage can be identified easily with the naked eye. Dermatoscopy is a diagnostic method intended to maximise early detection of CM performed by the dermatoscopy system. To address the limitations of existing systems a novel, wireless digital dermatoscopy system is presented for providing high-resolution images. It integrates a wire-free camera operation and offers a safe transfer of captured images to the computer. The working process of available dermatoscopy systems was studied, which are the most commonly used in everyday dermatology practice. Some findings, like operability, image quality, scalability, user-friendliness, and safeness, were used for the development of an e-Derma dermatoscopy system. An assessment method was performed by a group of dermatoscopy trained dermatologists to evaluate the quality of the testing images. Finally, a laboratory evaluation of images in regard to different parameters like sharpness, colour representation and illumination was performed with the side-by-side comparison of images of available dermatoscopy systems. e-Derma is a novel dermatoscopy system, which eliminates some limitations of existing systems and provides high-quality images. A novel low-budget highly capable dermatoscopy system is presented. The integrated wireless image transfer technology eliminates the movement limitations of a therapist. The image resolution is not limited by the integrated camera; it is easily upgradable with a wide range of on market alternative or improved camera models.
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Affiliation(s)
- Bogdan Dugonik
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000, Maribor, Slovenia.
| | - A Dugonik
- Department of Dermatology, University Medical Centre Maribor, 2000, Maribor, Slovenia
| | - D Horvat
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000, Maribor, Slovenia
| | - B Žalik
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000, Maribor, Slovenia
| | - D Špelič
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000, Maribor, Slovenia
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Health-related quality of life in melanoma patients: Impact of melanoma-related limb lymphoedema. Eur J Cancer 2017; 85:122-132. [PMID: 28918186 DOI: 10.1016/j.ejca.2017.07.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/29/2017] [Accepted: 07/30/2017] [Indexed: 11/22/2022]
Abstract
AIM To explore health-related quality of life (HRQoL) in recurrence-free melanoma patients, with a focus on the association between melanoma-related limb lymphoedema and HRQoL. METHODS HRQoL was evaluated using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the breast cancer module (EORTC QLQ-BR23) subscales body image and future perspective, the Functional Assessment for Cancer Therapy-General subscale social/family well-being and the Hospital Anxiety and Depression Scale. Data were analysed using linear and ordinal logistic regression adjusting for age and gender. RESULTS A total of 431 melanoma patients who had undergone wide local excision and axillary or inguinal sentinel lymph node biopsy (SLNB) and/or complete lymph node dissection (CLND) participated. No patients had had recurrence of the disease or had received adjuvant radiotherapy. The HRQoL scores improved with time after surgery. Melanoma-related limb lymphoedema was present in 109 patients (25%). Patients with lymphoedema had significantly worse HRQoL scores in the EORTC QLQ-C30 subscales global health status/quality of life, role and social functioning, fatigue, pain and financial difficulties, as well as in the QLQ-BR23 body image subscale. No associations were found between the limb affected (upper or lower limb), clinical stage of lymphoedema, duration of lymphoedema or type of surgery (SLNB or CLND) and HRQoL. We found an interaction with age and gender in the associations between lymphoedema and HRQoL: younger patients and women with lymphoedema had worse social functioning and women had significantly more impaired body image. CONCLUSIONS The negative impact of melanoma-related limb lymphoedema on HRQoL emphasises the importance of developing strategies for increasing awareness and improving prevention and treatment of lymphoedema.
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KMT2A promotes melanoma cell growth by targeting hTERT signaling pathway. Cell Death Dis 2017; 8:e2940. [PMID: 28726783 PMCID: PMC5550845 DOI: 10.1038/cddis.2017.285] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/08/2023]
Abstract
Melanoma is an aggressive cutaneous malignancy, illuminating the exact mechanisms and finding novel therapeutic targets are urgently needed. In this study, we identified KMT2A as a potential target, which promoted the growth of human melanoma cells. KMT2A knockdown significantly inhibited cell viability and cell migration and induced apoptosis, whereas KMT2A overexpression effectively promoted cell proliferation in various melanoma cell lines. Further study showed that KMT2A regulated melanoma cell growth by targeting the hTERT-dependent signal pathway. Knockdown of KMT2A markedly inhibited the promoter activity and expression of hTERT, and hTERT overexpression rescued the viability inhibition caused by KMT2A knockdown. Moreover, KMT2A knockdown suppressed tumorsphere formation and the expression of cancer stem cell markers, which was also reversed by hTERT overexpression. In addition, the results from a xenograft mouse model confirmed that KMT2A promoted melanoma growth via hTERT signaling. Finally, analyses of clinical samples demonstrated that the expression of KMT2A and hTERT were positively correlated in melanoma tumor tissues, and KMT2A high expression predicted poor prognosis in melanoma patients. Collectively, our results indicate that KMT2A promotes melanoma growth by activating the hTERT signaling, suggesting that the KMT2A/hTERT signaling pathway may be a potential therapeutic target for melanoma.
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Environmental effects of ozone depletion and its interactions with climate change: Progress report, 2016. Photochem Photobiol Sci 2017; 16:107-145. [PMID: 28124708 PMCID: PMC6400464 DOI: 10.1039/c7pp90001e] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 12/12/2022]
Abstract
The Parties to the Montreal Protocol are informed by three Panels of experts. One of these is the Environmental Effects Assessment Panel (EEAP), which deals with two focal issues. The first focus is the effects of UV radiation on human health, animals, plants, biogeochemistry, air quality, and materials. The second focus is on interactions between UV radiation and global climate change and how these may affect humans and the environment. When considering the effects of climate change, it has become clear that processes resulting in changes in stratospheric ozone are more complex than previously believed. As a result of this, human health and environmental issues will be longer-lasting and more regionally variable. Like the other Panels, the EEAP produces a detailed report every four years; the most recent was published as a series of seven papers in 2015 (Photochem. Photobiol. Sci., 2015, 14, 1-184). In the years in between, the EEAP produces less detailed and shorter Progress Reports of the relevant scientific findings. The most recent of these was for 2015 (Photochem. Photobiol. Sci., 2016, 15, 141-147). The present Progress Report for 2016 assesses some of the highlights and new insights with regard to the interactive nature of the direct and indirect effects of UV radiation, atmospheric processes, and climate change. The more detailed Quadrennial Assessment will be made available in 2018.
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Padrik P, Valter A, Valter E, Baburin A, Innos K. Trends in incidence and survival of cutaneous malignant melanoma in Estonia: a population-based study. Acta Oncol 2017; 56:52-58. [PMID: 27796149 DOI: 10.1080/0284186x.2016.1243804] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previous studies have shown an increase in the incidence of cutaneous melanoma (CM) in Estonia, but also poor survival in international comparisons, with a significant survival gap between the sexes. The aim of this study was to analyze the time trends in CM incidence and relative survival by age, TNM stage and anatomical subsite among men and women in Estonia. MATERIALS AND METHODS Data from the Estonian Cancer Registry were used to calculate age-standardized (World) and age-specific incidence of CM in 1995-2013, and five-year relative survival ratios (RSR) for cases diagnosed in 1995-2012 and followed through in 2014. Period hybrid analysis was used to calculate the most recent survival estimates for 2010-2014. RESULTS Between 1995 and 2013, the age-standardized incidence of CM increased significantly in Estonia among both sexes, at a rate of around 4% per year. Among women, the proportion of trunk melanomas increased from 26% in 1995-1999 to 39% in 2010-2012 and became the most common site. The proportion of stage I cases and T1 tumors increased considerably. Women had more favorable stage distribution and thinner tumors than men. The age-adjusted five-year RSR increased significantly, from 64% in 1995-1999 to 81% in 2010-2014. The latest age-adjusted RSRs were 76% among men and 84% among women. Survival gains were the largest in patients below 50 years, those with head and neck or trunk melanomas, and stage III cancer. CONCLUSIONS The proportion of stage I and T1 cases is lower in Estonia compared with the Scandinavian data and is likely a major contributor to the persisting overall survival deficit in Estonia. The apparent deficit in stage II survival also warrants further investigation. A public health program is necessary in Estonia to raise awareness of CM and to significantly increase early stage diagnosis.
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Affiliation(s)
- Peeter Padrik
- a Tartu University Hospital , Tartu , Estonia
- b University of Tartu , Tartu , Estonia
| | | | | | - Aleksei Baburin
- c Department of Epidemiology and Biostatistics , National Institute for Health Development , Tallinn , Estonia
| | - Kaire Innos
- c Department of Epidemiology and Biostatistics , National Institute for Health Development , Tallinn , Estonia
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Rockberg J, Amelio JM, Taylor A, Jörgensen L, Ragnhammar P, Hansson J. Epidemiology of cutaneous melanoma in Sweden-Stage-specific survival and rate of recurrence. Int J Cancer 2016; 139:2722-2729. [PMID: 27563839 DOI: 10.1002/ijc.30407] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 08/10/2016] [Indexed: 12/19/2022]
Abstract
Cutaneous malignant melanoma (CMM) incidence is increasing globally, making a thorough understanding of the disease and its outcomes essential for optimizing care even more urgent. In this population-based, retrospective study, we investigated stage-specific survival and recurrence/progression rates of CMM among patients diagnosed in Stockholm County Council during 2005-2012, before the wide introduction of targeted therapy. A total of 3,554 CMM patients from the Stockholm Melanoma Register were included. Information on comorbidities, progression, death, and treatments was obtained from nationwide registers and hospital electronic medical records. Unadjusted 5-year survival varied from 91.4% for stage I to 24.6% for stage IV patients. Stage, age and gender were predictors of survival, with gender an independent predictor of survival for stages IA and IIA. 74.6% of patients remained recurrence/progression-free during follow-up, with 5-year recurrence/progression-free survival rates varying from 85.3% to 12.9% among stages I and IV patients, respectively. In addition to stage, male gender, and age, circulatory system comorbidities increased the risk for recurrence/progression. No statistically significant differences in progression rate for operated and non-operated patients could be detected, possibly due to high rate (98.9%) of surgery. Our estimates of survival and recurrence rates are consistent with historical and global expectations and can serve as a baseline to gauge population-level improvements with use of novel melanoma treatments.
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Affiliation(s)
- Julia Rockberg
- Pygargus AB/IMS Health Sweden AB, Pyramidvägen 7, Solna, Sweden 169 56
| | | | - Aliki Taylor
- Amgen Inc, Uxbridge Business Park, Uxbridge, UK UB8 1DH
| | - Leif Jörgensen
- Pygargus AB/IMS Health Sweden AB, Pyramidvägen 7, Solna, Sweden 169 56
| | - Peter Ragnhammar
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden 171 76
| | - Johan Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden 171 76.
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Meyle KD, Gamborg M, Hölmich LR, Baker JL. Associations between childhood height and morphologically different variants of melanoma in adulthood. Eur J Cancer 2016; 67:99-105. [PMID: 27640136 PMCID: PMC5068922 DOI: 10.1016/j.ejca.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Abstract
Aim of the study Melanoma subtypes have different aetiological characteristics. Child height is positively associated with adult melanoma; however, a clarification of associations with specific melanoma variants is necessary for an improved understanding of risk factors underlying the histologic entities. This study investigated associations between childhood height and future development of cutaneous melanoma variants. Method A cohort study of 316,193 individuals from the Copenhagen School Health Records Register, with measured heights at ages 7–13 years who were born from 1930 to 1989. Melanoma cases were identified via linkage to the national Danish Cancer Registry and subdivided into subtypes. Cox proportional hazards regressions were performed. Results A total of 2223 cases of melanoma distributed as 60% superficial spreading melanoma (SSM), 27.5% melanoma not otherwise specified (NOS), 8.5% nodular melanoma (NM), and 2% lentigo maligna melanoma (LMM). The remaining rare melanoma forms were not analysed. Childhood height was positively and significantly associated with SSM, melanoma NOS, and NM, but not LMM, in adulthood. Per height z-score at age 13 years, the hazard ratios were 1.20 (95% confidence intervals [CI]: 1.13–1.27) for SSM, 1.19 (95% CI: 1.09–1.29) for melanoma NOS, and 1.21 (95% CI: 1.04–1.41) for NM. Further, growth patterns were linked to the melanoma variants with persistently tall children having an increased risk of developing SSM, melanoma NOS, or NM. Conclusion Childhood height is positively associated with the majority of the melanoma variants. These results suggest that the underlying processes contributing to childhood height and growth patterns interconnect early-life events with the predisposition to melanomagenesis in adulthood. Childhood height was positively and significantly associated with the majority of melanoma subtypes. Diverse growth patterns in childhood were differentially associated with future melanomagenesis. Height and melanoma risk may be linked by biological mechanisms, and these remain to be elucidated.
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Affiliation(s)
- Kathrine Damm Meyle
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Michael Gamborg
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | | | - Jennifer Lyn Baker
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Superficial spreading melanoma: an analysis of 97 702 cases using the SEER database. Melanoma Res 2016; 26:395-400. [DOI: 10.1097/cmr.0000000000000245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Timosaponin AIII induces apoptosis and autophagy in human melanoma A375-S2 cells. Arch Pharm Res 2016; 40:69-78. [PMID: 27271334 DOI: 10.1007/s12272-016-0763-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
Timosaponin AIII (AIII), a steroidal saponin isolated from Anemarrhena asphodeloides Bge. Our study showed that AIII induced both apoptosis and autophagy, and autophagy inhibited apoptosis in A375S2 cells. Furtherly, this study was carried out to investigate what kind of cytokines plays an important role in this process. The results revealed that AIII induced apoptosis through activating c-Jun N-terminal protein kinase (JNK) or extracellular signal related kinase (ERK) signaling pathway and generating NO. However, JNK or ERK inhibited autophagy, while NO had no effect on autophagy. Therefore, JNK, ERK or NO regulates two programmed death processes in different ways. AIII did not show obvious cytotoxic effect on human peripheral blood mononuclear cells, which indicated that AIII has less side effects on normal cells, and could be considered as a leading compound for developing novel anticancer drug.
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Svedman FC, Pillas D, Taylor A, Kaur M, Linder R, Hansson J. Stage-specific survival and recurrence in patients with cutaneous malignant melanoma in Europe - a systematic review of the literature. Clin Epidemiol 2016; 8:109-22. [PMID: 27307765 PMCID: PMC4887072 DOI: 10.2147/clep.s99021] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the increasing incidence in cutaneous malignant melanoma (CMM) and the recent changes in the treatment landscape, it is important to understand stage-specific overall and recurrence-free survival patterns in Europe. Despite publications such as EUROCARE-5, there is limited information on stage-specific survival for CMM in Europe. METHOD We carried out a systematic literature review to provide an up-to-date summary of stage-specific survival and recurrence-free survival patterns in patients with CMM in Europe. Studies were included if they were published in Medline during the past 12 years and included information on stage-specific survival and/or recurrence in CMM. RESULTS Of the 8,749 studies identified, 26 studies were included, representing nine countries. Collectively, the studies covered a population of 152,422 patients and included data from 1978 to 2011. Randomized clinical trials and single-center observational studies comprised the most common study designs, including five large registry-based studies. Stage-specific information for survival and recurrence varied: 5-year overall survival: 95%-100% (stage I), 65%-92.8% (stage II), 41%-71% (stage III), and 9%-28% (stage IV); 5-year relapse-free survival was reported less frequently: 56% (stage II), and 28%-44% (stage III). Studies reporting survival by sentinel node (SN) status reported 5-year overall survival as 80%-95% for negative SN (stage I/II) and 35%-75% for positive SN (stage III) status; recurrence-free survival at 5 years: 76%-90% for negative and 35%-58% for positive SN status. Some studies included comparisons of survival by key patient sociodemographic characteristics, suggesting that these have a substantial influence on survival and recurrence estimates. CONCLUSION The studies identified in this review show large variations in stage-specific overall and recurrence-free survival by study type and by country. Owing to differing study designs and populations, it is difficult to make detailed comparisons. Large population-based studies that include stage-specific survival and recurrence in Europe are therefore important.
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Affiliation(s)
- Fernanda Costa Svedman
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - Aliki Taylor
- Centre for Observational Research, Amgen Ltd, Uxbridge, UK
| | - Moninder Kaur
- Centre for Observational Research, Amgen Ltd, Uxbridge, UK
| | | | - Johan Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
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Tumour stage and implementation of standardised cancer patient pathways: a comparative cohort study. Br J Gen Pract 2016; 66:e434-43. [PMID: 27025558 DOI: 10.3399/bjgp16x684805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/04/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Some European countries have introduced standardised cancer patient pathways (CPPs), including urgent referrals, with the aim of diagnosing cancer at an earlier stage. This is despite a lack of evidence, particularly in patients with symptomatic cancer diagnosed via general practice. AIM To compare tumour stages in patients with incident cancer diagnosed via general practice before, during, and after CPP implementation in Denmark in 2008-2009. DESIGN AND SETTING A comparative cohort study of data from GPs and registries on patients with incident cancer listed with a GP before (n = 1420), during (n = 5272), and after (n = 2988) CPP implementation. METHOD χ(2) test was used to compare stage distributions and logistic regression to estimate odds ratios (OR) of having local cancer after versus before CPP implementation. RESULTS Distribution of tumour stages did not differ statistically significantly across time (P = 0.494) or between CPP use (P = 0.202). For all cancers combined, the OR of having local cancer after CPP implementation was 0.88 (95% confidence interval [CI] = 0.73 to 1.06) compared with before. For CPP-referred patients, the OR of having local cancer was 0.77 (95% CI = 0.62 to 0.94) compared with all patients before CPP implementation; the corresponding OR for non-CPP-referred patients was 0.96 (95% CI = 0.80 to 1.14). CONCLUSION No clear tendencies were observed confirming earlier detection of cancer after rather than before CPP implementation. CPP-referred patients had lower odds of having local cancer after CPP implementation than all patients before CPP implementation; this could be because the GPs refer patients who are 'more ill' as urgent referrals.
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He J, Duan S, Yu X, Qian Z, Zhou S, Zhang Z, Huang X, Huang Y, Su J, Lai C, Meng J, Zhou N, Lu X, Zhao Y. Folate-modified Chitosan Nanoparticles Containing the IP-10 Gene Enhance Melanoma-specific Cytotoxic CD8(+)CD28(+) T Lymphocyte Responses. Am J Cancer Res 2016; 6:752-61. [PMID: 27022421 PMCID: PMC4805668 DOI: 10.7150/thno.14527] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/01/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adoptive immunotherapy with cytotoxic T lymphocytes (CTLs) has great potential for the treatment of some malignant cancers. Therefore, augmenting the responses of tumor-specific CTLs is significant for the adoptive immunotherapy of melanoma. This study aimed to investigate the anti-tumor response of a combination therapy employing folate-modified chitosan nanoparticles containing IP-10 (interferon-γ-inducible protein-10) plus melanoma TRP2-specific CD8(+)CD28(+) T cells. METHODS We prepared folate-modified chitosan nanoparticles containing the mouse IP-10 gene (FA-CS-mIP-10), and induced melanoma TRP2-specific CD8(+)CD28(+) T cells by co-culturing them with artificial antigen-presenting cells. B16-bearing mice were treated with FA-CS-mIP-10, melanoma TRP2-specific CD8(+)CD28(+) T cells, a combination of both, and the saline control. Tumor volumes and the survival time of mice were recorded. The proportion of myeloid-derived suppressor cells (MDSCs) infiltrating the tumor microenvironment and regulatory T cells (Tregs) in the spleen was analyzed by flow cytometry. We also detected the proliferation and angiogenesis of tumors by immunohistochemistry and apoptosis by TUNEL. RESULTS The combination therapy inhibited the progression of melanoma in vivo. Compared with other treatments, it more efficiently inhibited tumor growth and increased the survival time of mice. After treatment with combination therapy, the proportion of MDSCs and Tregs decreased, while the percentage of CXCR3(+)CD8(+) T cells increased. Furthermore, combination therapy inhibited proliferation and promoted apoptosis of tumor cells and significantly inhibited tumor angiogenesis in vivo. CONCLUSION We describe a novel strategy for improving the anti-tumor response of CD8(+)CD28(+) CTLs by combining them with FA-CS-mIP-10 nanoparticles.
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Skin Delivery and in Vitro Biological Evaluation of Trans-Resveratrol-Loaded Solid Lipid Nanoparticles for Skin Disorder Therapies. Molecules 2016; 21:E116. [PMID: 26805794 PMCID: PMC6273087 DOI: 10.3390/molecules21010116] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the skin delivery and in vitro biological activity of trans-resveratrol (RES)-loaded solid lipid nanoparticles (SLNs). The SLNs were composed of stearic acid, poloxamer 407, soy phosphatidylcholine (SPC), an aqueous phase and 0.1% RES. The particle size, polydispersity index (PdI) and zeta potential were analyzed by dynamic light scattering (DLS). The SLNs were analyzed by scanning electron microscopy (SEM-FEG) and differential scanning calorimetry (DSC). In vitro RES-SLN skin permeation/retention assays were conducted, and their tyrosinase inhibitory activity was evaluated. An MTT reduction assay was performed on HaCat keratinocytes to determine in vitro cytotoxicity. The formulations had average diameter lower than 200 nm, the addition of SPC promoted increases in PdI in the RES-SLNs, but decreases PdI in the RES-free SLNs and the formulations exhibited zeta potentials smaller than −3 mV. The DSC analysis of the SLNs showed no endothermic peak attributable to RES. Microscopic analysis suggests that the materials formed had nanometric size distribution. Up to 45% of the RES permeated through the skin after 24 h. The RES-loaded SLNs were more effective than kojic acid at inhibiting tyrosinase and proved to be non-toxic in HaCat keratinocytes. The results suggest that the investigated RES-loaded SLNs have potential use in skin disorder therapies.
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Crocetti E, Mallone S, Robsahm TE, Gavin A, Agius D, Ardanaz E, Lopez MDC, Innos K, Minicozzi P, Borgognoni L, Pierannunzio D, Eisemann N. Survival of patients with skin melanoma in Europe increases further: Results of the EUROCARE-5 study. Eur J Cancer 2015; 51:2179-2190. [PMID: 26421821 DOI: 10.1016/j.ejca.2015.07.039] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 07/20/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND In Europe skin melanoma (SM) survival has increased over time. The aims were to evaluate recent trends and differences between countries and regions of Europe. METHODS Relative survival (RS) estimates and geographical comparisons were based on 241,485 patients aged 15years and over with a diagnosis of invasive SM in Europe (2000-2007). Survival time trends during 1999-2007 were estimated using the period approach, for 213,101 patients. Age, gender, sub-sites and morphology subgroups were considered. RESULTS In European patients, estimated 5-year RS was 83% (95% confidence interval, CI 83-84%). The highest values were found for patients resident in Northern (88%; 87-88%) and Central (88%; 87-88%) Europe, followed by Ireland and United Kingdom (UK) (86%; 85-86%) and Southern Europe (83%; 82-83%). The lowest survival was in Eastern Europe (74%; 74-75%). Within regions the intercountry absolute difference in percentage points of RS varied from 4% (North) to 34% (East). RS decreased markedly with patients' age and was higher in women than men. Differences according to SM morphology and skin sub-sites also emerged. Survival has slightly increased from 1999 to 2007, with a small improvement in Northern and the most pronounced improvement in Eastern Europe. DISCUSSION SM survival is high and still increasing in European patients. The gap between Northern and Southern and especially Eastern European countries, although still present, diminished over time. Differences in stage distribution at diagnosis may explain most of the geographical differences. However, part of the improvement in survival may be attributed to overdiagnosis from early diagnosis practices.
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Affiliation(s)
- Emanuele Crocetti
- UO Epidemiologia Clinica, Descrittiva e Registri - ISPO, Firenze, Italy.
| | - Sandra Mallone
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queens University, Belfast, Northern Ireland, UK
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research, Pieta, Malta
| | - Eva Ardanaz
- Navarra Cancer Registry, Navarra Public Health Institute, Pamplona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque Lopez
- Servicio de Epidemiología, Department of Epidemiology, Consejería de Sanidad, Murcia Health Authority, Murcia, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kaire Innos
- Department of Epidemiology and Biostatistics National, Institute for Health Development, Tallinn, Estonia
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenzo Borgognoni
- SC Chirurgia Plastica e Ricostruttiva, Ospedale S.M. Annunziata - Azienda Sanitaria di Firenze Centro di Riferimento Regionale per il Melanoma, Istituto Toscano Tumori, Firenze, Italy
| | - Daniela Pierannunzio
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Nora Eisemann
- Institute of Cancer Epidemiology, University of Luebeck, Luebeck, Germany
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