1
|
Spanos S, Singh N, Laginha BI, Arnolda G, Smith AL, Wilkinson D, Cust AE, Braithwaite J, Rapport F. Quality measures in primary care skin cancer management: a qualitative study of the views of key informants. BMJ Open 2024; 14:e080670. [PMID: 38991668 PMCID: PMC11243125 DOI: 10.1136/bmjopen-2023-080670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVES This study explored potential quality measures to improve skin cancer management in primary care settings, and the barriers and facilitators associated with their implementation. DESIGN Semistructured interviews and qualitative proforma surveys were conducted with skin cancer experts from a range of healthcare settings. Framework analysis was employed to identify key groups of quality measures within the domains of the Donabedian model of healthcare quality (structure, process, outcome). Interview and survey data were triangulated to identify common groups of quality measures, barriers and facilitators. PARTICIPANTS We purposively recruited skin cancer experts from Australia and internationally with knowledge and experience in skin cancer management. The final sample consisted of 15 participants who had clinical or academic backgrounds. RESULTS Participants unequivocally expressed the need for quality measures to guide skin cancer care. Ten groups of quality measures were identified: three groups related to the structural elements of care (eg, diagnostic tools), four related to the processes of care (eg, diagnostic process) and three related to outcomes of care (eg, treatment outcomes). Implementation barriers included clinician resistance, system inadequacies and external factors (eg, patient risk). Facilitators included incentives, education, agreed and feasible indicators and support and guidance. CONCLUSIONS To service a growing population of skin cancer patients in Australia, the role of primary care needs to be more clearly specified, and its care providers supported and more engaged in quality improvement processes. Structure, process and outcome quality measures, derived from detailed guidance for primary care settings, can be used to track practitioner performance and facilitate ongoing improvement.
Collapse
Affiliation(s)
- Samantha Spanos
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Nehal Singh
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Bela I Laginha
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Andrea L Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - David Wilkinson
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- National Skin Cancer Centres, South Brisbane, Queensland, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Elliott TM, Gordon LG, Webb A, Kift R, Foeglein A, Neale RE. Making the sunshine vitamin - How much sun exposure is needed to maintain 25-hydroxy vitamin D concentration? Photochem Photobiol 2024; 100:746-755. [PMID: 37691266 DOI: 10.1111/php.13854] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
Our objective was to calculate the time in the sun necessary to maintain existing 25-hydroxyvitamin D (25(OH)D) concentration at locations across Australia and New Zealand. We used a microsimulation model to estimate changes in monthly 25(OH)D concentration using data on standard erythemal dose, solar zenith angle, and climatological ozone. We estimated the number of standard vitamin D doses per 10-min interval and used a dose-response equation to determine the average time in the sun to maintain existing 25(OH)D concentration according to month and time of day. Across all locations in summer, 5-10 min outdoors between 8 a.m. and 4 p.m. on most days of the week, with 35% of the body surface area exposed, is sufficient to maintain existing 25(OH)D concentration. In winter, at mid-to-high latitudes, time outdoors during the middle of the day is required. In winter, with 10% of the body surface area exposed, greater than 45 min in the middle of the day is required in most locations to maintain existing 25(OH)D concentration. These data can be used to inform guidelines regarding maintaining vitamin D via sun exposure and may help health practitioners identify patients who may be vitamin D deficient.
Collapse
Affiliation(s)
- Thomas M Elliott
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
| | - Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
- School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia
| | - Ann Webb
- Department of Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - Richard Kift
- Department of Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - Anna Foeglein
- Heisenberg Analytics, Indooroopilly, Queensland, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Herston, Brisbane, Australia
| |
Collapse
|
3
|
Bahashwan E. Awareness and knowledge of sun exposure and use of sunscreen among adults in Aseer region, Saudi Arabia. Saudi Pharm J 2024; 32:102019. [PMID: 38525268 PMCID: PMC10960100 DOI: 10.1016/j.jsps.2024.102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Background Excessive sun exposure and inadequate sunscreen use can lead to skin cancer and other harmful effects on the skin, eyes, and immune system. Purpose This observational cross-sectional study aimed to assess awareness and knowledge of sun exposure and sunscreen use among adults in the Aseer region, Saudi Arabia. This study also focused on evaluating the risks of skin cancer and participants' sun-protective attitudes and practices. Methods A population-based cross-sectional study was conducted among adults in the Aseer region, Saudi Arabia. Data were collected using a questionnaire from November 2022 to January 2023 that assessed participants' knowledge, practices, and beliefs regarding sun exposure and sunscreen use. A total of 400 participants were selected for the study. Approval for the study was granted by the Local Research Ethics Committee of the University of Bisha, Saudi Arabia. Results The results revealed that (59.8 %) of the participants were female, while (40.3 %) were male. Regarding age, the majority fell within the 26-35 age range (37.5 %), with (16.0 %) of participants using sunscreen regularly, with a total of (74.0 %) of participants using sunscreen. Men exhibited a higher prevalence of negative attitudes towards sun protection, while women demonstrated more favourable sun protection practices. In addition, (1.25 %) of the participants had skin cancer in the past; (81.0 %) of participants agreed that skin cancer could cause death, while (19.0 %) were unsure of the effects of skin cancer. Moreover, the results indicated that sun exposure had a significant positive effect on awareness levels (p < 0.05), indicating that increased sun exposure was associated with higher awareness of the harmful effects of the sun. Additionally, awareness level significantly positively affected sunscreen use (p < 0.01), suggesting that individuals with higher awareness were more likely to use sunscreen. Conclusion There was an average awareness of sun exposure and its detrimental effects. In addition, a significant portion of the population demonstrates proactive measures to minimize sunlight exposure. However, sunscreen usage among Saudi adults was low despite having knowledge and awareness. Future research must enhance sun protection practices and reduce sun-related skin damage in the Aseer region.
Collapse
Affiliation(s)
- Emad Bahashwan
- Division of Dermatology, Department of Internal Medicine, College of Medicine, University of Bisha, 255, Al Nakhil, Bisha 67714, Saudi Arabia
| |
Collapse
|
4
|
Miller I, Rosic N, Stapelberg M, Hudson J, Coxon P, Furness J, Walsh J, Climstein M. Performance of Commercial Dermatoscopic Systems That Incorporate Artificial Intelligence for the Identification of Melanoma in General Practice: A Systematic Review. Cancers (Basel) 2024; 16:1443. [PMID: 38611119 PMCID: PMC11011068 DOI: 10.3390/cancers16071443] [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: 02/29/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Cutaneous melanoma remains an increasing global public health burden, particularly in fair-skinned populations. Advancing technologies, particularly artificial intelligence (AI), may provide an additional tool for clinicians to help detect malignancies with a more accurate success rate. This systematic review aimed to report the performance metrics of commercially available convolutional neural networks (CNNs) tasked with detecting MM. METHODS A systematic literature search was performed using CINAHL, Medline, Scopus, ScienceDirect and Web of Science databases. RESULTS A total of 16 articles reporting MM were included in this review. The combined number of melanomas detected was 1160, and non-melanoma lesions were 33,010. The performance of market-approved technology and clinician performance for classifying melanoma was highly heterogeneous, with sensitivity ranging from 16.4 to 100.0%, specificity between 40.0 and 98.3% and accuracy between 44.0 and 92.0%. Less heterogeneity was observed when clinicians worked in unison with AI, with sensitivity ranging between 83.3 and 100.0%, specificity between 83.7 and 87.3%, and accuracy between 86.4 and 86.9%. CONCLUSION Instead of focusing on the performance of AI versus clinicians for classifying melanoma, more consistent performance has been obtained when clinicians' work is supported by AI, facilitating management decisions and improving health outcomes.
Collapse
Affiliation(s)
- Ian Miller
- Aquatic Based Research, Southern Cross University, Bilinga, QLD 4225, Australia; (I.M.); (N.R.)
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia (P.C.)
- Specialist Suite, John Flynn Hospital, Tugun, QLD 4224, Australia
| | - Nedeljka Rosic
- Aquatic Based Research, Southern Cross University, Bilinga, QLD 4225, Australia; (I.M.); (N.R.)
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia (P.C.)
| | - Michael Stapelberg
- Aquatic Based Research, Southern Cross University, Bilinga, QLD 4225, Australia; (I.M.); (N.R.)
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia (P.C.)
- Specialist Suite, John Flynn Hospital, Tugun, QLD 4224, Australia
| | - Jeremy Hudson
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia (P.C.)
- North Queensland Skin Centre, Townsville, QLD 4810, Australia
| | - Paul Coxon
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia (P.C.)
- North Queensland Skin Centre, Townsville, QLD 4810, Australia
| | - James Furness
- Water Based Research Unit, Bond University, Robina, QLD 4226, Australia;
| | - Joe Walsh
- Sport Science Institute, Sydney, NSW 2000, Australia;
- AI Consulting Group, Sydney, NSW 2000, Australia
| | - Mike Climstein
- Aquatic Based Research, Southern Cross University, Bilinga, QLD 4225, Australia; (I.M.); (N.R.)
- Faculty of Health, Southern Cross University, Bilinga, QLD 4225, Australia (P.C.)
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney, NSW 2050, Australia
| |
Collapse
|
5
|
Neale RE, Beedle V, Ebeling PR, Elliott T, Francis D, Girgis CM, Gordon L, Janda M, Jones G, Lucas RM, Mason RS, Monnington PK, Morahan J, Paxton G, Sinclair C, Shumack S, Smith J, Webb AR, Whiteman DC. Balancing the risks and benefits of sun exposure: A revised position statement for Australian adults. Aust N Z J Public Health 2024; 48:100117. [PMID: 38350754 DOI: 10.1016/j.anzjph.2023.100117] [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: 09/03/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To describe the development of a new position statement regarding balancing the risks and benefits of sun exposure for Australian adults. METHODS We conducted a Sun Exposure Summit in March 2021, with presentations from invited experts and a workshop including representation from academic, clinical, policy, and patient stakeholder organisations. The group considered advice about balancing the risks and benefits of sun exposure for Australian adults and developed a revised consensus position statement. RESULTS The balance of risks and benefits of sun exposure is not the same for everybody. For people at very high risk of skin cancer, the risks of exposure likely outweigh the benefits; sun protection is essential. Conversely, people with deeply pigmented skin are at low risk of skin cancer but at high risk of vitamin D deficiency; routine sun protection is not recommended. For those at intermediate risk of skin cancer, sun protection remains a priority, but individuals may obtain sufficient sun exposure to maintain adequate vitamin D status. CONCLUSIONS The new position statement provides sun exposure advice that explicitly recognises the differing needs of Australia's diverse population. IMPLICATIONS FOR PUBLIC HEALTH Mass communication campaigns should retain the focus on skin cancer prevention. The new position statement will support the delivery of personalised advice.
Collapse
Affiliation(s)
- Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | | | - Peter R Ebeling
- Monash University, Melbourne, Australia; Healthy Bones Australia, Australia
| | - Thomas Elliott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Christian M Girgis
- University of Sydney, Sydney, Australia; Australa and New Zealand Bone and Mineral Society, Australia
| | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | | | - Graeme Jones
- Australa and New Zealand Bone and Mineral Society, Australia; University of Tasmania, Hobart, Australia
| | | | - Rebecca S Mason
- University of Sydney, Sydney, Australia; Healthy Bones Australia, Australia
| | | | | | | | | | | | - Jane Smith
- Royal Australian College of General Practitioners, Australia
| | - Ann R Webb
- University of Manchester, Manchester, United Kingdom
| | - David C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia
| |
Collapse
|
6
|
Busam KJ, Gerami P, Scolyer RA. Perspectives and Strategies to Minimize Harm From Melanoma Diagnosis. JAMA Dermatol 2023; 159:1307-1309. [PMID: 37938819 DOI: 10.1001/jamadermatol.2023.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Pandeya N, Olsen CM, Shalit MM, Dusingize JC, Neale RE, Whiteman DC. The diagnosis and initial management of melanoma in Australia: findings from the prospective, population-based QSkin study. Med J Aust 2023; 218:402-407. [PMID: 37041657 PMCID: PMC10953446 DOI: 10.5694/mja2.51919] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVES To determine the proportions of newly diagnosed melanomas treated by different medical specialist types, to describe the types of excisions performed, and to investigate factors associated with treating practitioner specialty and excision type. DESIGN, SETTING Prospective cohort study; analysis of linked data: baseline surveys, hospital, pathology, Queensland Cancer Register, and Medical Benefits Schedule databases. PARTICIPANTS Random sample of 43 764 Queensland residents aged 40-69 years recruited during 2011, with initial diagnoses of in situ or invasive melanoma diagnosed to 31 December 2019. MAIN OUTCOME MEASURES Treating practitioner type and treatment modality for first incident melanoma; second and subsequent treatment events for the primary melanoma. RESULTS During a median follow-up of 8.4 years (interquartile range, 8.3-8.8 years), 1683 eligible participants (720 women, 963 men) developed at least one primary melanoma (in situ melanoma, 1125; invasive melanoma, 558), 1296 of which (77.1%) were initially managed in primary care; 248 were diagnosed by dermatologists (14.8%), 83 by plastic surgeons (4.9%), 43 by general surgeons (2.6%), and ten by other specialists (0.6%). The most frequent initial procedures leading to histologically confirmed melanoma diagnosis were first excision (854, 50.7%), shave biopsy (549, 32.6%), and punch biopsy (178, 10.6%); 1339 melanomas (79.6%) required two procedures, 187 (11.1%) three. Larger proportions of melanomas diagnosed by dermatologists (87%) or plastic surgeons (71%) were in people living in urban areas than of those diagnosed in primary care (63%); larger proportions of melanomas diagnosed by dermatologists or plastic surgeons than of those diagnosed in primary care were in people with university degrees (45%, 42% v 23%) or upper quartile clinical risk scores (63%, 59% v 47%). CONCLUSIONS Most incident melanomas in Queensland are diagnosed in primary care, and nearly half are initially managed by partial excision (shave or punch biopsy). Second or third, wider excisions are undertaken in about 90% of cases.
Collapse
Affiliation(s)
| | | | - Maja M Shalit
- QIMR Berghofer Medical Research InstituteBrisbaneQLD
| | | | | | | |
Collapse
|
8
|
El Sharouni MA, Rawson RV, Potter AJ, Paver EC, Wilmott JS, Witkamp AJ, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, Lo SN, van Gils CH. Melanomas in children and adolescents: Clinicopathologic features and survival outcomes. J Am Acad Dermatol 2023; 88:609-616. [PMID: 36509217 DOI: 10.1016/j.jaad.2022.08.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Melanomas in the first 2 decades of life are uncommon and poorly understood. OBJECTIVE To assess clinicopathologic features and survival of children (≤11 years) and adolescents (12-19 years) diagnosed with melanoma. METHODS A pooled cohort of 514 patients was analyzed (397 Dutch, 117 Australian; 62 children, 452 adolescents). Pathology reports were reevaluated to determine melanoma subtypes. Multivariable Cox models were generated for recurrence-free survival (RFS) and overall survival (OS). RESULTS Melanoma subtypes were conventional melanoma (superficial spreading, nodular, desmoplastic, and acral lentiginous), spitzoid melanoma, and melanoma associated with a congenital nevus in 428, 78, and 8 patients, respectively. Ten-year RFS was 91.5% (95% confidence interval [CI], 82.4%-100%) in children and 86.4% (95% CI, 82.7%-90.3%) in adolescents (P = .32). Ten-year OS was 100% in children and 92.7% (95% CI, 89.8%-95.8%) in adolescents (P = .09). On multivariable analysis possible only for the adolescent cohort due to the small number of children, ulceration status, and anatomic site were associated with RFS and OS, whereas age, sex, mitotic index, sentinel node status and melanoma subtype were not. Breslow thickness >4 mm was associated with worse RFS. LIMITATIONS Retrospective study. CONCLUSIONS Survival rates for children and adolescents with melanomas were high. Ulceration, head or neck location and Breslow thickness >4 mm predicted worse survival in adolescents.
Collapse
Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Alison J Potter
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Elizabeth C Paver
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| |
Collapse
|
9
|
Microbiota, Oxidative Stress, and Skin Cancer: An Unexpected Triangle. Antioxidants (Basel) 2023; 12:antiox12030546. [PMID: 36978794 PMCID: PMC10045429 DOI: 10.3390/antiox12030546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Mounting evidence indicates that the microbiota, the unique combination of micro-organisms residing in a specific environment, plays an essential role in the development of a wide range of human diseases, including skin cancer. Moreover, a persistent imbalance of microbial community, named dysbiosis, can also be associated with oxidative stress, a well-known emerging force involved in the pathogenesis of several human diseases, including cutaneous malignancies. Although their interplay has been somewhat suggested, the connection between microbiota, oxidative stress, and skin cancer is a largely unexplored field. In the present review, we discuss the current knowledge on these topics, suggesting potential therapeutic strategies.
Collapse
|
10
|
Olsen CM, Pandeya N, Dusingize JC, Neale RE, MacGregor S, Law MH, Whiteman DC. Risk Factors Associated With First and Second Primary Melanomas in a High-Incidence Population. JAMA Dermatol 2023; 159:37-46. [PMID: 36416830 PMCID: PMC9685542 DOI: 10.1001/jamadermatol.2022.4975] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022]
Abstract
Importance An increasing number of people develop more than 1 primary melanoma, yet to date, no population-based prospective cohort studies have reported on risk factors for developing first vs second primary melanomas. Objective To compare the clinical characteristics of first and second melanomas and then to estimate the relative risks of developing 1 vs multiple melanomas associated with demographic, phenotypic, sun exposure, and genetic factors. Design, Setting, and Participants This population-based prospective cohort study included men and women aged 40 to 69 years recruited in 2011 and followed up until December 2018 in Queensland, Australia. Data analysis was performed from February to July 2022. Exposures Self-reported information about demographic, phenotypic, and sun exposure measures captured using a survey completed at baseline, and polygenic risk score for melanoma. Main Outcomes and Measures Incident first or second primary melanoma diagnosis, and histologic and clinical characteristics thereof. The Wei-Lin-Weissfeld model for recurrent events was used to estimate the association of each factor with the risks of first and second primary melanoma. Results A total of 38 845 patients (mean [SD] age at baseline, 56.1 [8.2] years; 17 775 men and 21 070 women) were included in the study. During a median follow-up period of 7.4 years, 1212 (3.1%) participants had a single primary melanoma diagnosis, and 245 (0.6%) had a second primary melanoma diagnosis. Second melanomas were more likely than first melanomas to be in situ; for invasive tumors, second melanomas were more likely to be thin (ie, ≤1 mm) than first melanomas. Having many moles at age 21 years (self-reported using visual scoring tool) was more strongly associated with second (hazard ratio [HR], 6.36; 95% CI, 3.77-10.75) than first primary melanoma (HR, 3.46; 95% CI, 2.72-4.40) (P value for difference between the HRs = .01). A high genetic predisposition (ie, polygenic risk score in tertile 3) was also more strongly associated with second (HR, 3.28; 95% CI, 2.06-5.23) than first melanoma (HR, 2.06; 95% CI, 1.71-2.49; P = .03). Second melanomas were more strongly associated with a history of multiple skin cancer excisions (HR, 2.63; 95% CI, 1.80-3.83) than first melanomas (HR, 1.86; 95% CI, 1.61-2.16; P = .05). For all other phenotypic characteristics and sun exposure measures, similarly elevated associations with first vs second melanomas were observed. Conclusions and Relevance Findings of this cohort study suggest that within the general population, the presence of many nevi and having a high genetic predisposition to melanoma were associated with the highest risks of developing second primary melanomas.
Collapse
Affiliation(s)
- Catherine M. Olsen
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Nirmala Pandeya
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Jean Claude Dusingize
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Rachel E. Neale
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Stuart MacGregor
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Matthew H. Law
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Faculty of Health, Queensland University of Technology, Queensland, Australia
- School of Biomedical Sciences, University of Queensland, Queensland, Australia
| | - David C. Whiteman
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Faculty of Medicine, University of Queensland, Queensland, Australia
| |
Collapse
|
11
|
Blazek K, Furestad E, Ryan D, Damian D, Fernandez-Penas P, Tong S. The impact of skin cancer prevention efforts in New South Wales, Australia: Generational trends in melanoma incidence and mortality. Cancer Epidemiol 2022; 81:102263. [PMID: 36174452 DOI: 10.1016/j.canep.2022.102263] [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: 04/26/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND In Australia, skin cancer awareness campaigns have focused on raising the awareness and consequences of skin cancer and highlighting the importance of utilising sun protection. METHODS Trends in melanoma incidence and mortality have been explored elsewhere in Australia and this study sought to examine the trends in NSW. Anonymised incidence and mortality data for in situ and invasive melanoma from 1988 to 2014 were obtained from the NSW Cancer Registry. Trends of melanoma incidence and mortality were analysed using segmented regression to allow for changes over time. Birth cohort patterns were assessed using age-period-cohort models. RESULTS Over the period, incidence of in situ melanoma increased in all age groups although the rates were lowest in those under 40 years of age. Incidence of invasive melanoma was either stable or decreased in people under 60, while it increased in those aged 60 and above, particularly in men. Age-period-cohort analysis revealed decreasing age-specific incidence of invasive melanoma under 40 years of age. Melanoma mortality over the period was stable or decreased in all groups except in men aged 60 or over. Overall, mortality rates generally declined or remained stable particularly in recent years. CONCLUSION It is encouraging that rates of invasive melanoma are declining in the younger age cohorts - which could be attributed to both primary prevention efforts with individuals protecting their skin as well as early detection through self assessment and clinician performed skin checks. In addition, whilst it is important to monitor the increasing rates of in situ melanoma, the increase is likely due to early detection and treatment of melanoma that could have progressed to invasive melanoma and therefore detection whilst still in situ is an improved outcome. Overall, the results demonstrate the need to continue to improve the understanding of and compliance with primary skin cancer prevention measures in order to reduce population UVR exposure and overall melanoma incidence.
Collapse
Affiliation(s)
- Katrina Blazek
- Cancer Institute NSW, Sydney, NSW, Australia; NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia.
| | | | - David Ryan
- Melanoma Institute of Australia, Sydney, NSW, Australia.
| | - Diona Damian
- Melanoma Institute of Australia, Sydney, NSW, Australia; Sydney Medical School, the University of Sydney, Sydney, NSW, Australia; Dermatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Pablo Fernandez-Penas
- Sydney Medical School, the University of Sydney, Sydney, NSW, Australia; Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia.
| | | |
Collapse
|
12
|
Calvache Ruales MF, Westerhausen S, Zapata Gallo HA, Strehl B, Naza Guzman SD, Versteeg H, Stöppelmann W, Wittlich M. UVR Exposure and Prevention of Street Construction Workers in Colombia and Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127259. [PMID: 35742508 PMCID: PMC9223545 DOI: 10.3390/ijerph19127259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 12/10/2022]
Abstract
(1) Solar ultraviolet radiation (UVR) poses a major risk factor for developing skin cancer after years of chronic exposure. The irradiation is strongly dependent upon the activity or occupation carried out, but also on the climate conditions at the workplace. Knowledge of both has been tested within the occupational group of road construction workers in Colombia and Germany. (2) The GENESIS-UV measurement system has been used at both locations for consistency. A number of workers in both countries wore an electronic data logging dosimeter for several months to deliver detailed information on UVR exposure. (3) It was found that in a tropical climate, UVR exposure remains constant throughout the year, while in a temperate climate seasonal effects are visible, superimposed by behavioural aspects e.g., in springtime. The daily distribution of the radiation shows a distinct dip, especially in the Colombian data. Derived data show the high fraction of working days exceeding a threshold set by the skin type. (4) Road construction work involves high UVR exposure. In both countries, preventive measures are required to reduce the personal exposure to a minimum. Exceedance of the minimal erythema dose (MED) suggests a possible enhancing effect, especially in fair skinned people. Intercomparison of UVR exposure at workplaces is possible between countries and climate zones, emphasizing efforts for global action against skin cancer.
Collapse
Affiliation(s)
| | - Stephan Westerhausen
- Department of Ergonomics: Physical Environmental Factors, Institute for Occupational Safety and Health of the German Social Accident Insurance, D-53757 Sankt Augustin, Germany;
| | | | - Benjamin Strehl
- Department Accident Prevention: Digitalisation—Technologies, Institute for Occupational Safety and Health of the German Social Accident Insurance, D-53757 Sankt Augustin, Germany;
| | - Sergio D. Naza Guzman
- Risk Management Consultancy CGR, SURA, Cali 760046, Colombia; (M.F.C.R.); (S.D.N.G.)
| | - Helmut Versteeg
- Department Exposure and Risk Assessment, Institute for Occupational Safety and Health of the German Social Accident Insurance, D-53757 Sankt Augustin, Germany; (H.V.); (W.S.)
| | - Wiho Stöppelmann
- Department Exposure and Risk Assessment, Institute for Occupational Safety and Health of the German Social Accident Insurance, D-53757 Sankt Augustin, Germany; (H.V.); (W.S.)
| | - Marc Wittlich
- Department Accident Prevention: Digitalisation—Technologies, Institute for Occupational Safety and Health of the German Social Accident Insurance, D-53757 Sankt Augustin, Germany;
- Correspondence: ; Tel.: +49-(0)30-13001-3500
| |
Collapse
|
13
|
Hughes MCB, Malt M, Khosrotehrani K, Smithers BM, Green AC. Diet quality is associated with primary melanoma thickness. J Eur Acad Dermatol Venereol 2022; 36:1745-1750. [PMID: 35462440 PMCID: PMC9544655 DOI: 10.1111/jdv.18174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Background Objective Methods Results Conclusions
Collapse
Affiliation(s)
- MCB Hughes
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
| | - M Malt
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
| | - K Khosrotehrani
- Experimental Dermatology Group The University of Queensland Diamantina Institute Brisbane Australia
- Department of Dermatology, Princess Alexandra Hospital Brisbane Australia
| | - BM Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital The University of Queensland Australia
| | - AC Green
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| |
Collapse
|
14
|
Gaudy-Marqueste C, Macagno N, Loundou A, Pellegrino E, Ouafik L, Budden T, Mundra P, Gremel G, Akhras V, Lin L, Cook M, Kumar R, Grob JJ, Nagore E, Marais R, Virós A. Molecular characterization of fast-growing melanomas. J Am Acad Dermatol 2022; 86:312-321. [PMID: 34280484 DOI: 10.1016/j.jaad.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The rate of growth of primary melanoma is a robust predictor of aggressiveness, but the mutational profile of fast-growing melanomas (FGMM) and the potential to stratify patients at high risk of death has not been comprehensively studied. OBJECTIVE To investigate the epidemiologic, clinical, and mutational profile of primary cutaneous melanomas with a thickness ≥ 1 mm, stratified by rate of growth. METHODS Observational prospective study. Deep-targeted sequencing of 40 melanoma driver genes on formalin fixed, paraffin-embedded primary melanoma samples. Comparison of FGMM (rate of growth > 0.5 mm/month) and nonFGMM (rate of growth ≤ 0.5 mm/month). RESULTS Two hundred patients were enrolled, among wom 70 had FGMM. The relapse-free survival was lower in the FGMM group (P = .014). FGMM had a higher number of predicted deleterious mutations within the 40 genes than nonFGMM (P = .033). Ulceration (P = .032), thickness (P = .006), lower sun exposure (P = .049), and fibroblast growth factor receptor 2 (FGFR2) mutations (P = .037) were significantly associated with fast growth. LIMITATIONS Single-center study, cohort size, potential memory bias, number of investigated genes. CONCLUSION Fast growth is linked to specific tumor biology and environmental factors. Ulceration, thickness, and FGFR2 mutations are associated with fast growth. Screening for FGFR2 mutations might provide an additional tool to better identify FGMM, which are probably good candidates for adjuvant therapies.
Collapse
Affiliation(s)
- Caroline Gaudy-Marqueste
- Aix Marseille University, Assistance Publique des Hopitaux de Marseille, Centre de Recherche en Cancérologie de Marseille Insitut National de la Santé Et de la Recherche Médicale U1068, Centre National de la Recherche Scientifique U7258, Centre Hospitalo-Universitaire Timone, Dermatology and Skin Cancer Department, Marseille, France.
| | - Nicolas Macagno
- Aix Marseille University, Assistance Publique des Hopitaux de Marseille, Insitut National de la Santé Et de la Recherche Médicale, Marseille Medical Genetics, Centre Hospitalo-Universitaire Timone, Department of Pathology, Marseille, France
| | - Anderson Loundou
- Aix Marseille University, Santé Publique et Maladie Chroniques EA3279, Clinical Research Unit, Department of Public Health, Marseille, France
| | - Eric Pellegrino
- Aix Marseille Univ, Assistance Publique des Hopitaux de Marseille, Centre National de la Recherche Scientifique, Institute of NeuroPhysiopathology, Faculté de Médecine Secteur Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - L'houcine Ouafik
- Aix Marseille Univ, Assistance Publique des Hopitaux de Marseille, Centre National de la Recherche Scientifique, Institute of NeuroPhysiopathology, Faculté de Médecine Secteur Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Timothy Budden
- Skin Cancer and Ageing Lab, Cancer Research United Kingdom Manchester Institute, The University of Manchester, Manchester, United Kingdom
| | - Piyushkumar Mundra
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Gabriela Gremel
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Victoria Akhras
- Department of Dermatology, St. George's National Health Service Foundation Trust, London, United Kingdom
| | - Lijing Lin
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Martin Cook
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Rajiv Kumar
- Division of Functional Genome Analysis, German Cancer Research Center, Heidelberg, Germany
| | - Jean-Jacques Grob
- Aix Marseille University, Assistance Publique des Hopitaux de Marseille, Centre de Recherche en Cancérologie de Marseille Insitut National de la Santé Et de la Recherche Médicale U1068, Centre National de la Recherche Scientifique U7258, Centre Hospitalo-Universitaire Timone, Dermatology and Skin Cancer Department, Marseille, France
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano Oncología, València, Spain
| | - Richard Marais
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Amaya Virós
- Skin Cancer and Ageing Lab, Cancer Research United Kingdom Manchester Institute, The University of Manchester, Manchester, United Kingdom.
| |
Collapse
|
15
|
Regional variability of melanoma incidence and prevalence in Hungary. Epidemiological impact of ambient UV radiation and socioeconomic factors. Eur J Cancer Prev 2021; 31:377-384. [PMID: 34545023 DOI: 10.1097/cej.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidence of cutaneous melanoma has risen faster than almost any other type of cancer in the last 50 years. Ultraviolet (UV) radiation and genetic susceptibility are the most important risk factors. OBJECTIVE We aimed to determine the epidemiologic indicators of melanoma in Hungary, a country with an estimated population of 9.8 million and an area of 93 030 km2. METHODS Anonymized patient records from the National Health Insurance Fund Management covering the entire population were used to determine the incidence and prevalence of melanoma in the counties of Hungary from 2013 to 2017. Altogether 20 030 melanoma cases were identified for inclusion in this study. RESULTS The prevalence of melanoma increased over the investigated period and was significantly higher among women than men. The incidence of melanoma stagnated during this period and the incidence rate was the highest among the elderly. Interestingly, the incidence was higher in males in the elderly population, while the incidence was higher in females in the younger (<60 years) population. Geographical variations in ambient UV radiation did not show statistically significant correlation with the regional variability of epidemiologic indicators, probably due to small differences in the number of bright sunshine hours per year between regions. Although Hungary is a relatively small country, we observed regional heterogeneity in socioeconomic factors. Notably, a significant and strong negative correlation was found between single-person household rates and melanoma prevalence. CONCLUSION In addition to ambient UV radiation, melanoma incidence and prevalence appear to be related to age, gender and socioeconomic factors.
Collapse
|
16
|
Guitera P, Menzies SW, Coates E, Azzi A, Fernandez-Penas P, Lilleyman A, Badcock C, Schmid H, Watts CG, Collgros H, Liu R, van Kemenade C, Mann GJ, Cust AE. Efficiency of Detecting New Primary Melanoma Among Individuals Treated in a High-risk Clinic for Skin Surveillance. JAMA Dermatol 2021; 157:521-530. [PMID: 33729464 DOI: 10.1001/jamadermatol.2020.5651] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance A previous single-center study observed fewer excisions, lower health care costs, thinner melanomas, and better quality of life when surveillance of high-risk patients was conducted in a melanoma dermatology clinic with a structured surveillance protocol involving full-body examinations every 6 months aided by total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI). Objective To examine longer-term sustainability and expansion of the surveillance program to numerous practices, including a primary care skin cancer clinic setting. Design, Setting, and Participants This prospective cohort study recruited 593 participants assessed from 2012 to 2018 as having very high risk of melanoma, with a median of 2.9 years of follow-up (interquartile range, 1.9-3.3 years), from 4 melanoma high-risk clinics (3 dermatology clinics and 1 primary care skin cancer clinic) in New South Wales, Australia. Data analyses were conducted from February to September 2020. Exposures Six-month full-body examination with the aid of TBP and SDDI. For equivocal lesions, the clinician performed SDDI at 3 or 6 months. Main Outcomes and Measures All suspect monitored or excised lesions were recorded, and pathology reports obtained. Outcomes included the incidence and characteristics of new lesions and the association of diagnostic aids with rates of new melanoma detection. Results Among 593 participants, 340 (57.3%) were men, and the median age at baseline was 58 years (interquartile range, 47-66 years). There were 1513 lesions excised during follow-up, including 171 primary melanomas. The overall benign to malignant excision ratio, including keratinocyte carcinomas, was 0.8:1.0; the benign melanocytic to melanoma excision ratio was 2.4:1.0; and the melanoma in situ to invasive melanoma ratio was 2.2:1.0. The excision ratios were similar across the 4 centers. The risk of developing a new melanoma was 9.0% annually in the first 2 years and increased with time, particularly for those with multiple primary melanomas. The thicker melanomas (>1-mm Breslow thickness; 7 of 171 melanomas [4.1%]) were mostly desmoplastic or nodular (4 of 7), self-detected (2 of 7), or clinician detected without the aid of TBP (3 of 7). Overall, new melanomas were most likely to be detected by a clinician with the aid of TBP (54 of 171 [31.6%]) followed by digital dermoscopy monitoring (50 of 171 [29.2%]). Conclusions and Relevance The structured surveillance program for high-risk patients may be implemented at a larger scale given the present cohort study findings suggesting the sustainability and replication of results in numerous settings, including a primary care skin cancer clinic.
Collapse
Affiliation(s)
- Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Elliot Coates
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Pablo Fernandez-Penas
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Alister Lilleyman
- Newcastle Skin Check, Newcastle, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Caro Badcock
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helen Schmid
- Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Caroline G Watts
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helena Collgros
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rose Liu
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Clinical School, The University of Sydney, Sydney, Australia
| | | | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
17
|
Kittler H. Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma. Dermatol Pract Concept 2021; 11:e2021163S. [PMID: 34447612 DOI: 10.5826/dpc.11s1a163s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/31/2022] Open
Abstract
The conventional narrative states that the steadily rising incidence of melanoma among fair-skinned Caucasian populations during the last decades is caused by excessive UV-exposure. There is, however, no doubt that other factors had a significant impact on the rising incidence of melanoma. Pre-1980s the clinical diagnosis of melanoma was based on gross criteria such as ulceration or bleeding. Melanomas were often diagnosed in advanced stages when the prognosis was grim. In the mid-1980s education campaigns such as the propagation of the ABCD criteria, which addressed health care professionals and the public alike, shifted the focus towards early recognition. Dermatoscopy, which became increasingly popular in the mid-1990s, improved the accuracy for the diagnosis of melanoma in comparison to inspection with the unaided eye, especially for flat and small lesions lacking ABCD criteria. At the same time, pathologists began to lower their thresholds, particularly for the diagnosis of melanoma in situ. The melanoma epidemic that followed was mainly driven by an increase in the number of in situ or microinvasive melanomas. In a few decades, the landscape shifted from an undercalling to an overcalling of melanomas, a development that is now met with increased criticism. The gold standard of melanoma diagnosis is still conventional pathology, which is faced with low to moderate interobserver agreement. New insights in the molecular landscape of melanoma did not translate into techniques for the reliable diagnosis of gray zone lesions including small lesions. The aim of this review is to put our current view of melanoma diagnosis in historical context and to provide a narrative synthesis of its evolution. Based on this narrative I will provide suggestions on how to rebuild the trust in melanoma diagnosis accuracy and in the benefit of early recognition.
Collapse
Affiliation(s)
- Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
18
|
Jimenez Balcells C, Hay J, Keir J, Rosendahl N, Coetzer-Botha M, Wilson T, Clark S, Baade A, Becker C, Bookallil L, Clifopoulos C, Dicker T, Denby MP, Duthie D, Elliott C, Fishburn P, Foley M, Franck M, Giam I, Gordillo P, Lilleyman A, Macauley R, Maher J, McPhee E, Reid M, Shirlaw B, Siggs G, Spark R, Stretch J, van den Heever K, van Rensburg T, Watson C, Kittler H, Rosendahl C. Characteristics of 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database. Australas J Dermatol 2021; 62:496-503. [PMID: 34423846 DOI: 10.1111/ajd.13705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined. PATIENTS AND METHODS Six hundred and thirty-seven melanomas treated by 27 Australasian GPs during 2013 and documented on the Skin Cancer Audit Research Database (SCARD) were analysed by anatomical site, subtype, Breslow thickness, diameter, associated naevi and linked adverse outcomes. RESULTS Most melanomas (59.7%) were on males, mean age at diagnosis being 62.7 years (range 18-96). Most (65.0%) were in situ, with a high incidence of lentiginous melanoma (LM) (38.8%) and 32% were naevus associated. Most LM (86.4%) were in situ, compared to 55% of superficial spreading melanoma (SSM) (P < 0.0001). There was male predominance on the head, neck and trunk and female predominance on extremities. There was no significant association between Breslow thickness and diameter, with small melanomas as likely to be thick as large melanomas, and melanomas ≤3 mm diameter, on average, more likely to be invasive than larger melanomas. There was a positive correlation between age and both melanoma diameter and Breslow thickness. Seven cases progressed to melanoma-specific death: Five nodular melanoma (NM) and two SSM, one of which was thin (Breslow thickness 0.5 mm). CONCLUSIONS A large series of melanomas treated by Australasian GPs were predominantly in situ, with a high proportion of LM subtype. With implications for GP training, NM linked to death was over-represented and there was a novel finding that older patients had larger diameter melanomas.
Collapse
Affiliation(s)
| | - Jeremy Hay
- Upper Hutt Skin Clinic, Upper Hutt, Wellington, New Zealand
| | - Jeff Keir
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Nikita Rosendahl
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Martelle Coetzer-Botha
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | | | - Simon Clark
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,Tehran University of Medical Sciences, Tehran, Iran.,Douglas Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Astrid Baade
- Gladstone GP Superclinic, Gladstone, QLD, Australia
| | - Cath Becker
- Wairarapa Skin Clinic, Masterton, New Zealand.,Wairarapa Hospital, Lansdowne, Masterton, New Zealand
| | | | - Chris Clifopoulos
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Tony Dicker
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | | | | | | | - Paul Fishburn
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Mark Foley
- The Skin Clinic, Marlborough - Blenheim, New Zealand
| | - Mark Franck
- MoleSafe Skin Cancer Clinic, Windsor, VIC, Australia
| | | | | | | | | | - James Maher
- Skin Cancer Ballarat, Alfredton, VIC, Australia
| | - Ewen McPhee
- Emerald Medical Group, Emerald, QLD, Australia
| | - Michael Reid
- Nelson Bay Skin Cancer Clinic, Nelson Bay, NSW, Australia
| | - Bob Shirlaw
- Lakeside Medical, Springfield Lakes, QLD, Australia
| | - Graeme Siggs
- Regency Medical Clinic, Sefton Park, SA, Australia
| | - Robert Spark
- Toukley Family Practice, Toukley, NSW, Australia
| | | | | | | | | | - Harald Kittler
- Vienna Dermatologic Imaging Research Group, Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Cliff Rosendahl
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Wright CL, Miller ED, Contreras C, Knopp MV. Precision Nuclear Medicine: The Evolving Role of PET in Melanoma. Radiol Clin North Am 2021; 59:755-772. [PMID: 34392917 DOI: 10.1016/j.rcl.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The clinical management of melanoma patients has been rapidly evolving with the introduction of new targeted immuno-oncology (IO) therapeutics. The current diagnostic paradigms for melanoma patients begins with the histopathologic confirmation of melanoma, initial staging of disease burden with imaging and surgical approaches, treatment monitoring during systemic cytotoxic chemotherapy or IO therapeutics, restaging after completion of adjuvant systemic, surgical, and/or external radiation therapy, and the detection of recurrent malignancy/metastatic disease following therapy. New and evolving imaging approaches with positron-emission tomography (PET) imaging technologies, imaging methodologies, image reconstruction, and image analytics will likely continue to improve tumor detection, tumor characterization, and diagnostic confidence, enabling novel precision nuclear medicine practices for managing melanoma patients. This review will examine current concepts and challenges with existing PET imaging diagnostics for melanoma patients and introduce exciting new opportunities for PET in the current era of IO therapeutics.
Collapse
Affiliation(s)
- Chadwick L Wright
- Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 460, Columbus, OH 43210, USA.
| | - Eric D Miller
- Department of Radiation Oncology, James Cancer Center, The Ohio State University Wexner Medical Center, 460 W. 10th Avenue, 2nd Floor, Columbus, OH 43210, USA
| | - Carlo Contreras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, 2050 Kenny Road, Tower 4th Floor, Columbus, OH 43221, USA
| | - Michael V Knopp
- Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 460, Columbus, OH 43210, USA
| |
Collapse
|
20
|
A Randomized Trial of Precision Prevention Materials to Improve Primary and Secondary Melanoma Prevention Activities among Individuals with Limited Melanoma Risk Phenotypes. Cancers (Basel) 2021; 13:cancers13133143. [PMID: 34201795 PMCID: PMC8267659 DOI: 10.3390/cancers13133143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Inherited genetic variation at the MC1R gene is associated with increased risk of melanoma among non-Hispanic whites (NHWs), especially among those with skin and pigmentation characteristics that are associated with average to lower melanoma risk, for whom MC1R genetic testing may reveal unrecognized melanoma risk. We conducted a randomized trial to examine whether providing MC1R genetic risk information together with precision prevention materials would increase primary and secondary melanoma preventive behaviors compared to providing generic prevention materials only. We found that among participants with MC1R variants associated with higher risk of melanoma, the intervention increased shade-seeking or using an umbrella, increased wearing sleeved shirts, and decreased sunburns among their young children. We conclude that MC1R genetic testing and precision prevention materials may increase the practice of some sun-protective behaviors. Abstract Inherited variation at MC1R is associated with elevated melanoma risk among non-Hispanic whites (NHWs). MC1R genetic testing may unmask previously unrecognized disease risk, especially among individuals with few melanoma phenotypic risk factors. We recruited NHW individuals with limited phenotypic risk factors from two primary care clinics in west-central Florida. Participants (n = 1134) were randomized within MC1R genotype risk group (average/higher) to receive mailed precision prevention (i.e., intervention) or generic prevention materials. Participants reported hours of weekday and weekend sun exposure, frequency of intentional outdoor tanning and sun protection behaviors, number of sunburns, indoor tanning episodes, and skin examinations at baseline, and after 6 and 12 months. Among MC1R higher-risk participants, the intervention increased the likelihood of often or always wearing a shirt with sleeves (OR = 1.49, p = 0.03) and seeking shade or using an umbrella (OR = 1.42, p = 0.046), and it decreased the number of sunburns among their young children (β = −0.13, p = 0.03). Intervention effects were not noted among MC1R average-risk participants. Moderation analyses identified intervention effects within subgroups in average-risk and higher-risk participants. Precision prevention information conveying MC1R testing results can increase the practice of some sun protection behaviors among at-risk individuals with limited melanoma risk phenotypes and may provide a cross-generational tool to counteract increasing incidence of melanoma.
Collapse
|
21
|
El Sharouni MA, Varey AHR, Witkamp AJ, Ahmed T, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, Lo SN, van Gils CH. Predicting sentinel node positivity in patients with melanoma: external validation of a risk-prediction calculator (the Melanoma Institute Australia nomogram) using a large European population-based patient cohort. Br J Dermatol 2021; 185:412-418. [PMID: 33657653 DOI: 10.1111/bjd.19895] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A nomogram to predict sentinel node (SN) positivity [the Melanoma Institute Australia (MIA) nomogram] was recently developed and externally validated using two large single-institution databases. However, there remains a need to further validate the nomogram's performance using population-based data. OBJECTIVES To perform further validation of the nomogram using a European national patient cohort. METHODS Patients with cutaneous melanoma who underwent SN biopsy in the Netherlands between 2000 and 2014 were included. Their data were obtained from the Dutch Pathology Registry. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. Negative predictive values (NPVs) were calculated at various predicted probability cutoffs. RESULTS Of the 3049 patients who met the eligibility criteria, 23% (691) were SN positive. Validation of the MIA nomogram (including the parameters Breslow thickness, ulceration, age, melanoma subtype and lymphovascular invasion) showed a good C-statistic of 0·69 (95% confidence interval 0·66-0·71) with excellent calibration (R2 = 0·985, P = 0·40). The NPV of 90·1%, found at a 10% predicted probability cutoff for having a positive SN biopsy, implied that by using the nomogram, a 16·3% reduction in the rate of performing an SN biopsy could be achieved with an error rate of 1·6%. Validation of the MIA nomogram considering mitotic rate as present or absent showed a C-statistic of 0·70 (95% confidence interval 0·68-0·74). CONCLUSIONS This population-based validation study in European patients with melanoma confirmed the value of the MIA nomogram in predicting SN positivity. Its use will spare low-risk patients the inconvenience, cost and potential risks of SN biopsy while ensuring that high-risk patients are still identified.
Collapse
Affiliation(s)
- M A El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - V Sigurdsson
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - R A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
22
|
School-based interventions to improve sun-safe knowledge, attitudes and behaviors in childhood and adolescence: A systematic review. Prev Med 2021; 146:106459. [PMID: 33609617 DOI: 10.1016/j.ypmed.2021.106459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Ultraviolet radiation exposure is the leading cause of skin cancer, and childhood and adolescence is a particularly susceptible life period for exposure. This systematic review assessed whether interventions in elementary and secondary school settings reduced sun exposure, sunburns, and development of melanocytic nevi, and improved sun-safe knowledge, attitudes and sun protection behaviors in childhood and adolescence. A systematic search up to June 2020 of MEDLINE, Embase, CINAHL, Cochrane and ProQuest databases was undertaken, for studies conducted among students in an elementary or secondary school setting that compared an intervention group with a pre-intervention or separate control group. Data were summarized using qualitative synthesis. Pooled effects from meta-analysis with random effects were also reported where appropriate. Sixty-five studies were included (22 randomized, 43 non-randomized). Most studies assessed measures of sun-safe behaviors, knowledge and attitudes (57, 48 and 33 studies, respectively), and observed improved sun protection behaviors and sun-safe knowledge, whereas few studies reduced time in the sun. About half improved participants' attitudes towards tanning desirability. Sunburns and nevus counts were less frequently assessed, but about half of these studies observed a reduction. There was substantial heterogeneity for outcomes except attitudes towards the desirability of tanning (pooled odds ratio from 6 studies: 0.81, 95% confidence interval 0.70-0.94). Key positive intervention features included: elementary school settings, interactive features or multiple components, and incorporating social norm influences. Most studies were classified at high risk of bias. In conclusion, school-based sun-related interventions had positive impacts on behaviors and attitudes among elementary and secondary school children.
Collapse
|
23
|
Nguyen J, Ting S, Paul E, Smith AL, Watts CG, Kelly J, Cust AE, Mar V. Diagnostic tools used for melanoma: A survey of Australian general practitioners and dermatologists. Australas J Dermatol 2021; 62:300-309. [PMID: 33860932 DOI: 10.1111/ajd.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND/OBJECTIVE Diagnostic tools such as dermoscopy, sequential digital dermoscopy imaging (SDDI), total body photography (TBP) and automated diagnostic tools are available to assist in early melanoma diagnosis. The use, accessibility and barriers of dermoscopy have been well studied; however, there are few similar studies regarding SDDI, TBP and automated diagnostic tools. We aim to understand the use of these diagnostic aids amongst Australian general practitioners (GPs) and dermatologists. METHODS Between June 2019 and January 2020, GPs and dermatologists across Australia were invited to participate in an online survey. Surveys were distributed through GP and dermatology organisations. RESULTS A total of 227 survey responses were received, 175 from GPs and 52 from dermatologists. Amongst GPs, 44.6% worked in a skin cancer clinic. Dermoscopy was used at least occasionally by 98.9% of all GPs. SDDI was used by 93.6% of skin cancer GPs, 80.8% of dermatologists and 45.3% of generalist GPs. TBP was used or recommended by 77.1% of generalist GPs, 82.3% of skin cancer GPs and 86.5% of dermatologists. The most common barriers to the use of TBP were cost, limited accessibility, poor patient compliance, and time required for both patients and doctors. Very few clinicians reported using automated diagnostic tools. There was an interest in future diagnostic aids for melanoma in 88% of GPs and dermatologists. CONCLUSION Dermoscopy, SDDI and TBP were commonly used by responding Australian skin cancer GPs and dermatologists in this survey. Automated diagnostic tools were not reported to be used routinely. Several barriers were identified for use of TBP.
Collapse
Affiliation(s)
- Jennifer Nguyen
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sarajane Ting
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,The Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea L Smith
- Macquarie University, Sydney, New South Wales, Australia
| | - Caroline G Watts
- The Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
| | - John Kelly
- The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anne E Cust
- The Sydney School of Public Health and Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Williams GJ, Webster AC, Thompson JF. Organ transplantation and outcomes in patients with a past history of melanoma: A systematic review and meta-analysis. Clin Transplant 2021; 35:e14287. [PMID: 33720403 DOI: 10.1111/ctr.14287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The incidence of melanoma is steadily rising around the world. There is uncertainty about the safety of solid organ transplantation in patients with a prior history of melanoma. AIM To review studies reporting patients with a history of melanoma before solid organ transplantation. METHODS Electronic searches of Medline, Embase, and the Cochrane library up to March 2020. All study designs, in any language and without sample size restriction, were eligible for inclusion. Risk of bias was assessed using established tools, and meta-analysis was performed using a random-effects model. RESULTS We identified 41 studies reporting 703 100 transplant recipients and 1692 had pre-transplantation melanomas. Risk of death, expressed as a hazard ratio, in patients with pre-transplantation melanoma relative to those without prior melanoma, was 1.32 (95% CI: 1.09-1.59). After transplantation, 13.1% of patients with pre-transplantation melanoma developed new or recurrent melanoma (IQR: 4.8%-18.2%). CONCLUSIONS Around 1-in-400 transplant recipients had a prior history of melanoma. This was associated with a greater than 1-in-10 risk of new or recurrent melanoma after transplantation and an increased risk of death. A 5-year waiting time between a melanoma diagnosis and transplantation has been recommended based on historic registry data, but very little additional information is available to justify or revise this.
Collapse
Affiliation(s)
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
25
|
Esse S, Mason KJ, Green AC, Warren RB. Melanoma Risk in Patients Treated With Biologic Therapy for Common Inflammatory Diseases: A Systematic Review and Meta-analysis. JAMA Dermatol 2021; 156:787-794. [PMID: 32432649 DOI: 10.1001/jamadermatol.2020.1300] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Biologic therapies are widely prescribed immunomodulatory agents. There are concerns that compared with treatment with conventional systemic therapy, long-term biologic treatment for common immune-mediated inflammatory diseases, namely inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis, may be associated with increased risk of melanoma. Objective To examine whether biologic treatment of IBD, RA, or psoriasis is associated with an increased risk of melanoma compared with conventional systemic therapy. Data Sources Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published from January 1, 1995, to February 7, 2019, for eligible studies. Study Selection Randomized clinical trials, cohort studies, and nested case-control studies quantifying the risk of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with patients treated with conventional systemic therapy were included. Data Extraction and Synthesis Two reviewers independently extracted key study characteristics and outcomes. Study-specific risk estimates were pooled, and random- and fixed-effects model meta-analyses were conducted. Heterogeneity was assessed using the I2 statistic. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Main Outcomes and Measures The pooled relative risk (pRR) of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with biologic-naive patients treated with conventional systemic therapy. Results Seven cohort studies comprising 34 029 biologic-treated patients and 135 370 biologic-naive patients treated with conventional systemic therapy were eligible for inclusion. Biologic treatment was positively associated with melanoma in patients with IBD (pRR, 1.20; 95% CI, 0.60-2.40), RA (pRR, 1.20; 95% CI, 0.83-1.74), or psoriasis (hazard ratio, 1.57; 95% CI, 0.61-4.09) compared with those who received conventional systemic therapy, but the differences were not statistically significant. Adjustment for other risk factors was absent from most studies. Conclusions and Relevance The findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence. However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.
Collapse
Affiliation(s)
- Shamarke Esse
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom.,Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Kayleigh J Mason
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Adele C Green
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom.,QIMR Berghofer Medical Research Institute, Brisbane, New South Wales, Australia.,Cancer Research UK Manchester Institute, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Richard B Warren
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
26
|
Fidrus E, Hegedűs C, Janka EA, Paragh G, Emri G, Remenyik É. Inhibitors of Nucleotide Excision Repair Decrease UVB-Induced Mutagenesis-An In Vitro Study. Int J Mol Sci 2021; 22:ijms22041638. [PMID: 33562002 PMCID: PMC7915687 DOI: 10.3390/ijms22041638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
The high incidence of skin cancers in the Caucasian population is primarily due to the accumulation of DNA damage in epidermal cells induced by chronic ultraviolet B (UVB) exposure. UVB-induced DNA photolesions, including cyclobutane–pyrimidine dimers (CPDs), promote mutations in skin cancer driver genes. In humans, CPDs are repaired by nucleotide excision repair (NER). Several commonly used and investigational medications negatively influence NER in experimental systems. Despite these molecules’ ability to decrease NER activity in vitro, the role of these drugs in enhancing skin cancer risk is unclear. In this study, we investigated four molecules (veliparib, resveratrol, spironolactone, and arsenic trioxide) with well-known NER-inhibitory potential in vitro, using UVB-irradiated CHO epithelial and HaCaT immortalized keratinocyte cell lines. Relative CPD levels, hypoxanthine phosphoribosyltransferase gene mutation frequency, cell viability, cell cycle progression, and protein expression were assessed. All four molecules significantly elevated CPD levels in the genome 24 h after UVB irradiation. However, veliparib, spironolactone, and arsenic trioxide reduced the mutagenic potential of UVB, while resveratrol did not alter UVB-induced mutation formation. UVB-induced apoptosis was enhanced by spironolactone and arsenic-trioxide treatment, while veliparib caused significantly prolonged cell cycle arrest and increased autophagy. Spironolactone also enhanced the phosphorylation level of mammalian target of rapamycin (mTOR), while arsenic trioxide modified UVB-driven mitochondrial fission. Resveratrol induced only mild changes in the cellular UVB response. Our results show that chemically inhibited NER does not result in increased mutagenic effects. Furthermore, the UVB-induced mutagenic potential can be paradoxically mitigated by NER-inhibitor molecules. We identified molecular changes in the cellular UVB response after NER-inhibitor treatment, which may compensate for the mitigated DNA repair. Our findings show that metabolic cellular response pathways are essential to consider in evaluating the skin cancer risk–modifying effects of pharmacological compounds.
Collapse
Affiliation(s)
- Eszter Fidrus
- Department of Dermatology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, 4032 Debrecen, Hungary; (E.F.); (C.H.); (E.A.J.); (G.E.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Csaba Hegedűs
- Department of Dermatology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, 4032 Debrecen, Hungary; (E.F.); (C.H.); (E.A.J.); (G.E.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Eszter Anna Janka
- Department of Dermatology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, 4032 Debrecen, Hungary; (E.F.); (C.H.); (E.A.J.); (G.E.)
| | - György Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, 665 Elm St, Buffalo, NY 14203, USA;
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, 665 Elm St, Buffalo, NY 14203, USA
| | - Gabriella Emri
- Department of Dermatology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, 4032 Debrecen, Hungary; (E.F.); (C.H.); (E.A.J.); (G.E.)
| | - Éva Remenyik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei Krt, 4032 Debrecen, Hungary; (E.F.); (C.H.); (E.A.J.); (G.E.)
- Correspondence: ; Tel.: +36-52-412-345
| |
Collapse
|
27
|
Thrift AP, Gudenkauf FJ. Melanoma Incidence Among Non-Hispanic Whites in All 50 US States From 2001 Through 2015. J Natl Cancer Inst 2021; 112:533-539. [PMID: 31346623 DOI: 10.1093/jnci/djz153] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/13/2019] [Accepted: 07/16/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The United States has large regional variation in primary prevention campaigns for skin cancer. We collected data from all 50 states to examine changes in melanoma incidence and performed age-period-cohort analyses to describe the simultaneous effects of age, period, and cohort on incidence rates. METHODS Annual melanoma incidence rates for non-Hispanic whites from 2001 to 2015 were extracted from the US Cancer Statistics registry. Secular trends were examined overall and by sex and state. We used joinpoint regression to compute annual percent change and average annual percent change and corresponding 95% confidence intervals (CIs). We also analyzed incidence trends by 5-year age group and birth cohort using incidence rate ratios and age-period-cohort modeling. RESULTS Melanoma incidence increased from 20.7 per 100 000 (95% CI = 20.5 to 20.9) in 2001 to 28.2 per 100 000 (95% CI = 28.0 to 28.5) in 2015, increasing by 3.90% (95% CI = 2.36% to 5.48%) annually between 2001 and 2005 and 1.68% (95% CI = 1.37% to 1.99%) annually from 2005 through 2015. The average annual percent change in melanoma incidence rates were similar for men (2.34%, 95% CI = 1.91 to 2.78) and women (2.25%, 95% CI = 1.60 to 2.91). Age-specific relative risk by birth cohort increased from circa 1921 to 1981 before decreasing. Compared with adults born circa 1956, those born circa 1991 had lower melanoma risk (incidence rate ratio = 0.85; 95% CI = 0.77 to 0.94). Geographic variation was observed; some states still have melanoma rates trending upwards in all birth cohorts. CONCLUSIONS The continued increase in melanoma incidence among non-Hispanic whites, particularly in states where rates continue to rise among recent and current birth cohorts, underscores the need for increased public health campaigns aimed at reducing sun exposure.
Collapse
Affiliation(s)
- Aaron P Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Franciska J Gudenkauf
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX.,University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| |
Collapse
|
28
|
Olsen CM, Thompson JF, Pandeya N, Whiteman DC. Evaluation of Sex-Specific Incidence of Melanoma. JAMA Dermatol 2020; 156:553-560. [PMID: 32211827 DOI: 10.1001/jamadermatol.2020.0470] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Men and women develop melanoma at different rates on different body sites, with variation across countries, but explanations for these disparities remain elusive. Objective To test whether observed differences in melanoma incidence between men and women vary by population, age, or anatomic site. Design Cross-sectional analysis of sex- and site-specific temporal trends in melanoma incidence over 3 decades was conducted for men and women diagnosed with invasive melanoma in the US (limited to white race), Canada, Australia, New Zealand, the UK, Sweden, Norway, and Denmark. Using cancer registry data, male to female incidence rate ratios (IRRs) were calculated overall and by anatomic site, and Joinpoint regression models were used to estimate the annual percentage rate changes in sex- and site-specific incidence in each population. Incidence rates were standardized to the US 2000 population. Data on the incidence between January 1, 1982, and December 31, 2015, were obtained; analysis was conducted from March 1 to October 15, 2019. Main Outcomes and Measures Male to female IRRs and annual percentage change in rates. Results Total melanoma incidence was higher in men than women in US individuals (limited to white race), Canada, Australia, and New Zealand, but not in Denmark, the UK, Norway, and Sweden. In all populations, men had higher rates of melanoma of the head and neck and trunk than women (male to female IRR >1), but lower melanoma rates on the lower limbs (ie, male to female IRR approximately 0.5). The male to female IRR increased log linearly with age, with excess melanomas in women younger than 45 years in all populations (eg, IRR for 20-24 y age group, 0.3 in Denmark and 0.7 in Australia), and excess melanomas in men older than 69 years (eg, IRR for 70-74 y age group, 1.1 in Denmark and 2.1 in the US white population). The age at which the melanoma incidence in men exceeded the melanoma incidence in women differed by population, being achieved the earliest in Australia (45-49 years) and latest in Denmark (65-69 years). Conclusions and Relevance In predominantly fair-skinned populations, melanoma incidence appears to differ systematically and consistently between men and women by age and anatomic site.
Collapse
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Nirmala Pandeya
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,The University of Queensland School of Public Health, Brisbane, Queensland, Australia
| | - David C Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
29
|
Green AC, Pandeya N, Morton S, Simonidis J, Whiteman DC. Early detection of melanoma in specialised primary care practice in Australia. Cancer Epidemiol 2020; 70:101872. [PMID: 33360359 DOI: 10.1016/j.canep.2020.101872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Primary care skin cancer clinics facilitate early treatment of melanoma in Australia. We investigated the clinical and histopathological features of melanomas diagnosed and treated in an established clinic in Brisbane. METHODS Retrospective audit of medical records of patients diagnosed with in situ or invasive primary cutaneous melanoma in a primary care clinic specializing in skin cancer, 2000-2017. Demographic and clinical data were standardly extracted by a medically-trained investigator. We used descriptive analyses to assess characteristics of patients and melanomas, and examine surgical management according to tumour thickness. RESULTS Of 380 patients (median age 57 years; 57 % male) newly diagnosed with 497 histologically-confirmed primary cutaneous melanomas, 369 were in situ and 128 invasive. Of the 369 in situ melanomas, 143 (39 %) were on the trunk and 87 (24 %) on the head and neck; 247 (67 %) were diagnosed by shave biopsy; and 141 (38 %) referred for wide local excision (WLE). Of the 128 invasive melanomas, only 21 (16 %) had thickness ≥ 0.8 mm and these occurred more often on head and neck than thin invasive melanomas (p = 0.02). The majority of invasive melanomas were diagnosed by excision biopsy, and WLE was carried out in a median of 3 days (melanomas ≥ 0.8 mm) and 2 days (<0.8 mm). The doctor detected the majority of in situ (83 %) and thin invasive (73 %) melanomas during surveillance, compared with 48 % of thicker invasive melanomas ≥ 0.8 mm (p < 0.001). CONCLUSION In Australia, specialised primary care practice plays a major role in detection and treatment of early primary melanoma.
Collapse
Affiliation(s)
- Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia; CRUK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - Nirmala Pandeya
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia.
| | - Sarah Morton
- Royal Brisbane and Women's Hospital, Brisbane, Herston, Queensland, 4006, Australia.
| | - John Simonidis
- The Melanoma Centre, Spring Hill, Brisbane 4000, Australia.
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia.
| |
Collapse
|
30
|
Bachari A, Piva TJ, Salami SA, Jamshidi N, Mantri N. Roles of Cannabinoids in Melanoma: Evidence from In Vivo Studies. Int J Mol Sci 2020; 21:E6040. [PMID: 32839414 PMCID: PMC7503316 DOI: 10.3390/ijms21176040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022] Open
Abstract
Melanoma is the fourth most common type of cancer diagnosed in Australians after breast, prostate, and colorectal cancers. While there has been substantial progress in the treatment of cancer in general, malignant melanoma, in particular, is resistant to existing medical therapies requiring an urgent need to develop effective treatments with lesser side effects. Several studies have shown that "cannabinoids", the major compounds of the Cannabis sativaL. plant, can reduce cell proliferation and induce apoptosis in melanoma cells. Despite prohibited use of Cannabis in most parts of the world, in recent years there have been renewed interests in exploiting the beneficial health effects of the Cannabis plant-derived compounds. Therefore, the aim of this study was in the first instance to review the evidence from in vivo studies on the effects of cannabinoids on melanoma. Systematic searches were carried out in PubMed, Embase, Scopus, and ProQuest Central databases for relevant articles published from inception. From a total of 622 potential studies, six in vivo studies assessing the use of cannabinoids for treatment of melanoma were deemed eligible for the final analysis. The findings revealed cannabinoids, individually or combined, reduced tumor growth and promoted apoptosis and autophagy in melanoma cells. Further preclinical and animal studies are required to determine the underlying mechanisms of cannabinoids-mediated inhibition of cancer-signaling pathways. Well-structured, randomized clinical studies on cannabinoid use in melanoma patients would also be required prior to cannabinoids becoming a viable and recognized therapeutic option for melanoma treatment in patients.
Collapse
Affiliation(s)
- Ava Bachari
- School of Science, RMIT University, Melbourne, VIC 3083, Australia;
| | - Terrence J. Piva
- School of Health and Biomedical Sciences, RMIT University, PO Box 71, Melbourne, VIC 3083, Australia; (T.J.P.); (N.J.)
| | - Seyed Alireza Salami
- Faculty of Agricultural Science and Engineering, University of Tehran, Karaj 31587, Iran;
| | - Negar Jamshidi
- School of Health and Biomedical Sciences, RMIT University, PO Box 71, Melbourne, VIC 3083, Australia; (T.J.P.); (N.J.)
| | - Nitin Mantri
- School of Science, RMIT University, Melbourne, VIC 3083, Australia;
| |
Collapse
|
31
|
Esse S, Mason KJ, Green AC, Warren RB. Melanoma Risk in Patients Treated With Biologic Therapy for Common Inflammatory Diseases: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 156:787-794. [PMID: 32432649 PMCID: PMC7240639 DOI: 10.1001/jamadermatol.2020.1300.doi: 10.1001/jamadermatol.2020.1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/21/2020] [Indexed: 10/24/2023]
Abstract
IMPORTANCE Biologic therapies are widely prescribed immunomodulatory agents. There are concerns that compared with treatment with conventional systemic therapy, long-term biologic treatment for common immune-mediated inflammatory diseases, namely inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis, may be associated with increased risk of melanoma. OBJECTIVE To examine whether biologic treatment of IBD, RA, or psoriasis is associated with an increased risk of melanoma compared with conventional systemic therapy. DATA SOURCES Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published from January 1, 1995, to February 7, 2019, for eligible studies. STUDY SELECTION Randomized clinical trials, cohort studies, and nested case-control studies quantifying the risk of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with patients treated with conventional systemic therapy were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted key study characteristics and outcomes. Study-specific risk estimates were pooled, and random- and fixed-effects model meta-analyses were conducted. Heterogeneity was assessed using the I2 statistic. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. MAIN OUTCOMES AND MEASURES The pooled relative risk (pRR) of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with biologic-naive patients treated with conventional systemic therapy. RESULTS Seven cohort studies comprising 34 029 biologic-treated patients and 135 370 biologic-naive patients treated with conventional systemic therapy were eligible for inclusion. Biologic treatment was positively associated with melanoma in patients with IBD (pRR, 1.20; 95% CI, 0.60-2.40), RA (pRR, 1.20; 95% CI, 0.83-1.74), or psoriasis (hazard ratio, 1.57; 95% CI, 0.61-4.09) compared with those who received conventional systemic therapy, but the differences were not statistically significant. Adjustment for other risk factors was absent from most studies. CONCLUSIONS AND RELEVANCE The findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence. However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.
Collapse
Affiliation(s)
- Shamarke Esse
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Kayleigh J. Mason
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Adele C. Green
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
- QIMR Berghofer Medical Research Institute, Brisbane, New South Wales, Australia
- Cancer Research UK Manchester Institute, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Richard B. Warren
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
32
|
GPs' involvement in diagnosing, treating, and referring patients with suspected or confirmed primary cutaneous melanoma: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101028. [PMID: 32295791 PMCID: PMC7330208 DOI: 10.3399/bjgpopen20x101028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background In Australia, melanoma is managed in primary and secondary care settings. An individual concerned about a suspicious lesion typically presents first to their GP. Aim To identify factors influencing GPs’ decisions to diagnose, treat, or refer patients with suspected melanoma. Design & setting Semi-structured interviews were undertaken with 23 GPs working in general practice or skin cancer clinics in Australia. Method The semi-structured interviews were audio-recorded, de-identified, and professionally transcribed. Thematic analysis was used to analyse the data. Results Considerable variation existed in GPs’ self-reported confidence and involvement in melanoma management. Multiple factors were identified as influencing GPs’ decisions to diagnose, treat, or refer patients with suspected or confirmed melanoma. Health system level factors included the overlapping roles of GPs and specialists, and access to and/or availability of specialists. Practice level factors included opportunities for formal and informal training, and having a GP with a special interest in skin cancer within their practice. GP and patient level factors included the GP’s clinical interests, the clinical features (for example, site and size) and histopathology of the suspected melanoma, eligibility for possible sentinel lymph node biopsy, and patient preferences. For some GPs, concerns over misdiagnosis and the option of referring patients at any stage in the melanoma management continuum appeared to affect their interest and confidence in melanoma management. Conclusion GP involvement in melanoma patient care can extend well beyond cancer screening, prevention and supportive care roles to include provision of definitive melanoma patient management. GPs with an interest in being involved in melanoma management should be encouraged and supported to develop the skills needed to manage these patients, and to refer when appropriate.
Collapse
|
33
|
Van Rooij N, Adams A, De'Ambrosis B, Nathan V, Hayward N, Whiteman D. Cluster of pregnancy-associated melanoma: A case report and brief update. J Dermatol 2020; 47:1054-1057. [PMID: 32557800 DOI: 10.1111/1346-8138.15455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/11/2020] [Indexed: 01/31/2023]
Abstract
Melanoma incidence is increasing globally with Australia having the highest incidence in the world. Pregnancy-associated melanoma is recognized in the published work; however, significant knowledge deficiencies exist. We present the case of a 34-year-old woman with dysplastic nevus syndrome who over a 15-year period developed a total of nine melanomas, with eight clustered around an 18-month peri- to post-partum period. The first eight lesions were in situ with the ninth lesion invasive. No metastatic disease was observed over the 18-year follow-up period. This case identifies the potential sensitivity of a subset of melanomas to pregnancy-related factors, with particular relevance to the development of lesions in the post-partum period. We suggest that patients with a history of any documented melanoma risk factors, particularly dysplastic nevus syndrome, require close monitoring especially during pregnancy and early post-partum.
Collapse
Affiliation(s)
- Nicholas Van Rooij
- The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Southport, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Agnieszka Adams
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Brian De'Ambrosis
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia.,South East Dermatology, Annerley, Queensland, Australia.,Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Vaishnavi Nathan
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nicholas Hayward
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - David Whiteman
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| |
Collapse
|
34
|
Filippi L, Bruno G, Domazetovic V, Favre C, Calvani M. Current Therapies and New Targets to Fight Melanoma: A Promising Role for the β3-Adrenoreceptor. Cancers (Basel) 2020; 12:cancers12061415. [PMID: 32486190 PMCID: PMC7352170 DOI: 10.3390/cancers12061415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023] Open
Abstract
Melanoma is one of the most aggressive types of cancer and the most deadly skin cancer. According to World Health Organization, about 132,000 melanoma skin cancers occur globally each year. Thanks to the efficacy of new therapies, life expectation has been improved over the last years. However, some malignant melanomas still remain unresponsive to these therapies. The β-adrenergic system, among its many physiological roles, has been recognized as the main mediator of stress-related tumorigenic events. In particular, catecholamine activation of β-adrenergic receptors (β-ARs) affects several processes that sustain cancer progression. Among the β-AR subtypes, the β3-AR is emerging as an important regulator of tumorigenesis. In this review, we summarize data of different experimental studies focused on β3-AR involvement in tumor development in various types of cancer and, particularly, in melanoma. Taken together, the preclinical evidences reported in this review demonstrate the crucial role of β3-AR in regulating the complex signaling network driving melanoma progression. Therefore, a need exists to further disseminate this new concept and to investigate more deeply the role of β3-AR as a possible therapeutic target for counteracting melanoma progression at clinical level.
Collapse
Affiliation(s)
- Luca Filippi
- Neonatal Intensive Care Unit, Medical Surgical Feto-Neonatal Department, A. Meyer University Children’s Hospital, 50139 Florence, Italy
- Correspondence: (L.F.); (G.B.)
| | - Gennaro Bruno
- Department of Health Science, University of Florence, 50139 Florence, Italy;
- Department of Paediatric Haematology-Oncology, A. Meyer University Children’s Hospital, 50139 Florence, Italy; (C.F.); (M.C.)
- Correspondence: (L.F.); (G.B.)
| | - Vladana Domazetovic
- Department of Health Science, University of Florence, 50139 Florence, Italy;
- Department of Paediatric Haematology-Oncology, A. Meyer University Children’s Hospital, 50139 Florence, Italy; (C.F.); (M.C.)
| | - Claudio Favre
- Department of Paediatric Haematology-Oncology, A. Meyer University Children’s Hospital, 50139 Florence, Italy; (C.F.); (M.C.)
| | - Maura Calvani
- Department of Paediatric Haematology-Oncology, A. Meyer University Children’s Hospital, 50139 Florence, Italy; (C.F.); (M.C.)
| |
Collapse
|
35
|
Bernhard GH, Neale RE, Barnes PW, Neale PJ, Zepp RG, Wilson SR, Andrady AL, Bais AF, McKenzie RL, Aucamp PJ, Young PJ, Liley JB, Lucas RM, Yazar S, Rhodes LE, Byrne SN, Hollestein LM, Olsen CM, Young AR, Robson TM, Bornman JF, Jansen MAK, Robinson SA, Ballaré CL, Williamson CE, Rose KC, Banaszak AT, Häder DP, Hylander S, Wängberg SÅ, Austin AT, Hou WC, Paul ND, Madronich S, Sulzberger B, Solomon KR, Li H, Schikowski T, Longstreth J, Pandey KK, Heikkilä AM, White CC. Environmental effects of stratospheric ozone depletion, UV radiation and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2019. Photochem Photobiol Sci 2020; 19:542-584. [PMID: 32364555 PMCID: PMC7442302 DOI: 10.1039/d0pp90011g] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022]
Abstract
This assessment, by the United Nations Environment Programme (UNEP) Environmental Effects Assessment Panel (EEAP), one of three Panels informing the Parties to the Montreal Protocol, provides an update, since our previous extensive assessment (Photochem. Photobiol. Sci., 2019, 18, 595-828), of recent findings of current and projected interactive environmental effects of ultraviolet (UV) radiation, stratospheric ozone, and climate change. These effects include those on human health, air quality, terrestrial and aquatic ecosystems, biogeochemical cycles, and materials used in construction and other services. The present update evaluates further evidence of the consequences of human activity on climate change that are altering the exposure of organisms and ecosystems to UV radiation. This in turn reveals the interactive effects of many climate change factors with UV radiation that have implications for the atmosphere, feedbacks, contaminant fate and transport, organismal responses, and many outdoor materials including plastics, wood, and fabrics. The universal ratification of the Montreal Protocol, signed by 197 countries, has led to the regulation and phase-out of chemicals that deplete the stratospheric ozone layer. Although this treaty has had unprecedented success in protecting the ozone layer, and hence all life on Earth from damaging UV radiation, it is also making a substantial contribution to reducing climate warming because many of the chemicals under this treaty are greenhouse gases.
Collapse
Affiliation(s)
- G H Bernhard
- Biospherical Instruments Inc., San Diego, California, USA
| | - R E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - P W Barnes
- Biological Sciences and Environment Program, Loyola University, New Orleans, USA
| | - P J Neale
- Smithsonian Environmental Research Center, Edgewater, Maryland, USA
| | - R G Zepp
- United States Environmental Protection Agency, Athens, Georgia, USA
| | - S R Wilson
- School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, Australia
| | - A L Andrady
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - A F Bais
- Department of Physics, Aristotle University of Thessaloniki, Greece
| | - R L McKenzie
- National Institute of Water & Atmospheric Research, Lauder, Central Otago, New Zealand
| | - P J Aucamp
- Ptersa Environmental Consultants, Faerie Glen, South Africa
| | - P J Young
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - J B Liley
- National Institute of Water & Atmospheric Research, Lauder, Central Otago, New Zealand
| | - R M Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - S Yazar
- Garvan Institute of Medical Research, Sydney, Australia
| | - L E Rhodes
- Faculty of Biology Medicine and Health, University of Manchester, and Salford Royal Hospital, Manchester, UK
| | - S N Byrne
- School of Medical Sciences, University of Sydney, Sydney, Australia
| | - L M Hollestein
- Erasmus MC, University Medical Center Rotterdam, Manchester, The Netherlands
| | - C M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - A R Young
- St John's Institute of Dermatology, King's College, London, London, UK
| | - T M Robson
- Organismal & Evolutionary Biology, Viikki Plant Science Centre, University of Helsinki, Helsinki, Finland
| | - J F Bornman
- Food Futures Institute, Murdoch University, Perth, Australia.
| | - M A K Jansen
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - S A Robinson
- Centre for Sustainable Ecosystem Solutions, University of Wollongong, Wollongong, Australia
| | - C L Ballaré
- Faculty of Agronomy and IFEVA-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - C E Williamson
- Department of Biology, Miami University, Oxford, Ohio, USA
| | - K C Rose
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - A T Banaszak
- Unidad Académica de Sistemas Arrecifales, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | - D -P Häder
- Department of Biology, Friedrich-Alexander University, Möhrendorf, Germany
| | - S Hylander
- Centre for Ecology and Evolution in Microbial Model Systems, Linnaeus University, Kalmar, Sweden
| | - S -Å Wängberg
- Department of Marine Sciences, University of Gothenburg, Gothenburg, Sweden
| | - A T Austin
- Faculty of Agronomy and IFEVA-CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - W -C Hou
- Department of Environmental Engineering, National Cheng Kung University, Tainan City, Taiwan, China
| | - N D Paul
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - S Madronich
- National Center for Atmospheric Research, Boulder, Colorado, USA
| | - B Sulzberger
- Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - K R Solomon
- Centre for Toxicology, School of Environmental Sciences, University of Guelph, Guelph, Canada
| | - H Li
- Institute of Atmospheric Environment, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - T Schikowski
- Research Group of Environmental Epidemiology, Leibniz Institute of Environmental Medicine, Düsseldorf, Germany
| | - J Longstreth
- Institute for Global Risk Research, Bethesda, Maryland, USA
| | - K K Pandey
- Institute of Wood Science and Technology, Bengaluru, India
| | - A M Heikkilä
- Finnish Meteorological Institute, Helsinki, Finland
| | - C C White
- , 5409 Mohican Rd, Bethesda, Maryland, USA
| |
Collapse
|
36
|
Mabeta P. Paradigms of vascularization in melanoma: Clinical significance and potential for therapeutic targeting. Biomed Pharmacother 2020; 127:110135. [PMID: 32334374 DOI: 10.1016/j.biopha.2020.110135] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 02/06/2023] Open
Abstract
Melanoma is the most aggressive form of skin cancer. Malignant melanoma in particular has a poor prognosis and although treatment has improved, drug resistance continues to be a challenge. Angiogenesis, the formation of blood vessels from existing microvessels, precedes the progression of melanoma from a radial growth phase to a malignant phenotype. In addition, melanoma cells can form networks of vessel-like fluid conducting channels through vasculogenic mimicry (VM). Both angiogenesis and VM have been postulated to contribute to the development of resistance to treatment and to enable metastasis. Also, the metastatic spread of melanoma is highly dependent on lymphangiogenesis, the formation of lymphatic vessels from pre-existing vessels. Interestingly, the design and clinical testing of drugs that target VM and lymphangiogenesis lag behind that of angiogenesis inhibitors. Despite this, antiangiogenic drugs have not significantly improved the overall survival of melanoma patients, thus necessitating the targeting of alternative mechanisms. In this article, I review the roles of the three paradigms of tissue perfusion, namely, angiogenesis, VM and lymphangiogenesis, in promoting melanoma progression and metastasis. This article also explores the latest development and potential opportunities in the therapeutic targeting of these processes.
Collapse
Affiliation(s)
- Peace Mabeta
- Angiogenesis Laboratory, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| |
Collapse
|
37
|
McMeniman EK, Duffy DL, Jagirdar K, Lee KJ, Peach E, McInerney-Leo AM, De'Ambrosis B, Rayner JE, Smithers BM, Soyer HP, Sturm RA. The interplay of sun damage and genetic risk in Australian multiple and single primary melanoma cases and controls. Br J Dermatol 2020; 183:357-366. [PMID: 31794051 DOI: 10.1111/bjd.18777] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Skin phenotype, host genotype and ultraviolet (UV) damage play a role in the development of melanoma. OBJECTIVES To ascertain whether the level of UV damage at the site of melanomas was associated with genetic polymorphisms. METHODS Deep phenotyping was performed on 1244 individuals; 281 with multiple primary melanomas (MPMs), 304 with single primary melanoma (SPM) and 659 convenience controls. Genotype data was generated using the Illumina CoreExome microarray platform, assaying over 500 000 single-nucleotide polymorphisms. A subset of variants were combined to assess a polygenic risk score (PRS) for melanoma. RESULTS Most MPM cases were diagnosed in patients aged > 40 years, in sites with visible chronic UV damage. Women and those diagnosed at age ≤ 40 years were less likely to have perilesional UV damage. Patients with MPM had higher frequencies of MITF E318K, MC1R R-alleles and the ASIP risk haplotype. Individuals who had melanoma in a visibly UV-damaged site were more likely to carry MC1R rs75570604 [odds ratio (OR) 2·5], 9q31.2 rs10816595 (OR 1·4) and MTAP rs869329 (OR 1·4). These same alleles were more common in patients with MPM who were diagnosed at age ≤ 40 years. The mean PRS was significantly higher in MPM than in SPM and controls. Naevus count was comparable in early-onset MPM cases and those diagnosed at age > 40 years. CONCLUSIONS Our cohort demonstrated higher frequencies of previously reported alleles associated with melanoma. MPM melanomas more commonly occur in UV-damaged areas, and these individuals are more likely to carry MC1R red hair colour alleles. Awareness of the interplay of genetic vulnerability with UV damage can stratify risk and guide recommendations for melanoma screening. What's already known about this topic? Skin phenotype, host genotype and ultraviolet (UV) damage all play a role in melanoma development. One of the main risk factors is a personal history of melanoma; second and subsequent primary melanomas account for over 20% of all melanomas registered in Queensland. Multiple loci are associated with melanoma risk, including many low-penetrance loci, which may have a cumulatively significant risk. Population-wide screening programmes for melanoma are not yet economically viable. What does this study add? Patients diagnosed with melanoma at age ≤ 40 years were more likely than older patients to have melanomas in non-UV-damaged sites. Patients with multiple melanomas had higher frequencies of MITF E318K, MC1R R-alleles, and the ASIP extended risk haplotype than patients with single melanoma. CDKN2A, MC1R and MTAP variants were more frequent in patients who developed melanomas at a younger age, but also in those whose melanomas were all on visibly UV-damaged sites. What is the translational message? Incorporating these genetic findings into the known risk factors of skin phenotype and visible UV damage may allow for a more customized and economically feasible approach to early detection of melanoma, particularly in younger patients. Plain language summary available online.
Collapse
Affiliation(s)
- E K McMeniman
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D L Duffy
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - K J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - E Peach
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B De'Ambrosis
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,South East Dermatology, Annerley Square, Annerley, Brisbane, Queensland, Australia
| | - J E Rayner
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| |
Collapse
|
38
|
Abstract
Melanoma and keratinocyte skin cancer (KSC) are the most common types of cancer in White-skinned populations. Both tumor entities showed increasing incidence rates worldwide but stable or decreasing mortality rates. Rising incidence rates of cutaneous melanoma (CM) and KSC are largely attributed to increasing exposure to ultraviolet (UV) radiation, the main causal risk factor for skin cancer.Incidence rates of KSC, comprising of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are much higher than that of melanoma. BCC development is mainly the cause of an intensive UV exposure in childhood and adolescence, while SCC development is related to chronic, cumulative UV exposure over decades. Although mortality is relatively low, KSC is an increasing problem for health care services causing significant morbidity.Cutaneous melanoma is rapidly increasing in White populations, with an estimated annual increase of around 3-7% over the past decades. In contrast to SCC, melanoma risk is associated with intermittent and chronic exposure to sunlight. The frequency of its occurrence is closely associated with the constitutive color of the skin and the geographical zone. Changes in outdoor activities and exposure to sunlight during the past 70 years are an important factor for the increasing incidence of melanoma. Mortality rates of melanoma show stabilization in the USA, Australia, and in European countries. In the USA even dropping numbers of death cases were recently reported, probably reflecting efficacy of the new systemic treatments.Among younger cohorts in some populations (e.g., Australia and New Zealand,), stabilizing or declining incidence rates of CM are observed, potentially caused by primary prevention campaigns aimed at reducing UV exposure. In contrast, incidence rates of CM are still rising in most European countries and in the USA. Ongoing trends towards thinner melanoma are largely ascribed to earlier detection.
Collapse
|
39
|
Halling-Overgaard AS, Thyssen JP. Modifiable risk factors in paediatric atopic dermatitis: is the sun finally shining? Br J Dermatol 2019; 182:263-264. [PMID: 31788788 DOI: 10.1111/bjd.18690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A-S Halling-Overgaard
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| |
Collapse
|
40
|
Gaudy-Marqueste C. Quoi de neuf en oncodermatologie ? Ann Dermatol Venereol 2019; 146:12S39-12S45. [DOI: 10.1016/s0151-9638(20)30105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Rodriguez-Acevedo AJ, Green AC, Sinclair C, van Deventer E, Gordon LG. Indoor tanning prevalence after the International Agency for Research on Cancer statement on carcinogenicity of artificial tanning devices: systematic review and meta-analysis. Br J Dermatol 2019; 182:849-859. [PMID: 31381131 DOI: 10.1111/bjd.18412] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Exposure to artificial tanning devices is carcinogenic to humans, and government regulations to restrict or ban indoor tanning appear to be increasing. OBJECTIVES We evaluated changes in the international prevalence of indoor tanning among adolescents and adults after artificial tanning devices were classified as carcinogenic by the International Agency for Research on Cancer (IARC) in 2009. METHODS Systematic searches in PubMed and Web of Science databases were undertaken. Overall, 43 studies reporting 'ever' or 'past-year' indoor tanning exposure after 2009 were identified. We used metaregression analysis to evaluate the prevalence of indoor tanning over time. Random effects meta-analysis was used to summarize the prevalence of indoor tanning in adolescents and adults according to sex, region and presence of age prohibitions. RESULTS Global prevalence of indoor tanning in adolescents for 2013-2018 was 6·5% [95% confidence interval (CI) 3·3-10·6], 70% lower than the 22·0% (95% CI 17·2-26·8) prevalence for 2007-2012. Among adults, the prevalence was 10·4% (95% CI 5·7-16·3) for 2013-2018, a decrease of 35% from 18·2% for 2007-2012. Since 2009, the overall past-year prevalence among adolescents was 6·7% (95% CI 4·4-9·6) and 12·5% (95% CI 9·5-15·6) among adults. The prevalence of tanning indoors in the past year was similar in North America (adults, 12·5%; adolescents, 7·6%) and Europe (adults, 11·1%; adolescents, 5·1%). In 2009, three countries had regulations restricting indoor tanning, compared with 26 countries today. CONCLUSIONS Prevalence of indoor tanning has declined substantially and significantly in adolescents and adults since the 2009 IARC statement, reflecting the rise in regulations that limit this source of unnecessary exposure to carcinogenic ultraviolet radiation. What is already known about this topic? Indoor tanning is associated with an increased risk of melanoma. A meta-analysis of worldwide indoor tanning prevalence for 1986-2012 found a past-year prevalence of 18% in adolescents and 14% in adults, with higher prevalences during the period 2007-2012. Policies to regulate indoor tanning began to be implemented across the globe in 2009. Only one study carried out in the U.S.A. has evaluated the efficacy of such policies in reducing indoor tanning prevalence. What does this study add? For the period 2013-2018, we found indoor tanning prevalences of 6·7% in adolescents and 11·9% in adults. This implies a reduction in indoor tanning use of 70% in adolescents and 35% in adults during the last 10 years. Our study encourages policy makers to strengthen indoor tanning regulations that reduce sunbed use among the general population in order to produce maximum public health benefit.
Collapse
Affiliation(s)
| | - A C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, U.K
| | - C Sinclair
- Cancer Council Victoria, Melbourne, Victoria, 3004, Australia
| | - E van Deventer
- Department of Public Health, Environmental and Social Determinants of Health (PHE), CH1211 Geneva 27, Switzerland
| | - L G Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, 4006, Australia.,Queensland University of Technology, School of Nursing, Kelvin Grove, Brisbane, Q4059, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
42
|
Olsen CM, Miura K, Dusingize JC, Hosegood I, Brown R, Drane M, Clem P, Marsden J, Tinker R, Karipidis K, Coroneo M, Green AC. Melanoma incidence in Australian commercial pilots, 2011-2016. Occup Environ Med 2019; 76:462-466. [PMID: 31113813 DOI: 10.1136/oemed-2018-105676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Occupational exposure to cosmic and ultraviolet radiation may increase airline pilots' risk of cutaneous melanoma. Meta-analyses of available data show a higher than average incidence of melanoma in airline pilots, but the most recent systematic review revealed that few contemporary data are available. Moreover, all relevant studies have been conducted in Northern Hemisphere populations. We therefore aimed to examine if Australian commercial pilots have a raised incidence of melanoma compared with the general population. METHODS We examined all melanoma histologically diagnosed among Australian-licensed commercial pilots in the period 2011-2016 by manually reviewing de-identified data in the medical records system of the Australian Civil Aviation Safety Authority. We estimated age-specific incidence rates and compared these with corresponding population rates using standardised incidence ratios (SIRs) as measures of relative risk. Expected numbers were calculated by multiplying age- and calendar period-specific person-years (PYs) with corresponding rates from the entire Australian population; 95% CI were calculated assuming a Poisson distribution of the observed cases. RESULTS In this cohort of Australian-licensed commercial pilots observed for 91 370 PYs, 114 developed a melanoma (51 invasive, 63 in situ). More than 50% of melanomas occurred on the trunk, and the predominant subtype was superficial spreading melanoma. The SIR for invasive melanoma was 1.20 (95% CI 0.89 to 1.55) and for melanoma in situ, 1.39 (95% CI 1.08 to 1.78). CONCLUSION Australian-licensed commercial pilots have a modestly raised risk of in situ melanoma but no elevation of invasive melanoma compared with the general population.
Collapse
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kyoko Miura
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jean Claude Dusingize
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | | | - Peter Clem
- Civil Aviation Safety Authority, Canberra, Australia
| | | | - Rick Tinker
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia
| | - Ken Karipidis
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia
| | - Minas Coroneo
- Department of Ophthalmology, University of New South Wales at Prince of Wales Hospital, Sydney, Australia
| | - Adele C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,CRUK Manchester Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|