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Gefeller O, Kaiser I, Brockmann EM, Uter W, Pfahlberg AB. The Level of Agreement between Self-Assessments and Examiner Assessments of Melanocytic Nevus Counts: Findings from an Evaluation of 4548 Double Assessments. Curr Oncol 2024; 31:2221-2232. [PMID: 38668067 PMCID: PMC11048774 DOI: 10.3390/curroncol31040164] [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: 02/27/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Cutaneous melanoma (CM) is a candidate for screening programs because its prognosis is excellent when diagnosed at an early disease stage. Targeted screening of those at high risk for developing CM, a cost-effective alternative to population-wide screening, requires valid procedures to identify the high-risk group. Self-assessment of the number of nevi has been suggested as a component of such procedures, but its validity has not yet been established. We analyzed the level of agreement between self-assessments and examiner assessments of the number of melanocytic nevi in the area between the wrist and the shoulder of both arms based on 4548 study subjects in whom mutually blinded double counting of nevi was performed. Nevus counting followed the IARC protocol. Study subjects received written instructions, photographs, a mirror, and a "nevometer" to support self-assessment of nevi larger than 2 mm. Nevus counts were categorized based on the quintiles of the distribution into five levels, defining a nevus score. Cohen's weighted kappa coefficient (κ) was estimated to measure the level of agreement. In the total sample, the agreement between self-assessments and examiner assessments was moderate (weighted κ = 0.596). Self-assessed nevus counts were higher than those determined by trained examiners (mean difference: 3.33 nevi). The level of agreement was independent of sociodemographic and cutaneous factors; however, participants' eye color had a significant impact on the level of agreement. Our findings show that even with comprehensive guidance, only a moderate level of agreement between self-assessed and examiner-assessed nevus counts can be achieved. Self-assessed nevus information does not appear to be reliable enough to be used in individual risk assessment to target screening activities.
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Affiliation(s)
- Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (I.K.); (W.U.); (A.B.P.)
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Beaulieu D, Tsao H, Michaud DS, Okhovat JP, Halpern AC, Geller AC. Factors associated with suspected nonmelanoma skin cancers, dysplastic nevus, and cutaneous melanoma among first-time SpotMe screening program participants during 2009-2010. J Am Acad Dermatol 2023; 88:60-70. [PMID: 30543833 DOI: 10.1016/j.jaad.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/30/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND There have been no studies of the American Academy of Dermatology's SpotMe skin cancer screening program to collectively analyze and determine the factors associated with suspected basal cell carcinoma (BCC), squamous cell carcinoma (SCC), dysplastic nevus (DN), and cutaneous melanoma (CM) diagnoses. OBJECTIVE Describe the demographics, risk factors, and access to care profiles associated with suspected diagnoses of BCC, SCC, DN, and CM among first-time SpotMe screenees during 2009-2010. METHODS We conducted a cross-sectional analysis of data from the SpotMe skin cancer screenings conducted in 2009 and 2010. We performed multivariable logistic regression analysis for each diagnosis, incorporating standard demographic, access to care, and risk factor variables in the models. RESULTS Men, those without a regular dermatologist, persons reporting recently changing moles, and those with a personal history of melanoma were at increased risk for each of the suspected diagnoses analyzed. Uninsured persons were at increased risk for suspected malignancies (BCC, SCC, and CM). LIMITATIONS Lack of histologic confirmation for diagnoses and cross-sectional design. CONCLUSION Among first-time SpotMe participants, suspected diagnoses of BCC, SCC, DN, and CM shared several associated factors, which may be considered when planning outreach and screening for populations at risk for skin cancer.
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Affiliation(s)
- Derek Beaulieu
- Tufts University School of Medicine, Tufts Clinical and Translational Science Institute, Boston, Massachusetts; Signature Healthcare Brockton Hospital, Beth Israel Deaconess Medical Center, Brockton, Massachusetts
| | - Hensin Tsao
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Tufts Clinical and Translational Science Institute, Boston, Massachusetts
| | - Jean-Phillip Okhovat
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Allan C Halpern
- Dermatology Service of the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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Olsen CM, Pandeya N, Dusingize JC, Thompson BS, Whiteman DC. Can People Correctly Assess their Future Risk of Melanoma? J Invest Dermatol 2020; 141:695-698. [PMID: 32926899 DOI: 10.1016/j.jid.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Catherine M Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Nirmala Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jean Claude Dusingize
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Bridie S Thompson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - David C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
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Olsen CM, Pandeya N, Thompson BS, Dusingize JC, Webb PM, Green AC, Neale RE, Whiteman DC. Risk Stratification for Melanoma: Models Derived and Validated in a Purpose-Designed Prospective Cohort. J Natl Cancer Inst 2018. [DOI: 10.1093/jnci/djy023] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Catherine M Olsen
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
- School of Public Health, University of Queensland, Queensland, Australia
| | - Nirmala Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
- School of Public Health, University of Queensland, Queensland, Australia
| | - Bridie S Thompson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Jean Claude Dusingize
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - Penelope M Webb
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
- School of Public Health, University of Queensland, Queensland, Australia
| | - Adele C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
- Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
- School of Public Health, University of Queensland, Queensland, Australia
| | - David C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Queensland, Australia
- School of Public Health, University of Queensland, Queensland, Australia
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Jongenelis M, Pettigrew S, Strickland M, Minto C, Slevin T. The relationship between skin checking and sun protection behaviours: implications for skin cancer prevention campaigns. Public Health 2018; 155:55-58. [DOI: 10.1016/j.puhe.2017.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/12/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
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Cust AE, Pickles KM, Goumas C, Vu T, Schmid H, Nagore E, Kelly J, Aitken JF, Giles GG, Hopper JL, Jenkins MA, Mann GJ. Accuracy of self-reported nevus and pigmentation phenotype compared with clinical assessment in a population-based study of young Australian adults. Cancer Epidemiol Biomarkers Prev 2015; 24:736-43. [PMID: 25628333 DOI: 10.1158/1055-9965.epi-14-1203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/17/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Awareness of individual risk may encourage improved prevention and early detection of melanoma. METHODS We evaluated the accuracy of self-reported pigmentation and nevus phenotype compared with clinical assessment, and examined agreement between nevus counts from selected anatomical regions. The sample included 456 cases with invasive cutaneous melanoma diagnosed between ages 18 to 39 years and 538 controls from the population-based Australian Melanoma Family Study. Participants completed a questionnaire about their pigmentation and nevus phenotype, and attended a dermatologic skin examination. RESULTS There was strong agreement between self-reported and clinical assessment of eye color [κ, = 0.78; 95% confidence interval (CI), 0.74-0.81]; and moderate agreement for hair color (κ = 0.46; 95% CI, 0.42-0.50). Agreement between self-reported skin color and spectrophotometer-derived measurements was poor (κ = 0.12; 95% CI, 0.08-0.16) to moderate (Spearman correlation rs = -0.37; 95% CI, -0.32 to -0.42). Participants tended to underestimate their nevus counts and pigmentation; men were more likely to underreport their skin color. The rs was 0.43 (95% CI, 0.38-0.49) comparing clinical total body nevus counts with self-reported nevus categories. There was good agreement between total body nevus counts and site-specific nevus counts, particularly on both arms. CONCLUSIONS Young adults have suboptimal accuracy when assessing important risk characteristics including nevus numbers and pigmentation. Measuring nevus count on the arms is a good predictor of full body nevus count. IMPACT These results have implications for the likely success of targeted public health programs that rely on self-assessment of these factors.
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Affiliation(s)
- Anne E Cust
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Kristen M Pickles
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Chris Goumas
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Thao Vu
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helen Schmid
- Centre for Cancer Research, University of Sydney at Westmead Millennium Institute for Medical Research and Melanoma Institute Australia, Sydney, Australia
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - John Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - Joanne F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Graham J Mann
- Centre for Cancer Research, University of Sydney at Westmead Millennium Institute for Medical Research and Melanoma Institute Australia, Sydney, Australia
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Mayer JE, Swetter SM, Fu T, Geller AC. Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part I. Epidemiology, high-risk groups, clinical strategies, and diagnostic technology. J Am Acad Dermatol 2014; 71:599.e1-599.e12; quiz 610, 599.e12. [PMID: 25219716 DOI: 10.1016/j.jaad.2014.05.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/15/2014] [Accepted: 05/21/2014] [Indexed: 01/22/2023]
Abstract
While most cancers have shown both decreased incidence and mortality over the past several decades, the incidence of melanoma has continued to grow, and mortality has only recently stabilized in the United States and in many other countries. Certain populations, such as men >60 years of age and lower socioeconomic status groups, face a greater burden from disease. For any given stage and across all ages, men have shown worse melanoma survival than women, and low socioeconomic status groups have increased levels of mortality. Novel risk factors can help identify populations at greatest risk for melanoma and can aid in targeted early detection. Risk assessment tools have been created to identify high-risk patients based on various factors, and these tools can reduce the number of patients needed to screen for melanoma detection. Diagnostic techniques, such as dermatoscopy and total body photography, and new technologies, such as multispectral imaging, may increase the accuracy and reliability of early melanoma detection.
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Affiliation(s)
- Jonathan E Mayer
- Harvard School of Public Health, Boston, Massachusetts; Columbia University College of Physicians and Surgeons, New York, New York
| | - Susan M Swetter
- Department of Dermatology, Stanford University, Redwood City, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Teresa Fu
- Department of Dermatology, Stanford University, Redwood City, California
| | - Alan C Geller
- Harvard School of Public Health, Boston, Massachusetts.
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Abstract
The objective of this study was to create a self-administrated questionnaire for people to enable them to assess their own melanoma risk factors. To test the validity of this questionnaire in a large prospective study, the answers given by the patient were systematically checked by his or her general practitioner. In this prospective study, the choice of questions was based on a review of the literature. The validity of the questionnaire was assessed by testing 1500 consecutive patients attending a consultation with their general practitioner. Considerable variations concerning the prevalence of different melanoma risk factors were noticed in the population: 44.1% had a phototype I or II, 41% had severe sunburn during infancy, 29.9% had freckling tendency, 22% had more than 50 naevi and 1.4% a personal history of melanoma. In total, 45% had more than one melanoma risk factor. The accuracy of the answers given by the patients was assured by the correction given by their general practitioners. The percentage of correct answers given by the patients was 79.9% for the phototype, 90.6% for freckling tendency, 86.6% for the number of naevi, 96.5% for severe sunburn during infancy and 98.1 and 95.8% for personal and familial history of melanoma. This study confirms that individuals with multiple risk factors for melanoma are common among patients consulting their general practitioners. Furthermore, self-screening with the self-assessment questionnaire is easily feasible and is accurate for identifying high-risk individuals. This tool might be useful for carrying out melanoma-targeted screening.
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Richtig E, Jung E, Asbäck K, Trapp M, Hofmann-Wellenhof R. Knowledge and perception of melanocytic nevi and sunburn in young children. Pediatr Dermatol 2009; 26:519-23. [PMID: 19840304 DOI: 10.1111/j.1525-1470.2008.00854.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Understanding the public's perception of nevi and sunburn is crucial to melanoma prevention efforts. METHODS We investigated the knowledge and perception of melanocytic nevi and sunburns in 77 children 6 to 10 years old (mean 8.2) in two elementary schools in Styria, Austria. The children were interviewed by specially trained psychologists about the number of their moles and how they felt having them. Additionally questions about sunburn history and sunburn perception were asked. The spontaneous answers of the children were recorded, there were no pregiven answers. Afterwards the children were examined by dermatologists clinically and with dermatoscopes. RESULTS The 96% of the children could describe a nevus (the term "mole" was translated to "nevus") and 91% did not feel bothered about theirs. Only 26% had noted the appearance of new nevi within the last year. The 67% of all children had at least one sunburn and remembered the clinical features. The 20% of the children knew that sunburns could provoke skin cancer. All children felt comfortable during the clinical and dermatoscopic examination. CONCLUSION Children aged from 6 to 10 years know exactly why they had suffered from sunburn, can describe the sunburn and how to avoid it. They do not feel bothered by their nevi and are alert to the appearance of new nevi.
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Affiliation(s)
- Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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