Comparison of time trends in skin cancer incidence (1973-97) in East Asia, Europe and USA, from Cancer Incidence in Five Continents Vol. IV-VIII

The Risk of Keratinocyte Cancer in Vitiligo and the Potential Mechanisms Involved

Although light skin types are associated with increased skin cancer risk, a lower incidence of both melanoma and nonmelanoma skin cancer (NMSC) has been reported in patients with vitiligo. We performed a systematic review and meta-analysis on the NMSC risk in patients with vitiligo, indicating a reduced relative risk ratio of NMSC in vitiligo. Furthermore, we propose a series of hypotheses on the underlying mechanisms, including both immune-mediated and nonimmune-mediated pathways. This study reveals insights into the relationship between vitiligo and keratinocyte cancer and can also be used to better inform patients with vitiligo.

Skin Cancer in People of Color: A Systematic Review

BACKGROUND

People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS).

OBJECTIVES

In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature.

METHODS

An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search.

RESULTS

We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review.

CONCLUSION

Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.

Adequacy of sentinel lymph node biopsy in malignant melanoma of the trunk and extremities: Clinical observations regarding prognosis

Background

Methods for identifying local lymph node metastasis in malignant melanoma include sentinel lymph node biopsy (SLNB) and lymph node dissection (LND). In particular, SLNB has been widely used in recent years. This study aimed to retrospectively confirm the adequacy of the current indication criteria for SLNB by applying those criteria to a mixed group of patients who previously received SLNB and LND.

Methods

This study included 77 patients with malignant melanoma of the extremities and trunk who were monitored for >24 months. The patients were classified according to whether the current indication criteria for SLNB were applicable. The sentinel lymph nodes were evaluated for each group. Patients for whom the indication criteria for SLNB and LND were applicable were analyzed according to whether SLNB or LND was performed. Finally, the outpatient records of these patients were reviewed to evaluate recurrence, metastasis, and prognosis.

Results

Of the 77 patients, SLNB was indicated according to the current criteria in 60 cases. Among the 60 patients for whom SLNB was indicated, 35 survived the follow-up period disease-free, 21 died during the follow-up period, and four experienced metastasis. The 17 patients for whom SLNB was not indicated had no recurrence or metastasis.

Conclusions

Patients for whom SLNB was not indicated had no recurrence or metastasis. In cases where SLNB is indicated, the possibility of metastasis and recurrence may be high even if SLNB is negative or LND is performed, so more aggressive treatment and careful follow-up are crucial.

Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in restaging and prognosis of recurrent melanoma after curative surgery

Malignant melanoma is a highly aggressive tumor and surgical resection is the primary treatment. However, the chances of recurrence are quite high despite complete resection. The aim of study was to evaluate the 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography-computed tomography (PET/CT) in detection of recurrent melanoma after curative surgery and its prognostic value. Fifty-four melanoma patients (32 women) with prior primary lesion resection were evaluated with 18F-FDG PET/CT for clinically suspicious recurrent disease. The diagnostic accuracy of 18F-FDG PET/CT (visual interpretation as well as semi-quantitative parameter) was determined on the basis of subsequent imaging and clinical follow-up. Melanoma-specific survival and risk of progression (hazard ratio [HR]) were assessed using Kaplan-Meier method and Cox regression analysis. 18F-FDG PET/CT detected recurrent diseases in 36 (66%) patients including distant metastases in 13 patients and second synchronous malignancy in 2 patients. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of 18F-FDG PET/CT were 91.2%, 80.0%, 88.6%, and 84.2%, respectively, with area under the curve of 0.86 (95% confidence interval: 0.74-0.97; P < 0.05). Positive 18F-FDG PET/CT study was associated with a significantly shorter overall survival than negative study (30.8 ± 4.6 vs. 64.5 ± 6.9 months, P < 0.05). Apart from positive 18F-FDG PET/CT scan, maximum standardized uptake value (SUVmax) >2.7 and combination of both were independently associated with an increased risk of disease progression (HR = 7.72, 21.58, and 11.37, respectively; P < 0.05). 18F-FDG PET/CT showed enhanced diagnostic performance in patients with suspicious recurrent malignant melanoma leading to appropriate management. FDG positivity along with SUVmax >2.7 provides important prognostic value in predicting the survival outcomes and assessing the risk of disease progression.

Prognostic Value of Volumetric Parameters Measured by Pretreatment 18F FDG PET/CT in Patients With Cutaneous Malignant Melanoma

PURPOSE OF THE REPORT

This study was performed to evaluate the prognostic relevance of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured using F FDG PET/CT in patients with primary cutaneous malignant melanoma (CMM).

MATERIALS AND METHODS

We conducted a retrospective review (July 2005 to November 2010) of 41 patients with a histological diagnosis of CMM who underwent pretreatment F FDG PET/CT. PET parameters (maximum standardized uptake value [SUVmax], MTV, and TLG) of the primary tumor were measured. Clinical variables such as age, sex, clinical stage, location and thickness of the primary lesion, and existence of ulceration were also assessed. Univariate and multivariate analyses for disease-free survival (DFS) and melanoma-specific survival (MSS) were performed using the Kaplan-Meier method and Cox proportional hazards models.

RESULTS

SUVmax and TLG were found to be significantly higher in patients with recurrence than in patients without recurrence (3.98 ± 2.91 vs 1.89 ± 1.35, P = 0.0145; 9.16 ± 8.44 vs 3.72 ± 3.64, P = 0.0249). SUVmax and TLG were also found to be significantly higher in nonsurvivors than in survivors (4.21 ± 3.06 vs 2.00 ± 1.46, P = 0.0260; 10.53 ± 8.83 vs 3.67 ± 3.44, P = 0.0170). The optimal cutoff values for DFS determined using a time-dependent receiver operating characteristic (ROC) curve were 1.8 for SUVmax, 6.07 cm for MTV, and 4.046 for TLG. Sixteen (39%) of the 41 patients experienced recurrence during the follow-up period. In univariate analysis, age (P = 0.0382), male sex (P = 0.0187), ulceration of the primary lesion (P = 0.0001), stage ≥ III (P = 0.0011), SUVmax greater than 1.8 (P = 0.0006), MTV greater than 6.07 cm (P = 0.0136), and TLG greater than 4.046 (P = 0.0010) affected DFS, whereas the other variables (location of the primary lesion and thickness of primary lesion) did not. After adjustment for the effects of the clinical parameters (age, sex, clinical stage, and existence of ulceration), SUVmax, MTV, and TLG were all significant predictors of DFS, and the best predictive factor was SUVmax. Thirteen (32%) of the 41 patients died because of CMM during the follow-up period. The optimal cutoff values for MSS determined using a time-dependent ROC curve were 2.2 for SUVmax, 4.02 cm for MTV, and 4.352 for TLG. In univariate analysis, ulceration of the primary lesion (P = 0.0005), SUVmax greater than 2.2 (P = 0.0001), MTV greater than 4.02 cm (P = 0.0071), and TLG greater than 4.352 (P = 0.0001) affected MSS, whereas the other variables (age, sex, clinical stage, primary lesion site, and thickness of the primary lesion) did not. After adjustment for the effect of the clinical parameter (existence of ulceration), MTV and TLG were significant predictors of MSS, and the best predictive factor of MSS was TLG.

CONCLUSIONS

Pretreatment MTV and TLG may be useful in stratifying the likelihood of recurrence and melanoma-specific death, and TLG was found to be the best predictive marker for predicting melanoma-specific death.

Knowledge, attitude and practice regarding solar ultraviolet exposure among medical university students in Northeast China

To assess the knowledge, attitudes and practices regarding the health effects of ultraviolet radiation (UVR) and sun exposure among medical university students in Northeast China, 385 subjects were investigated on October 2013 using a self-administered multiple-choice questionnaire. Most of the subjects knew the effects of UVR on skin cancer (95.6%) and sunburn (92.2%), but fewer knew of the eye damage that can result from UVR (27.8% cataract and 3.1% pterygium). Correspondingly, the main purpose of adopting sun protection was considered to be 'preventing sunburn' (55.4%), but 'preventing eye damage' was the least (1.8%). In actual behaviour, the eyes received the least protection as well. Although knowing the effects of UVR on vitamin D synthesis (87.3%), 66.8% of participants never or seldom increased sun exposure. Compared to men, women were more likely to reduce sun exposure (P<0.001). Only a small fraction of subjects (6.6%) thought that tanning was attractive. Considering the response variability to UVR in people with different skin colours, different sun protection programs should be provided. In China, especially in the North, the public should be educated to moderately increase sun exposure to maintain adequate vitamin D status while also protecting against eye damage from UVR.

Long-term survival analysis and clinical follow-up in acral lentiginous malignant melanoma undergoing sentinel lymph node biopsy in korean patients

BACKGROUND

In cutaneous malignant melanoma (MM) with clinically uninvolved regional lymph nodes, sentinel lymph node (SLN) status is the most powerful indicator of both overall survival (OS) and disease-free survival (DFS). However, no studies on the long-term survival and clinical follow-up of Korean patients with acral lentiginous MM (ALM) undergoing SLN biopsy (SLNB) have been published.

OBJECTIVE

The purpose of this study was to investigate the clinical prognosis and long-term survival of Korean patients with ALM according to SLN status.

METHODS

Thirty-four ALM patients undergoing SLNB were included in this study. We evaluated clinical and histopathological follow-up data such as the stage of disease, treatment, recurrence, and metastasis, and analyzed OS and DFS according to SLN status.

RESULTS

The median follow-up time was 60.5 months (range 3~127 months). Positive SLNs were noted in 14 patients (41.2%). Patients with negative SLNs had better OS and DFS than those with positive SLNs (p<0.05). Increased Breslow thickness was associated with short OS and DFS (p<0.05), and female patients showed better DFS than male patients (p<0.05).

CONCLUSION

To our knowledge, this is the first study on the long-term survival and clinical follow-up of patients undergoing SLNB for ALM in Korea. Our findings show that SLN status is an important prognostic factor for predicting OS and DFS.

Is the Global Solar UV Index an effective instrument for promoting sun protection? A systematic review

Exposure to ultraviolet radiation is an important risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was developed as a tool to visualize the amount of harmful radiation and to encourage people to use sun protection. We conducted a systematic review of the effectiveness of the UVI. We employed a comprehensive search strategy to explore the impact of the UVI on five outcome categories. Twenty-seven of a total of 260 studies met our inclusion criteria; data extraction and quality appraisal were undertaken for 25 studies, comprising 3 randomized controlled trials, 2 non-randomized intervention studies and 20 cross-sectional studies. Nearly half of these studies were from Australia and New Zealand. We found low to intermediate levels of UVI awareness and low levels of UVI understanding. Studies rated moderate or strong suggest that the UVI does not influence knowledge, attitudes, sun protection behavior or sun exposure. Overall, the findings imply that the UVI, as currently implemented, has not been successful at improving sun protection practices and reducing sun exposure among the population at large. Drawing on experience with theory-based sun protection programs, we advocate for more realistic expectations of what the UVI can and cannot achieve.

Unique features of PTCH1 mutation spectrum in Chinese sporadic basal cell carcinoma

BACKGROUND

Alterations of the PTCH1 gene have been found to contribute to both familial and sporadic basal cell carcinoma (BCC), especially in Caucasian patients. Furthermore, the majority of PTCH1 gene mutations in sporadic BCCs in Caucasian patients carry ultraviolet (UV) signatures, suggesting the key role of UV light in BCC development. However, sporadic BCC in non-Caucasian population has a lower incidence, and the pathogenesis remains largely unknown. To date, there has been no mutation analysis on PTCH1 gene in Chinese patients with sporadic BCCs.

OBJECTIVE

To investigate genetic alterations of the PTCH1 gene in Chinese sporadic BCCs.

METHODS

Direct sequencing was used to screen for mutations in PTCH1 in 31 microdissected samples in Chinese sporadic BCCs. In addition, single nucleotide polymorphisms (SNPs) were studied for loss of heterozygosity (LOH).

RESULTS

Nineteen PTCH1 mutations in 17 of the 31 BCCs (54.8%) were identified. SNP analysis revealed LOH of PTCH1 in 10 of 23 BCCs (43.5%). Interestingly, the majority of mutations identified (63.2%) were insertion/deletion, which was different from the results in Caucasian cases whose mutations are predominantly point mutations. Only two (10.5%) of the remaining seven mutations were UV-specific C → T transition or tandem CC → TT transitions. All mutations occurred evenly throughout the entire PTCH1 protein domain without a hot-spot detected.

CONCLUSION

Mutations and LOH in PTCH1 were also highly prevalent in Chinese sporadic BCCs. However, UV light plays a less role in causing these mutations, suggesting other potential mechanisms in the development of sporadic BCC in Chinese patients.

The feasibility of sentinel lymph node biopsy with a multidisciplinary cooperative team approach for the management of koreans with cutaneous malignant melanoma

BACKGROUND

The regional lymph nodal status is the most powerful independent predictor of survival for patients with clinical N0 primary cutaneous malignant melanoma.

OBJECTIVE

We wanted to evaluate the feasibility and morbidity of the sentinel lymph node biopsy (SLNB) staging using a multidisciplinary team approach, in cooperation with other surgical departments, at a university hospital setting.

METHODS

Twenty two patients with cutaneous melanoma and who were treated at Kyungpook National University Hospital were included in this study. They all received SLNB, which was done by the Departments of Dermatology and General Surgery. We evaluated the feasibility and side effects of SLNB.

RESULTS

Pathologically-positive sentinel nodes were found in 7 of the 22 cases (31.8%) and all 7 patients were consequently upstaged. The whole process involved in SLNB was well tolerated by nearly all the patients, with only mild and transient complications being observed.

CONCLUSION

We suggest that in a Korean setting, utilizing SLNB with a multi-disciplinary team approach is a technically feasible procedure that is able to detect occult nodal metastasis with low morbidity rates in patients with cutaneous malignant melanoma.