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Bolick NL, Geller AC. Epidemiology and Screening for Melanoma. Hematol Oncol Clin North Am 2024:S0889-8588(24)00052-2. [PMID: 38908959 DOI: 10.1016/j.hoc.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
Melanoma is the most commonly fatal type of skin cancer, and it is an important and growing public health problem in the United States and worldwide. Fortunately, incidence rates are decreasing in young people, stabilizing in middle-aged people, and increasing in older individuals. Herein, the authors further describe trends in melanoma incidence and mortality, review the literature on risk factors, and provide an up-to-date assessment of population-wide screening and new technology being utilized in melanoma screening.
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Affiliation(s)
- Nicole L Bolick
- Department of Dermatology, University of New Mexico School of Medicine, MSC08 4720 1 UNM, Albuquerque, NM 87131, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Kresge Building, Room 718, 677 Huntington Avenue, Boston, MA 02115, USA.
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Adamson AS, Naik G, Jones MA, Bell KJ. Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method. BMJ Evid Based Med 2024; 29:156-161. [PMID: 38242569 DOI: 10.1136/bmjebm-2023-112460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To quantify the proportion of melanoma diagnoses (invasive and in situ) in the USA that might be overdiagnosed. DESIGN In this ecological study, incidence and mortality data were collected from the Surveillance, Epidemiology and End Results 9 registries database. DevCan software was used to calculate the cumulative lifetime risk of being diagnosed with melanoma between 1975 and 2018, with adjustments made for changes in longevity and risk factors over the study period. SETTING USA. PARTICIPANTS White American men and women (1975-2018). MAIN OUTCOME MEASURES The primary outcome was excess lifetime risk of melanoma diagnosis between 1976 and 2018 (adjusted for year 2018 competing mortality and changes in risk factors), which was inferred as likely overdiagnosis. The secondary outcome was an excess lifetime risk of melanoma diagnosis in each year between 1976 and 2018 (adjusted and unadjusted). RESULTS Between 1975 and 2018 the adjusted lifetime risk of being diagnosed with melanoma (invasive and in situ) increased from 3.2% (1 in 31) to 6.4% (1 in 16) among white men, and from 1.6% (1 in 63) to 4.5% (1 in 22) among white women. Over the same period, the adjusted lifetime risk of being diagnosed with melanoma in situ increased from 0.17% (1 in 588) to 2.7% (1 in 37) in white men and 0.08% (1 in 1250) to 2.0% (1 in 50) in white women. An estimated 49.7% of melanomas diagnosed in white men and 64.6% in white women were overdiagnosed in 2018. Among people diagnosed with melanomas in situ, 89.4% of white men and 85.4% of white women were likely overdiagnosed in 2018. CONCLUSIONS Melanoma overdiagnosis among white Americans is significant and increasing over time with an estimated 44 000 overdiagnosed in men and 39 000 in women in 2018. A large proportion of overdiagnosed melanomas are in situ cancers, pointing to a potential focus for intervention.
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Affiliation(s)
- Adewole S Adamson
- Department of Internal Medicine (Division of Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Geetanjali Naik
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mark A Jones
- Institute for Evidence-based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Katy Jl Bell
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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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.
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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
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Knab A, Anwer AG, Pedersen B, Handley S, Marupally AG, Habibalahi A, Goldys EM. Towards label-free non-invasive autofluorescence multispectral imaging for melanoma diagnosis. JOURNAL OF BIOPHOTONICS 2024; 17:e202300402. [PMID: 38247053 DOI: 10.1002/jbio.202300402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024]
Abstract
This study focuses on the use of cellular autofluorescence which visualizes the cell metabolism by monitoring endogenous fluorophores including NAD(P)H and flavins. It explores the potential of multispectral imaging of native fluorophores in melanoma diagnostics using excitation wavelengths ranging from 340 nm to 510 nm and emission wavelengths above 391 nm. Cultured immortalized cells are utilized to compare the autofluorescent signatures of two melanoma cell lines to one fibroblast cell line. Feature analysis identifies the most significant and least correlated features for differentiating the cells. The investigation successfully applies this analysis to pre-processed, noise-removed images and original background-corrupted data. Furthermore, the applicability of distinguishing melanomas and healthy fibroblasts based on their autofluorescent characteristics is validated using the same evaluation technique on patient cells. Additionally, the study tentatively maps the detected features to underlying biological processes. This research demonstrates the potential of cellular autofluorescence as a promising tool for melanoma diagnostics.
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Affiliation(s)
- Aline Knab
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Ayad G Anwer
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Bernadette Pedersen
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Shannon Handley
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Abhilash Goud Marupally
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Abbas Habibalahi
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
| | - Ewa M Goldys
- Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales, Sydney, Australia
- ARC Centre of Excellence for Nanoscale Biophotonics, University of New South Wales, Sydney, Australia
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Smith AL, Smit AK, Laginha BI, Singh N, Gallo B, Martin L, Cust AE. Implementing systematic melanoma risk assessment and risk-tailored surveillance in a skin cancer focussed dermatology clinic: A qualitative study of feasibility and acceptability to patients and clinic staff. Cancer Med 2024; 13:e6976. [PMID: 38379327 PMCID: PMC10839129 DOI: 10.1002/cam4.6976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND International bodies recommend that melanoma risk assessment should be integrated into skin cancer care provision, but evidence to support implementation is lacking. AIM To explore the acceptability and feasibility of implementing personalised melanoma risk assessment and tailored patient education and skin surveillance within routine clinical care. METHODS This prospective qualitative implementation study was informed by the Theoretical Framework of Acceptability (TFA). Personalised, systematic melanoma risk assessment was implemented in the dermatology clinic at the Melanoma Institute Australia, Sydney, Australia February-May 2021. Pre- and post-implementation observations and semi-structured interviews with patients and staff were conducted (September 2020-March 2021). Observational notes and interview transcript data were analysed thematically using the TFA as a classifying framework. RESULTS A total of 37 h of observations were made, and 29 patients and 12 clinic staff were interviewed. We found that the delivery of personalised melanoma risk estimates did not impact on patient flow through the clinic. Dermatologists reported that the personalised risk information enhanced their confidence in assessing patient risk and recommending tailored surveillance schedules. Most patients reported that the risk assessment and tailored information were a beneficial addition to their care. Among patients whose risk deviated from their expectations, some reported feeling worried, confused or mistrust in the risk information, including those at lower risk who were recommended to decrease surveillance frequency. CONCLUSIONS It is feasible and acceptable to patients and clinic staff to calculate and deliver personalised melanoma risk information and tailored surveillance as part of routine clinical care within dermatology clinics.
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Affiliation(s)
- A. L. Smith
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - A. K. Smit
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute Australia, The University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - B. I. Laginha
- Australian Institute of Health Innovation, Macquarie UniversitySydneyNew South WalesAustralia
| | - N. Singh
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Australian Institute of Health Innovation, Macquarie UniversitySydneyNew South WalesAustralia
| | - B. Gallo
- Melanoma Institute Australia, The University of SydneySydneyNew South WalesAustralia
| | - L. Martin
- Melanoma Institute Australia, The University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - A. E. Cust
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute Australia, The University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
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Pandeya N, Dusingize JC, Olsen CM, MacGregor S, Neale RE, Law MH, Whiteman DC. Does genetic risk modify the effect of skin screening on melanoma detection rates? Br J Dermatol 2023; 190:37-44. [PMID: 37681503 DOI: 10.1093/bjd/ljad333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Skin screening is associated with higher melanoma detection rates, a potential indicator of overdiagnosis, but it remains possible that this effect is due to confounding by genetic risk. OBJECTIVES To compare melanoma incidence among screened vs. unscreened participants within tertiles of genetic risk. METHODS We investigated melanoma incidence in the QSkin study, a prospective cohort study which for this analysis comprised 15 283 participants aged 40-69 years with genotype data and no prior history of melanoma. We calculated a polygenic score (PGS) for melanoma. We first calculated the age-standardized rate (ASR) of melanoma within PGS tertiles, and then measured the association between skin examination and melanoma detection by calculating the hazard ratio (HR) and 95% confidence interval (95% CI), overall and within PGS tertiles. RESULTS Melanoma incidence increased with PGS (ASR per 100 000 per year): tertile 1 = 442; tertile 2 = 519; tertile 3 = 871. We found that the HRs for all melanomas (i.e. in situ and invasive) associated with skin examination differed slightly across PGS tertiles [age- and sex-adjusted tertile 1 HR 1.88 (95% CI 1.26-2.81); tertile 2 HR 1.70 (95% CI 1.20-2.41); tertile 3 HR 1.96 (95% CI 1.43-2.70); fully adjusted tertile 1 HR 1.14 (95% CI 0.74-1.75); tertile 2 HR 1.21 (95% CI 0.82-1.78); tertile 3 HR 1.41 (95% CI 1.00-1.98)], but these differences were not statistically significant. HRs for in situ melanoma associated with skin examination were similar across PGS tertiles. For invasive melanomas, the point estimates appeared to be highest in PGS tertile 3 in both the minimally adjusted (age, sex) and fully adjusted models; however, these apparent differences were also not statistically significant. CONCLUSIONS Genetic risk predicts subsequent melanoma incidence, and is weakly associated with screening behaviour, but it does not explain the higher rate of melanoma detection between screened and unscreened people.
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Affiliation(s)
- Nirmala Pandeya
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
- Faculty of Medicine
| | - Jean Claude Dusingize
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
| | - Catherine M Olsen
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
- Faculty of Medicine
| | - Stuart MacGregor
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
| | - Rachel E Neale
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
- Faculty of Medicine
| | - Matthew H Law
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
- Faculty of Health, Queensland University of Technology, QLD, Australia
- School of Biomedical Sciences, The University of Queensland, QLD, Australia
| | - David C Whiteman
- Departments of Population Health and Computational Biology, QIMR Berghofer Medical Research Institute, QLD, Australia
- Faculty of Medicine
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7
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Smit AK, Cust AE. Unpacking factors contributing to melanoma overdiagnosis: does polygenic risk play a role? Br J Dermatol 2023; 190:4-5. [PMID: 37942844 DOI: 10.1093/bjd/ljad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 10/25/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Dunlop KLA, Keogh LA, Smith AL, Aranda S, Aitken J, Watts CG, Smit AK, Janda M, Mann GJ, Cust AE, Rankin NM. Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants. PLoS One 2023; 18:e0287591. [PMID: 38091281 PMCID: PMC10718433 DOI: 10.1371/journal.pone.0287591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers. METHODS This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist. RESULTS Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging. CONCLUSION Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.
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Affiliation(s)
- Kate L. A. Dunlop
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A. Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea L. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sanchia Aranda
- School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Caroline G. Watts
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Surveillance, Evaluation & Research Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amelia K. Smit
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Graham J. Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Reyes-Marcelino G, McLoughlin K, Harrison C, Watts CG, Kang YJ, Aranda S, Aitken JF, Guitera P, Cust AE. Skin cancer-related conditions managed in general practice in Australia, 2000-2016: a nationally representative, cross-sectional survey. BMJ Open 2023; 13:e067744. [PMID: 37142316 PMCID: PMC10186445 DOI: 10.1136/bmjopen-2022-067744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE Skin cancer is Australia's most common and costly cancer. We examined the frequency of Australian general practice consultations for skin cancer-related conditions, by patient and general practitioner (GP) characteristics and by time period. DESIGN Nationally representative, cross-sectional survey of general practice clinical activity. SETTING, PARTICIPANTS Patients aged 15 years or older having a skin cancer-related condition managed by GPs in the Bettering the Evaluation And Care of Health study between April 2000 and March 2016. PRIMARY OUTCOME MEASURES Proportions and rates per 1000 encounters. RESULTS In this period, 15 678 GPs recorded 1 370 826 patient encounters, of which skin cancer-related conditions were managed 65 411 times (rate of 47.72 per 1000 encounters, 95% CI 46.41 to 49.02). Across the whole period, 'skin conditions' managed were solar keratosis (29.87%), keratinocyte cancer (24.85%), other skin lesion (12.93%), nevi (10.98%), skin check (10.37%), benign skin neoplasm (8.76%) and melanoma (2.42%). Over time, management rates increased for keratinocyte cancers, skin checks, skin lesions, benign skin neoplasms and melanoma; but remained stable for solar keratoses and nevi. Skin cancer-related encounter rates were higher for patients aged 65-89 years, male, living in Queensland or in regional or remote areas, with lower area-based socioeconomic status, of English-speaking background, Veteran card holders and non-healthcare card holders; and for GPs who were aged 35-44 years or male. CONCLUSION These findings show the spectrum and burden of skin cancer-related conditions managed in general practice in Australia, which can guide GP education, policy and interventions to optimise skin cancer prevention and management.
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Affiliation(s)
- Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Kirstie McLoughlin
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Caroline G Watts
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Yoon-Jung Kang
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sanchia Aranda
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
- Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Classification of Skin Cancer Using Novel Hyperspectral Imaging Engineering via YOLOv5. J Clin Med 2023; 12:jcm12031134. [PMID: 36769781 PMCID: PMC9918106 DOI: 10.3390/jcm12031134] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Many studies have recently used several deep learning methods for detecting skin cancer. However, hyperspectral imaging (HSI) is a noninvasive optics system that can obtain wavelength information on the location of skin cancer lesions and requires further investigation. Hyperspectral technology can capture hundreds of narrow bands of the electromagnetic spectrum both within and outside the visible wavelength range as well as bands that enhance the distinction of image features. The dataset from the ISIC library was used in this study to detect and classify skin cancer on the basis of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and seborrheic keratosis (SK). The dataset was divided into training and test sets, and you only look once (YOLO) version 5 was applied to train the model. The model performance was judged according to the generated confusion matrix and five indicating parameters, including precision, recall, specificity, accuracy, and the F1-score of the trained model. Two models, namely, hyperspectral narrowband image (HSI-NBI) and RGB classification, were built and then compared in this study to understand the performance of HSI with the RGB model. Experimental results showed that the HSI model can learn the SCC feature better than the original RGB image because the feature is more prominent or the model is not captured in other categories. The recall rate of the RGB and HSI models were 0.722 to 0.794, respectively, thereby indicating an overall increase of 7.5% when using the HSI model.
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Medhin LB, Beasley AB, Warburton L, Amanuel B, Gray ES. Extracellular vesicles as a liquid biopsy for melanoma: Are we there yet? Semin Cancer Biol 2023; 89:92-98. [PMID: 36706847 DOI: 10.1016/j.semcancer.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
Melanoma is the most aggressive form of skin cancer owing to its high propensity to metastasise in distant organs and develop resistance to treatment. The scarce treatment options available for melanoma underscore the need for biomarkers to guide treatment decisions. In this context, an attractive alternative to overcome the limitations of repeated tissue sampling is the analysis of peripheral blood samples, referred to as 'liquid biopsy'. In particular, the analysis of extracellular vesicles (EVs) has emerged as a promising candidate due to their role in orchestrating cancer dissemination, immune modulation, and drug resistance. As we gain insights into the role of EVs in cancer and melanoma their potential for clinical use is becoming apparent. Herein, we critically summarise the current evidence supporting EVs as biomarkers for melanoma diagnosis, prognostication, therapy response prediction, and drug resistance. EVs are proposed as a candidate biomarker for predicting therapeutic response to immune checkpoint inhibition. However, to realise the potential of EV analysis for clinical decision-making strong clinical validation is required, underscoring the need for further research in this area.
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Affiliation(s)
- Lidia B Medhin
- Centre for Precision Health, Edith Cowan University, Joondalup WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup WA 6027, Australia
| | - Aaron B Beasley
- Centre for Precision Health, Edith Cowan University, Joondalup WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup WA 6027, Australia
| | - Lydia Warburton
- Centre for Precision Health, Edith Cowan University, Joondalup WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup WA 6027, Australia; Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, Australia
| | - Benhur Amanuel
- School of Medical and Health Sciences, Edith Cowan University, Joondalup WA 6027, Australia; Department of Anatomical Pathology PathWest, QEII Medical Centre, Nedlands WA 6009, Australia
| | - Elin S Gray
- Centre for Precision Health, Edith Cowan University, Joondalup WA 6027, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup WA 6027, Australia.
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12
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Elder DE. Obligate and Potential Precursors of Melanoma. J Natl Cancer Inst 2022; 114:1320-1322. [PMID: 36042556 PMCID: PMC9552272 DOI: 10.1093/jnci/djac139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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13
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Ahmadi F, Karamitanha F, Ramezanpour A. Clustering trends of melanoma incidence and mortality: A worldwide assessment from 1995 to 2019. Australas J Dermatol 2022; 63:e206-e217. [PMID: 35635491 DOI: 10.1111/ajd.13882] [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: 02/09/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melanoma is a skin cancer that has higher mortality among cutaneous malignant tumours. Tumour incidence in most world regions is rising. Here, we intend to highlight these trends in the world. METHODS We used the global burden of disease dataset to assess the incidence and mortality of melanoma from 1995 to 2019 in 204 countries/territories. To identify country/territory groups with similar trends of melanoma incidence and mortality, a model-based clustering with a mixture of multivariate t-distributions was used. RESULTS Australia and New Zealand had the largest incidence and mortality rates. Men in Egypt and women in Sri Lanka and Guam had the lowest incidence and mortality rates. The clustering analysis revealed 4 classes of incidence in both gender and 3 and 2 classes of mortality in male and female, respectively. All groups had a growing incidence rate in both gender, similar to the worldwide trend. In 10% of the countries/territories, central and Western Europe, the incidence increase rate was greater than in the countries/territories with the greatest incidence. The total mortality rate for men was steadily growing, although it was decreasing in Asian and African countries/territories. Overall, the mortality rate for women remained relatively steady over time. CONCLUSION Due to the increasing trend of melanoma in the world, primary and secondary prevention of this disease, especially in areas with higher incidence and mortality, is essential. Raising awareness about the disease is helpful in prevention and early detection of melanoma.
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Affiliation(s)
- Farzane Ahmadi
- Assistant Professor of Biostatistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Farzaneh Karamitanha
- Assistant Professor of Community Medicine, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Afshar Ramezanpour
- Associate professor of Dermatology, Dermatologic Ward, Valiasr Hospital School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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14
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Ince FA, Shariev A, Dixon K. PTEN as a target in melanoma. J Clin Pathol 2022; 75:jclinpath-2021-208008. [PMID: 35534199 DOI: 10.1136/jclinpath-2021-208008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/03/2022] [Indexed: 11/03/2022]
Abstract
PTEN is a well-known tumour suppressor protein that is frequently found to be mutated, inactivated or deleted in a wide range of different cancers. Its tumour suppressive properties result predominantly from its inhibitory effects on the PI3K-AKT signalling pathway. In melanoma, numerous different PTEN mutations have been identified in both melanoma cell lines and melanoma tissue. A number of different molecules can act on PTEN to either promote its suppression of melanoma, while other molecules may antagonise PTEN to inhibit its mechanism of action against melanoma. This review will discuss how the interactions of PTEN with other molecules may have a positive or negative impact on melanoma pathogenesis, giving rise to the potential for PTEN-targeted therapies against melanoma.
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Affiliation(s)
- Furkan Akif Ince
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Artur Shariev
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katie Dixon
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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15
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Shariev A, Painter N, Reeve VE, Haass NK, Rybchyn MS, Ince FA, Mason RS, Dixon KM. PTEN: A novel target for vitamin D in melanoma. J Steroid Biochem Mol Biol 2022; 218:106059. [PMID: 35033661 DOI: 10.1016/j.jsbmb.2022.106059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/07/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022]
Abstract
Melanoma is the most dangerous form of skin cancer, with poor prognosis in advanced stages. Vitamin D, also produced by ultraviolet radiation, is known for its anti-proliferative properties in some cancers including melanoma. While vitamin D deficiency has been associated with advanced melanoma stage and higher levels of vitamin D have been associated with better outcomes, the role for vitamin D in melanoma remains unclear. Vitamin D synthesis is initiated upon UVB exposure of skin cells and results in formation of the active metabolite 1,25-dihydroxyvitamin D3 (1,25D). We have previously demonstrated that 1,25D plays a role in protection against ultraviolet radiation-induced DNA damage, immune suppression, and skin carcinogenesis. In this study 1,25D significantly reduced cell viability and increased caspase levels in human melanoma cell lines. This effect was not present in cells that lacked both phosphatase and tensin homolog deleted on chromosome 10 (PTEN), a well-known tumour suppressor, and the vitamin D receptor (VDR). PTEN is frequently lost or mutated in melanoma. Incubation of selected melanoma cell lines with 1,25D resulted in significant increases in PTEN levels and downregulation of the AKT pathway and its downstream effectors. This suggests that 1,25D may act to reduce melanoma cell viability by targeting PTEN.
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Affiliation(s)
- Artur Shariev
- Discipline of Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales 2006, Australia
| | - Nicole Painter
- Discipline of Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales 2006, Australia
| | - Vivienne E Reeve
- Faculty of Veterinary Science, The University of Sydney, New South Wales 2006, Australia
| | - Nikolas K Haass
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland 4102, Australia
| | - Mark S Rybchyn
- School of Chemical Engineering, University of New South Wales, Sydney, New South Wales 2033, Australia
| | - Furkan A Ince
- Discipline of Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales 2006, Australia
| | - Rebecca S Mason
- School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, New South Wales 2006, Australia
| | - Katie M Dixon
- Discipline of Anatomy and Histology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales 2006, Australia.
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16
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Glenister K, Bougoulias M, Zgibor J, Bourke L, Simmons D. Self-reported skin cancer-related behaviours in rural Victoria: results from repeat cross-sectional studies in 2001-2003 and 2016-2018. Aust N Z J Public Health 2022; 46:382-386. [PMID: 35238449 DOI: 10.1111/1753-6405.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess whether self-reported use of sun-protective measures and skin examination have changed between 2001 and 2018 in a rural setting. METHODS Repeat cross-sectional survey of randomly selected households in four rural Victorian towns. People aged 16 years and older were eligible to participate. Logistic regression was used to identify demographic factors associated with sun-protective measures and skin examination. RESULTS Overall, 5,328 participated in 2001-2003 and 2,680 in 2016-2018. Among participants who go out in the sun, the mean number of reported sun-protective measures (2.6±1.3 vs. 2.6±1.6, p=0.867) and the proportion of participants reporting usually/always using sun protection (65.1% vs. 63.9%, p=0.307) were unchanged between the two surveys. However, an increased proportion of participants reported avoiding the sun when outdoors in the more recent survey (from 18.8% to 34.3%, p<0.001). Avoiding the sun was associated with being older, female, of European origin and having post-secondary school education. Skin examination rates increased between the two surveys (32.7% to 40.8%, p<0.001). Skin examinations were associated with older age groups, European origin and post-secondary school education and being male. CONCLUSIONS Given the small changes in sun protection over time, updated skin cancer campaigns are needed to encourage increased sun-protective behaviours and skin examinations among rural residents. Implications for public health: Results suggest that updated health promotion campaigns targeted to rural areas are warranted.
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Affiliation(s)
| | - Mary Bougoulias
- College of Public Health, University of South Florida Tampa, US
| | - Janice Zgibor
- College of Public Health, University of South Florida Tampa, US
| | - Lisa Bourke
- Department of Rural Health, University of Melbourne, Victoria
| | - David Simmons
- Department of Rural Health, University of Melbourne, Victoria.,Macarthur Clinical School, Western Sydney University, New South Wales
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17
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Elsner P. Unterlassene Biopsie und verspätete Diagnose eines malignen Melanoms. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1216-2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEine 41-jährige Patientin konsultierte eine Hautärztin wiederholt wegen einer nach einer Schwangerschaft aufgetretenen Melanom-verdächtigen Pigmentläsion im Bereich der Schulter; die Hautärztin vermerkte die Differenzialdiagnose eines malignen Melanoms, führte aber erst nach 2 Jahren eine Biopsie durch, die ein Melanom ergab (3,3 × 2,3 cm großes superfiziell spreitendes malignes Melanom mit Regression und Ulzeration sowie Satellitenmetastasen).Sowohl die von der Patientin angerufene Gutachterkommission bei der zuständigen Ärztekammer als auch das Landgericht, an dem die Patientin eine Arzthaftungsklage gegen die Hautärztin erhob, als auch schließlich das Oberlandesgericht als Berufungsinstanz bestätigten einen vorwerfbaren Behandlungsfehler der Hautärztin, da die Unterlassung einer Biopsie nicht dem Facharztstandard entsprochen habe. Aufgrund des Befunderhebungsfehlers trat eine Beweislastumkehr für die bei der Patientin aufgetretenen Gesundheitsschäden ein.Auch unter Einsatz zusätzlicher diagnostischer Verfahren wie der Dermatoskopie verbleibt eine diagnostische Ungewissheit bei einem Teil von Pigmentläsionen und das Vorliegen eines malignen Melanoms kann in diesen Fällen nicht mit Sicherheit ausgeschlossen werden. Diese Ungewissheit sollte mit dem Patienten besprochen und darauf hingewiesen werden, dass eine definitive diagnostische Klärung unklarer Pigmentveränderungen eine Exzision oder Biopsie der Läsion erforderlich macht mit der potenziellen Konsequenz, einen negativen dermatopathologischen Befund zu erhalten und damit retrospektiv eine „Übertherapie“ durchgeführt zu haben. Im Sinne der Einhaltung des Facharztstandards ist diese „Übertherapie“ anzuraten, da die mit einer im Nachhinein als unnötig beurteilten Exzision einhergehenden Folgen wie eine Narbenbildung geringer wiegen als die Diagnoseverspätung beim malignen Melanom. Die Entscheidung des Patienten für oder gegen eine Exzision oder Biopsie sollte zur Vermeidung haftungsrechtlicher Konsequenzen schriftlich dokumentiert werden.
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Affiliation(s)
- P. Elsner
- Klinik für Hautkrankheiten, Universitätsklinikum Jena
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18
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Lee KJ, Betz-Stablein B, Stark MS, Janda M, McInerney-Leo AM, Caffery LJ, Gillespie N, Yanes T, Soyer HP. The Future of Precision Prevention for Advanced Melanoma. Front Med (Lausanne) 2022; 8:818096. [PMID: 35111789 PMCID: PMC8801740 DOI: 10.3389/fmed.2021.818096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022] Open
Abstract
Precision prevention of advanced melanoma is fast becoming a realistic prospect, with personalized, holistic risk stratification allowing patients to be directed to an appropriate level of surveillance, ranging from skin self-examinations to regular total body photography with sequential digital dermoscopic imaging. This approach aims to address both underdiagnosis (a missed or delayed melanoma diagnosis) and overdiagnosis (the diagnosis and treatment of indolent lesions that would not have caused a problem). Holistic risk stratification considers several types of melanoma risk factors: clinical phenotype, comprehensive imaging-based phenotype, familial and polygenic risks. Artificial intelligence computer-aided diagnostics combines these risk factors to produce a personalized risk score, and can also assist in assessing the digital and molecular markers of individual lesions. However, to ensure uptake and efficient use of AI systems, researchers will need to carefully consider how best to incorporate privacy and standardization requirements, and above all address consumer trust concerns.
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Affiliation(s)
- Katie J. Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Brigid Betz-Stablein
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Mitchell S. Stark
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Liam J. Caffery
- Centre for Health Services Research, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nicole Gillespie
- The University of Queensland Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, QLD, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- *Correspondence: H. Peter Soyer
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19
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Watts CG, McLoughlin K, Goumas C, van Kemenade CH, Aitken JF, Soyer HP, Fernandez Peñas P, Guitera P, Scolyer RA, Morton RL, Menzies SW, Caruana M, Kang YJ, Mann GJ, Chakera AH, Madronio CM, Armstrong BK, Thompson JF, Cust AE. Association Between Melanoma Detected During Routine Skin Checks and Mortality. JAMA Dermatol 2021; 157:1425-1436. [PMID: 34730781 DOI: 10.1001/jamadermatol.2021.3884] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Early melanoma diagnosis is associated with better health outcomes, but there is insufficient evidence that screening, such as having routine skin checks, reduces mortality. Objective To assess melanoma-specific and all-cause mortality associated with melanomas detected through routine skin checks, incidentally or patient detected. A secondary aim was to examine patient, sociodemographic, and clinicopathologic factors associated with different modes of melanoma detection. Design, Setting, and Participants This prospective, population-based, cohort study included patients in New South Wales, Australia, who were diagnosed with melanoma over 1 year from October 23, 2006, to October 22, 2007, in the Melanoma Patterns of Care Study and followed up until 2018 (mean [SD] length of follow-up, 11.9 [0.3] years) by using linked mortality and cancer registry data. All patients who had invasive melanomas recorded at the cancer registry were eligible for the study, but the number of in situ melanomas was capped. The treating doctors recorded details of melanoma detection and patient and clinical characteristics in a baseline questionnaire. Histopathologic variables were obtained from pathology reports. Of 3932 recorded melanomas, data were available and analyzed for 2452 (62%; 1 per patient) with primary in situ (n = 291) or invasive (n = 2161) cutaneous melanoma. Data were analyzed from March 2020 to January 2021. Main Outcomes and Measures Melanoma-specific mortality and all-cause mortality. Results A total of 2452 patients were included in the analyses. The median age at diagnosis was 65 years (range, 16-98 years), and 1502 patients (61%) were men. A total of 858 patients (35%) had their melanoma detected during a routine skin check, 1148 (47%) self-detected their melanoma, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion, and 153 (6%) reported "other" presentation. Routine skin-check detection of invasive melanomas was associated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60; P < .001) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76; P < .001), adjusted for age and sex, compared with patient-detected melanomas. After adjusting for prognostic factors including ulceration and mitotic rate, the associations were 0.68 (95% CI, 0.44-1.03; P = .13), and 0.75 (95% CI, 0.63-0.90; P = .006), respectively. Factors associated with higher odds of routine skin-check melanoma detection included being male (female vs male, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), having previous melanoma (vs none, OR, 2.36; 95% CI, 1.77-3.15; P < .001), having many moles (vs not, OR, 1.39; 95% CI, 1.10-1.77; P = .02), being 50 years or older (eg, 50-59 years vs <40 years, OR, 2.89; 95% CI, 1.92-4.34; P < .001), and living in nonremote areas (eg, remote or very remote vs major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003). Conclusions and Relevance In this cohort study, melanomas diagnosed through routine skin checks were associated with significantly lower all-cause mortality, but not melanoma-specific mortality, after adjustment for patient, sociodemographic, and clinicopathologic factors.
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Affiliation(s)
- Caroline G Watts
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Surveillance, Epidemiology and Research Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kirstie McLoughlin
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia
| | - Chris Goumas
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia
| | | | - Joanne F Aitken
- School of Public Health, The University of Queensland, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Pablo Fernandez Peñas
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Hospital, Westmead, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia
| | - Yoon Jung Kang
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Annette H Chakera
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Christine M Madronio
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bruce K Armstrong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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20
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Bergeron C, Czajkowska Z, Coroiu A, Sewitch M, Hall NC, Körner A. The impact of physician support on skin self-examination among melanoma patients: A serial mediation model with self-efficacy and intentions to perform skin exams. PATIENT EDUCATION AND COUNSELING 2021; 104:2364-2370. [PMID: 33663904 DOI: 10.1016/j.pec.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Melanoma is the most lethal of skin cancers; however, survival rates are excellent if the tumor is detected early. Clinical practice guidelines for melanoma follow-up care recommend regular skin self-examination (SSE) for individuals at high risk for melanoma. The current analyses tested whether self-efficacy for SSE and intention to perform SSE mediate the relationship between physician support for SSE and SSE behavior among a sample of melanoma patients. METHODS We ran a serial mediation model on a cross-sectional sample of melanoma patients (n = 154) drawn from an observational study with longitudinal follow-up. RESULTS Self-efficacy and intention to perform SSE sequentially mediated the relationship between physician support and SSE behaviors (β = .31, t(152) = 3.61, p < .001 without mediators versus β = .11, t(150) = 1.50, p = .14 with mediators), as supported by a significant total indirect effect (β = .21, [95 % CI = .08-.35]). CONCLUSION Self-efficacy for SSE and intention to perform SSE together explain the link between perceived physician support for SSE and the practice of SSE. PRACTICE IMPLICATIONS Physician communication about the importance of SSE plays an important role in encouraging patient adherence to SSE recommendations and, thus, supporting early detection efforts.
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Affiliation(s)
- Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.
| | - Zofia Czajkowska
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Maida Sewitch
- Department of Medicine, McGill University, Montreal, Canada
| | - Nathan C Hall
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada; Department of Oncology, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre, Montreal, Canada; Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
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21
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Familial Risks and Proportions Describing Population Landscape of Familial Cancer. Cancers (Basel) 2021; 13:cancers13174385. [PMID: 34503195 PMCID: PMC8430802 DOI: 10.3390/cancers13174385] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/10/2021] [Accepted: 08/27/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Familial cancer can be defined through the occurrence of the same cancer in two or more family members. Hereditary cancer is a narrower definition of high-risk familial aggregation through identified predisposing genes. The absence of correlation between spouses for risk of most cancers, particularly those not related to tobacco smoking or solar exposure, suggests that familial cancers are mainly due to genetic causes. The aim of the present study was to define the frequency and increased risk for familial cancer. Data on 31 of the most common cancers were obtained from the Swedish Family-Cancer Database and familial relative risks (SIRs) were estimated between persons with or without family history of the same cancer in first-degree relatives. Practically all cancers showed a familial risk, with an SIR most commonly around two, or a doubling of the risk because of family history. Abstract Background: Familial cancer can be defined through the occurrence of the same cancer in two or more family members. We describe a nationwide landscape of familial cancer, including its frequency and the risk that it conveys, by using the largest family database in the world with complete family structures and medically confirmed cancers. Patients/methods: We employed standardized incidence ratios (SIRs) to estimate familial risks for concordant cancer among first-degree relatives using the Swedish Cancer Registry from years 1958 through 2016. Results: Cancer risks in a 20–84 year old population conferred by affected parents or siblings were about two-fold compared to the risk for individuals with unaffected relatives. For small intestinal, testicular, thyroid and bone cancers and Hodgkin disease, risks were higher, five-to-eight-fold. Novel familial associations included adult bone, lip, pharyngeal, and connective tissue cancers. Familial cancers were found in 13.2% of families with cancer; for prostate cancer, the proportion was 26.4%. High-risk families accounted for 6.6% of all cancer families. Discussion/Conclusion: High-risk family history should be exceedingly considered for management, including targeted genetic testing. For the major proportion of familial clustering, where genetic testing may not be feasible, medical and behavioral intervention should be indicated for the patient and their family members, including screening recommendations and avoidance of carcinogenic exposure.
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Dunlop K, Rankin NM, Smit AK, Salgado Z, Newson AJ, Keogh L, Cust AE. Acceptability of risk-stratified population screening across cancer types: Qualitative interviews with the Australian public. Health Expect 2021; 24:1326-1336. [PMID: 33974726 PMCID: PMC8369084 DOI: 10.1111/hex.13267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/12/2021] [Accepted: 04/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is mounting evidence of the benefit of risk-stratified (risk-tailored) cancer population screening, when compared to standard approaches. However, shifting towards this approach involves changes to practice that may give rise to implementation challenges. OBJECTIVES To explore the public's potential acceptance of risk-stratified screening across different cancer types, including reducing screening frequency if at low risk and the use of personal risk information, to inform implementation strategies. METHOD Semi-structured interviews were conducted with 40 public participants; half had received personal genomic risk information and half had not. Participants were prompted to consider different cancers. Data were analysed thematically as one dataset. RESULTS Themes included the following: (a) a sense of security; (b) tailored screening is common sense; (c) risk and the need to take action; (d) not every cancer is the same; and (e) trust and belief in health messages. Both groups expressed similar views. Participants were broadly supportive of risk-stratified screening across different cancer types, with strong support for increased screening frequency for high-risk groups. They were less supportive of reduced screening frequency or no screening for low-risk groups. Findings suggest the public will be amenable to reducing screening when the test is invasive and uncomfortable; be less opposed to forgo screening if offered the opportunity to screen at some stage; and view visible cancers such as melanoma differently. CONCLUSIONS Approaching distinct cancer types differently, tailoring messages for different audiences and understanding reasons for participating in screening may assist with designing future implementation strategies for risk-stratified cancer screening.
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Affiliation(s)
- Kate Dunlop
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
| | - Nicole M. Rankin
- Sydney School of Public Health, The Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Amelia K. Smit
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
| | - Zofia Salgado
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
| | - Ainsley J. Newson
- Sydney Health Ethics, Sydney School of Public Health, The Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Louise Keogh
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVICAustralia
| | - Anne E. Cust
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
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23
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Sikorska M, Skalski A, Wodzinski M, Witkowski A, Pellacani G, Ludzik J. Learning-based local quality assessment of reflectance confocal microscopy images for dermatology applications. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Cheong KH, Tang KJW, Zhao X, Koh JEW, Faust O, Gururajan R, Ciaccio EJ, Rajinikanth V, Acharya UR. An automated skin melanoma detection system with melanoma-index based on entropy features. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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25
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Shetty A, Janda M, Fry K, Brown S, Yau B, Schuckmann LV, Thomas S, Rayner JE, Spelman L, Wagner G, Jenkins H, Lun K, Parbery J, Soyer HP, Neale RE, Green AC, Whiteman DC, Olsen CM, Khosrotehrani K. Clinical utility of skin cancer and melanoma risk scores for population screening: TRoPICS study. J Eur Acad Dermatol Venereol 2020; 35:1094-1098. [PMID: 33274462 DOI: 10.1111/jdv.17062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Screening for skin cancer can be cost-effective if focused on high-risk groups. Risk prediction tools have been developed for keratinocyte cancers and melanoma to optimize advice and management. However, few have been validated in a clinical setting over the past few years. OBJECTIVES To assess the clinical utility of risk assessment tools to identify individuals with prevalent skin cancers in a volunteer-based screening clinic. METHODS Participants were adults presenting for a skin check at a volunteer-based skin cancer screening facility. We used previously published tools, based on questionnaire responses, to predict melanoma and keratinocyte cancers [KCs; basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)] and classified each participant into one of five risk categories. Participants subsequently underwent a full skin examination by a dermatologist. All suspicious lesions were biopsied, and all cancers were histopathologically confirmed. RESULTS Of 789 people who presented to the clinic, 507 (64%) consented to the study. Twenty-two BCCs, 19 SCCs and eight melanomas were diagnosed. The proportion of keratinocyte cancers diagnosed increased according to risk category from <1% in the lowest to 24% in the highest risk category (P < 0.001). Subtype analysis revealed similar proportionate increases in BCC or SCC prevalence according to risk category. However, a similar proportion of melanoma cases were detected in the low-risk and high-risk groups. CONCLUSION The risk prediction model for keratinocyte cancers can reliably identify individuals with a significant skin cancer burden prior to a skin examination in the community setting. The prediction tool for melanoma needs to be tested in a larger sample exposed to a wider range of environmental risk factors.
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Affiliation(s)
- A Shetty
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - M Janda
- Centre of Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - K Fry
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - S Brown
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - B Yau
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - L Von Schuckmann
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - S Thomas
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - J E Rayner
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - L Spelman
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - G Wagner
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - H Jenkins
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - K Lun
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - J Parbery
- Queensland Institute of Dermatology, Queensland Skin and Cancer Foundation, Brisbane, QLD, Australia
| | - H P Soyer
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - R E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - A C Green
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - D C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - C M Olsen
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - K Khosrotehrani
- UQ Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
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Reyes-Marcelino G, Tabbakh T, Espinoza D, Sinclair C, Kang YJ, McLoughlin K, Caruana M, Fernández-Peñas P, Guitera P, Aitken JF, Canfell K, Dobbinson S, Cust AE. Prevalence of skin examination behaviours among Australians over time. Cancer Epidemiol 2020; 70:101874. [PMID: 33341599 DOI: 10.1016/j.canep.2020.101874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to examine the prevalence and correlates of opportunistic skin check behaviours among Australians and whether changes over time might explain increasing underlying rates of melanoma in situ. METHODS The National Sun Protection Survey involved periodic telephone-based cross-sectional surveys during summer since 2003. Skin checks by a doctor in the past 12 months was asked in four summers over 2006-2017, and responses from 23,374 Australians aged 12-69 years were analysed. Prevalence estimates were weighted to be representative of the Australian population. Chi-square tests compared the prevalence over time and by characteristics. RESULTS The overall proportion reporting whole-body skin checks in the past 12 months was 20 % in 2006-07 and 2010-11, 21 % in 2013-14, and 22 % in 2016-17; but increased from 29 % in 2006-07 to 37 % in 2016-17 for those aged 45-69 years (p < 0.0001). In 2016-17, 5% reported a skin check of part-body and 9% for a specific mole or spot. The proportion reporting no skin checks increased from 61 % to 64 % over time (p < 0.0001). Whole-body skin checks were more common among older respondents, females, and also varied by residence location, skin sensitivity, skin colour, risk perception, and socio-economic index (all p < 0.001). CONCLUSION Approximately one third of Australians had their skin checked by a doctor within a 12-month period, but this varied across population sub-groups. Skin check behaviours were relatively stable over time, with modest increases in the prevalence of skin checks for those aged 45-69 years. These findings do not explain underlying large increases in rates of melanoma in situ.
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Affiliation(s)
- Gillian Reyes-Marcelino
- Sydney School of Public Health, Building A27, The University of Sydney, NSW 2006, Australia.
| | - Tamara Tabbakh
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia.
| | - Craig Sinclair
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Yoon-Jung Kang
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Kirstie McLoughlin
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Michael Caruana
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Pablo Fernández-Peñas
- Department of Dermatology, Westmead Clinical School, The University of Sydney, NSW 2006, Australia.
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft, NSW 2065, Australia; Department of Dermatology, Central Clinical School, The University of Sydney, NSW 2006, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, NSW 2050, Australia.
| | - Joanne F Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, QLD 4006, Australia.
| | - Karen Canfell
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Suzanne Dobbinson
- Cancer Council Victoria, 615St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Anne E Cust
- Sydney School of Public Health, Building A27, The University of Sydney, NSW 2006, Australia; Melanoma Institute Australia, The University of Sydney, 40 Rocklands Rd, Wollstonecraft, NSW 2065, Australia.
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27
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Barsoum R, Harrison SL. Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228680. [PMID: 33238422 PMCID: PMC7700251 DOI: 10.3390/ijerph17228680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups.
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Affiliation(s)
- Ramez Barsoum
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
- Princess Alexandra Hospital, Queensland Health, Woolloongabba, Brisbane 4102, Australia
| | - Simone L. Harrison
- Skin Cancer Research Unit, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville 4811, Australia;
- College of Medicine and Dentistry, James Cook University, Townsville 4811, Australia
- Correspondence: ; Tel.: +61-(0)423-489-083
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Young AT, Vora NB, Cortez J, Tam A, Yeniay Y, Afifi L, Yan D, Nosrati A, Wong A, Johal A, Wei ML. The role of technology in melanoma screening and diagnosis. Pigment Cell Melanoma Res 2020; 34:288-300. [PMID: 32558281 DOI: 10.1111/pcmr.12907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
Melanoma presents challenges for timely and accurate diagnosis. Expert panels have issued risk-based screening guidelines, with recommended screening by visual inspection. To assess how recent technology can impact the risk/benefit considerations for melanoma screening, we comprehensively reviewed non-invasive visual-based technologies. Dermoscopy increases lesional diagnostic accuracy for both dermatologists and primary care providers; total body photography and sequential digital dermoscopic imaging also increase diagnostic accuracy, are supported by automated lesion detection and tracking, and may be best suited to use by dermatologists for longitudinal follow-up. Specialized imaging modalities using non-visible light technology have unproven benefit over dermoscopy and can be limited by cost, access, and training requirements. Mobile apps facilitate image capture and lesion tracking. Teledermatology has good concordance with face-to-face consultation and increases access, with increased accuracy using dermoscopy. Deep learning models can surpass dermatologist accuracy, but their clinical utility has yet to be demonstrated. Technology-aided diagnosis may change the calculus of screening; however, well-designed prospective trials are needed to assess the efficacy of these different technologies, alone and in combination to support refinement of guidelines for melanoma screening.
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Affiliation(s)
- Albert T Young
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Niki B Vora
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jose Cortez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Tam
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Yildiray Yeniay
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Ladi Afifi
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Di Yan
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Adi Nosrati
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Andrew Wong
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Arjun Johal
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, CA, USA.,Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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