The future incidence of cutaneous melanoma within the U.K

Potential risk factors, clinicopathological features and determinants of survival for multiple primary melanoma patients compared to single primary melanoma: a large single-center Italian study

Melanoma patients have a high risk of developing subsequent primary melanomas, a condition known as multiple primary melanoma (MPM). We aimed to compare risk factors of patients with MPM and single primary melanoma (SPM). Primary MPM and SPM consecutively treated at the National Cancer Institute in Milan, Italy, from 1978 to 2021 were retrospectively investigated. Demographic and clinicopathological characteristics were analyzed. Multivariate hazard ratios and mortality were estimated using Cox proportional hazards regression models. Overall, 9122 patients with SPM and 944 with MPM were included. A total of 1437 and 85 deaths occurred in SPM and MPM group, respectively. Of these, 1315 (14.4%) within SPM patients and 60 (6.4%) in MPM group were melanoma-specific deaths (MSDs). Males had a higher risk for MPM (hazard ratio = 1.29), while age was not associated with MPM (hazard ratio = 0.98). The risk of MPM decreased by about 50% for Breslow thickness >1 mm, and by about 45 and 75% in presence of mitoses and ulceration, respectively. The multivariate hazard ratio of death for MPM compared to SPM patients was 0.85 (95% confidence interval, CI: 0.67-1.06), while considering MSD the corresponding hazard ratio was 0.93 (95% CI: 0.71-1.22). Melanoma patients should receive regular follow-up with complete skin examination to detect early subsequent primary melanoma. Patients with more advanced primary have decreased risk of MPM, while males have higher risk. Our study reported no significant difference in mortality between SPM and MPM, but the issue is still open for discussion and further studies.

Melanoma mortality in Spain: predictions up to 2043

BACKGROUND

Melanoma mortality rates are stabilizing and in certain regions and age groups are trending down. Although there are some studies that predict melanoma mortality in other countries, there are currently no studies that predict mortality in Spain in the coming years. The main aim of this study is to calculate melanoma mortality projections in Spain for the period 2019-2043.

METHODS

This is a population-based ecological study that utilized information from the Spanish National Statistics Institute. Analysis included deaths as a result of cutaneous melanoma in Spain in the period 1979-2018, and data was analyzed according to gender and age group. Projections were made until 2043 in five-year periods, calculated in Nordpred (within the R software).

RESULTS

Our estimates predict that in the period 2019-2043, there will be 30,477.9 deaths from melanoma in Spain, with the age group of >85 years being the group with the highest number of deaths. The expected average annual death rate for melanoma in both genders for the period 2019-2043 is 1,269.9 deaths / year. The predicted age-standardized mortality rates varied between 4.62/100.000 inhabitants in the 2019-2023 period and 3.94/100.000 inhabitants in the 2039-2043 period.

CONCLUSIONS

Overall mortality rate and age-standardized melanoma death rates in older people of both genders will increase in the coming years in Spain, while rates in younger people will stabilize or decrease progressively. In the coming years, prevention efforts should focus on the young, but the emphasis should also be on educating the elderly in early detection of melanoma.

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero-American patients

BACKGROUND

The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined.

OBJECTIVE

To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS).

MATERIALS AND METHODS

A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described.

RESULTS

The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS.

CONCLUSIONS

This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.

Burden of skin cancer in Belgium and cost-effectiveness of primary prevention by reducing ultraviolet exposure

Skin cancer (melanoma- and non-melanoma skin cancer) is one of the most rapidly increasing cancers worldwide. This study analysed the current and future economic burden of skin cancer in Belgium and the cost-effectiveness of primary prevention of skin cancer. A retrospective bottom-up cost-of-illness study was performed, together with a Markov model in order to analyse the cost-effectiveness and the budget impact analysis of primary prevention of skin cancer in Belgium. Total prevalence of skin cancer in Belgium was estimated to triple in the next 20years. The total economic burden of skin cancer in 2014 in Belgium was estimated at €106 million, with a cumulative cost of €3 billion in 2034. The majority of this total cost was due to melanoma (65%). Over a period of 50years, both a sensitisation campaign and a total ban on sunbed use would lead to a gain in quality-adjusted life-years and cost-savings. For every euro invested in the campaign, €3.6 would be saved on the long-term for the healthcare payer. Policy makers and clinicians should promote UV protection strategies, as they were estimated to be dominant strategies.

Ultraviolet radiation, aging and the skin: prevention of damage by topical cAMP manipulation

Being the largest and most visible organ of the body and heavily influenced by environmental factors, skin is ideal to study the long-term effects of aging. Throughout our lifetime, we accumulate damage generated by UV radiation. UV causes inflammation, immune changes, physical changes, impaired wound healing and DNA damage that promotes cellular senescence and carcinogenesis. Melanoma is the deadliest form of skin cancer and among the malignancies of highest increasing incidence over the last several decades. Melanoma incidence is directly related to age, with highest rates in individuals over the age of 55 years, making it a clear age-related disease. In this review, we will focus on UV-induced carcinogenesis and photo aging along with natural protective mechanisms that reduce amount of “realized” solar radiation dose and UV-induced injury. We will focus on the theoretical use of forskolin, a plant-derived pharmacologically active compound to protect the skin against UV injury and prevent aging symptoms by up-regulating melanin production. We will discuss its use as a topically-applied root-derived formulation of the Plectranthus barbatus (Coleus forskolii) plant that grows naturally in Asia and that has long been used in various Aryuvedic teas and therapeutic preparations.

Outcomes of routine ilioinguinal lymph node dissection for palpable inguinal melanoma nodal metastasis

BACKGROUND

Patients who present with palpable inguinal melanoma nodal metastasis have two surgical options: inguinal or ilioinguinal lymph node dissection. Indications for either operation remain controversial. This study examined survival and recurrence outcomes following ilioinguinal dissection for patients with palpable inguinal nodal metastasis, and assessed the incidence and preoperative predictors of pelvic nodal metastasis.

METHODS

This was a retrospective clinicopathological analysis of consecutive surgical patients with stage III malignant melanoma. All patients underwent a standardized ilioinguinal dissection at a specialist tertiary oncology hospital over a 12-year period (1998-2010).

RESULTS

Some 38.9 per cent of 113 patients had metastatic pelvic nodes. Over a median follow-up of 31 months, the 5-year overall survival rate was 28 per cent for patients with metastatic inguinal and pelvic nodes, and 51 per cent for those with inguinal nodal metastasis only (P = 0.002). The nodal basin control rate was 88.5 per cent. Despite no evidence of pelvic node involvement on preoperative computed tomography (CT), six patients (5.3 per cent) with a single metastatic inguinal lymph node had metastatic pelvic lymph nodes. Logistic regression analysis showed that the number of metastatic inguinal nodes (odds ratio 1.56; P = 0.021) and suspicious CT findings (odds ratio 9.89; P = 0.001) were both significantly associated with metastatic pelvic nodes. The specificity of CT was good (89.2 per cent) in detecting metastatic pelvic nodes, but the sensitivity was limited (57.9 per cent).

CONCLUSION

Metastatic pelvic nodes are common when palpable metastatic inguinal nodes are present. Long-term survival can be achieved following their resection by ilioinguinal dissection. As metastatic pelvic nodes cannot be diagnosed reliably by preoperative CT, patients presenting with palpable inguinal nodal metastasis should be considered for ilioinguinal dissection.

Emerging trends in the epidemiology of melanoma

Cutaneous melanoma (CM) is one of the most rapidly growing cancers worldwide, with a consistent increase in incidence among white populations over the past four decades. Despite the early detection of primarily thin melanomas and the improved survival rates observed in several countries, the rate of thick melanomas has remained constant or continues to increase, especially in the older age group. Current considerations in the epidemiology of melanoma focus on the observed survival benefit of females vs. males, the contributing role of indoor tanning in melanoma risk and the diverse effect of sun exposure in the development of different types of melanoma with respect to their clinical and mutational profile. Certain well-known risk factors, such as skin, hair and eye pigmentation and melanocytic naevi have been validated in large-scale association studies, while additional lifestyle factors and iatrogenic exposures, such as immunosuppressive agents and nonsteroidal anti-inflammatory drugs are being investigated. In addition, genome-wide association studies have revealed genetic loci that underlie the genetic susceptibility of melanoma, some of which are related to known risk factors. Recently, an interesting association of melanoma with Parkinson disease has been noted, with a higher than expected frequency of melanoma in patients with Parkinson disease and vice versa. This review article provides an update in the epidemiology of cutaneous melanoma and discusses recent developments in the field.

CSMD1 exhibits antitumor activity in A375 melanoma cells through activation of the Smad pathway

In this work, we studied the effects of CUB and Sushi multiple domains 1 gene (CSMD1) expression in A375 melanoma cells in vivo and in vitro. CSDM1 expression decreased proliferation and migration, and increased apoptosis and G(1) arrest in A375 cells in vitro. Expression of CSDM1 in established xenografted tumors decreased tumor size and weight, and decreased the density of intratumor microvessels. The survival rate of mice with tumors expressing CSMD1 was significantly higher than mice with tumors that did not express CSDM1. These results confirm the role of CSDM1 as a tumor suppressor gene in melanoma cells. Furthermore, we found that CSMD1 can interact with Smad3, activate Smad1, Smad2, and Smad3, and increase the expression of Smad4. These results might prove helpful for the development of novel therapies for melanoma treatment.

Trends in skin cancer knowledge, sun protection practices and behaviours in the Northern Ireland population

BACKGROUND

Sun exposure increases risk of skin cancer, especially melanoma, incidence of which continues to rise. Reported skin cancer knowledge and trends in sun care behaviours are documented in a UK region where there has been 20 years of sun-related health promotion campaigns.

METHODS

In 2000, 2004 and 2008, a 'care in the sun' module was included in the Northern Ireland (NI) Omnibus survey. Randomly selected subjects were asked to complete a sun-related questionnaire and proportions of respondents analysed by demographic and socio-economic factors, with differences tested using z-tests and the chi-squared test.

RESULTS

Around 3623 persons responded. Skin cancer knowledge was high (97%). Sun avoidance decreased with time and was lowest among younger age groups and males. Sunscreen use was high (70%), unchanged over 8 years, and more likely among younger age groups, females, those in paid employment, and those with tertiary level education. Use of sunscreen with minimum Sun Protection Factor (SPF) 15 (a campaign message) increased from 45% to 70% (P < 0.01). Skin self-examination was infrequent (8%), less common among those aged ≥65 years, males and those with only primary or secondary level education.

CONCLUSIONS

Messages on sunscreen use have penetrated the population well, but lower use among the unemployed suggests cost as an issue. Lack of sun avoidance in young people, especially men, poses a risk for further skin cancer increases. Low levels of reported skin self-examination in older people, men and those with lower educational attainment identify areas for further action.

Young park users' attitudes and behaviour to sun protection

The increase in skin cancer prevalence globally has prompted a range of health promotion sun safety initiatives. An area where evidence has been lacking is on the long-term impact of some of these initiatives on the attitudes and sun protection behaviour of young adults and of the sun protection measures used by people using city parks. This article disseminates a study that examined the knowledge, attitude and behaviour of 18- to 28-year-old Caucasian park users. An interview questionnaire was used with behaviour validation incorporated to corroborate the results and reduce recall bias. A cross comparison of answers and placement into pre-coded responses were made at regular intervals to ensure consistency of data collection. Knowledge of risks associated with sun exposure and knowledge of sun protection methods was high. The most common sources of knowledge on skin cancer prevention were parents and family, followed by television, then magazines and newspapers. Surprisingly, the citing of school sun safety health promotion initiatives as a source of knowledge was low. The vast majority of females and males felt that a suntan had aesthetic qualities and made them look more attractive and healthy. Only a small number of the participants' sun protection behaviour in the park corresponded with their reported normal sun protection behaviour. Males in this study use sunscreen less than females. Females also used sunscreen with a higher sun protection factor. Seeking a tan is intentional behaviour undertaken by the majority of the participants, although females were more likely to seek a tan in comparison to males. The majority of participants had experienced sunburn in the summer period with some reporting severe sunburn. Recommendations are made for a gender specific health promotion approach, which targets familial education with a supportive environment in the school or public domain.

Accuracy of SIAscopy for pigmented skin lesions encountered in primary care: development and validation of a new diagnostic algorithm

Background

Diagnosing pigmented skin lesions in general practice is challenging. SIAscopy has been shown to increase diagnostic accuracy for melanoma in referred populations. We aimed to develop and validate a scoring system for SIAscopic diagnosis of pigmented lesions in primary care.

Methods

This study was conducted in two consecutive settings in the UK and Australia, and occurred in three stages: 1) Development of the primary care scoring algorithm (PCSA) on a sub-set of lesions from the UK sample; 2) Validation of the PCSA on a different sub-set of lesions from the same UK sample; 3) Validation of the PCSA on a new set of lesions from an Australian primary care population. Patients presenting with a pigmented lesion were recruited from 6 general practices in the UK and 2 primary care skin cancer clinics in Australia. The following data were obtained for each lesion: clinical history; SIAscan; digital photograph; and digital dermoscopy. SIAscans were interpreted by an expert and validated against histopathology where possible, or expert clinical review of all available data for each lesion.

Results

A total of 858 patients with 1,211 lesions were recruited. Most lesions were benign naevi (64.8%) or seborrhoeic keratoses (22.1%); 1.2% were melanoma. The original SIAscopic diagnostic algorithm did not perform well because of the higher prevalence of seborrhoeic keratoses and haemangiomas seen in primary care. A primary care scoring algorithm (PCSA) was developed to account for this. In the UK sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.50 (0.18-0.81); specificity 0.84 (0.78-0.88); PPV 0.09 (0.03-0.22); NPV 0.98 (0.95-0.99). In the Australian sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.44 (0.32-0.58); specificity 0.95 (0.93-0.97); PPV 0.52 (0.38-0.66); NPV 0.95 (0.92-0.96). In an analysis of lesions for which histological diagnosis was available (n = 111), the PCSA had a significantly greater Area Under the Curve than the 7-point checklist for the diagnosis of melanoma (0.83; 95% CI 0.71-0.95 versus 0.61; 95% CI 0.44-0.78; p = 0.02 for difference).

Conclusions

The PCSA could have a useful role in improving primary care management of pigmented skin lesions. Further work is needed to develop and validate the PCSA in other primary care populations and to evaluate the cost-effectiveness of GP management of pigmented lesions using SIAscopy.

Mass media barriers to social marketing interventions: the example of sun protection in the UK

The role of the mass media in communicating health-related information to the wider population is the focus of this paper. Using the example of sun protection within the UK, we highlight some of the major challenges to raising awareness of steadily increasing melanoma rates and of effective sun protection strategies. The implications of potential barriers to official sun protection messages via conflicting messages in the media are discussed in terms of editorial on sun protection and in the way in which television programme content portrays the issues. Implications for public policy and future research conclude the paper.

Update on melanoma: the present position

Cutaneous melanoma is becoming increasingly common among people with fair skins, and this has been blamed on exposure to ultraviolet radiation from sunbathing, the use of sun beds, and holidays abroad. The key to controlling the epidemic of melanoma is prevention, but also important are the organisation of the skin cancer service, surgical advances, and the development of neoadjuvant treatments. Because there are many of these tumours in the head and neck region, head and neck surgeons are increasingly involved in the management of such patients. We review the current philosophy in the management of melanoma.

Epidemiology of invasive cutaneous melanoma

Data are presented on the current incidence of melanoma with recent and predicted future trends illustrating a likely continuing increase in incidence. Risk factors for developing melanoma are discussed, including current known melanoma susceptibility genes. Phenotypic markers of high-risk subjects include high counts of benign melanocytic naevi. Other risk factors considered include exposure to natural and artificial ultraviolet radiation, the effect of female sex hormones, socioeconomic status, occupation, exposure to pesticides and ingestion of therapeutic drugs including immunosuppressives and non-steroidal anti-inflammatory drugs. Aids to earlier diagnosis are considered, including public education, screening and use of equipment such as the dermatoscope. Finally, the current pattern of survival and mortality is described.

Melanoma epidemiology and trends

Rising incidence rates of cutaneous melanoma have been observed during the last four decades in white populations worldwide. The cancer statistics in the United States have revealed 6 cases per 100,000 and year at the beginning of the 1970s and 18 cases per 100,000 inhabitants and year at the beginning of 2000, demonstrating a threefold increase in incidence rates. Incidence rates in central Europe increased in the same time period from 3 to 4 cases to 10 to 15 cases per 100,000 inhabitants and year, which is very similar to the increase in the United States. Cohort studies from several countries indicate that the trend of increasing incidence rates will continue in the future for at least the next 2 decades; thus, an additional doubling of incidence rates is expected. The highest incidence rates have been reported from Australia and New Zealand, from 40 to 60 cases per 100,000 inhabitants and year. Mortality rates likewise slightly increased in the United States and in Europe during the 1970s and 1980s. In the 1990 s, however, a leveling off of mortality rates was observed in many countries. Simultaneously, a clear decrease of Breslow tumor thickness was reported in the United States and European countries. This development indicates improved early recognition of cutaneous melanoma, which is presently the main factor for a more favorable prognosis.

Recognition of skin malignancy by general practitioners: observational study using data from a population-based randomised controlled trial

Skin malignancy is an important cause of mortality in the United Kingdom and is rising in incidence every year. Most skin cancer presents in primary care, and an important determinant of outcome is initial recognition and management of the lesion. Here we present an observational study of interobserver agreement using data from a population-based randomised controlled trial of minor surgery. Trial participants comprised patients presenting in primary care and needing minor surgery in whom recruiting doctors felt to be able to offer treatment themselves or to be able to refer to a colleague in primary care. They are thus relatively unselected. The skin procedures undertaken in the randomised controlled trial generated 491 lesions with a traceable histology report: 36 lesions (7%) from 33 individuals were malignant or pre-malignant. Chance-corrected agreement (kappa) between general practitioner (GP) diagnosis of malignancy and histology was 0.45 (0.36-0.54) for lesions and 0.41 (0.32-0.51) for individuals affected with malignancy. Sensitivity of GPs for the detection of malignant lesions was 66.7% (95% confidence interval (CI), 50.3-79.8) for lesions and 63.6% (95% CI, 46.7-77.8) for individuals affected with malignancy. The safety of patients is of paramount importance and it is unsafe to leave the diagnosis and treatment of potential skin malignancy in the hands of doctors who have limited training and experience. However, the capacity to undertake all of the minor surgical demand works demanded in hospitals does not exist. If the capacity to undertake it is present in primary care, then the increased costs associated with enhanced training for general medical practitioners (GPs) must be borne.

Melanoma in organ transplant recipients: clinicopathological features and outcome in 100 cases

Organ transplant recipients have a higher incidence of melanoma compared to the general population but the prognosis of this potentially fatal skin cancer in this group of patients has not yet been established. To address this, we undertook a multicenter retrospective analysis to assess outcome for 100 melanomas (91 posttransplant and 9 pretransplant) in 95 individuals. Data were collected in 14 specialist transplant dermatology clinics across Europe belonging to the Skin Care in Organ Transplant Patients, Europe (SCOPE) Network, and compared with age, sex, tumor thickness and ulceration status-matched controls from the American Joint Committee on Cancer (AJCC) melanoma database. Outcome for posttransplant melanoma was similar to that of the general population for T1 and T2 tumors (< or = 2 mm thickness); but was significantly worse for T3 and T4 tumors (> 2 mm thickness); all nine individuals with a pretransplant melanoma survived without disease recurrence following organ transplantation. These data have implications for both cutaneous surveillance in organ transplant recipients and management of transplant-associated melanoma.

Sun safety: what are the health messages?

Solar ultraviolet radiation (UVR) is a human carcinogen. The UK and the worldwide incidence of cutaneous (skin) melanoma are rising. It is now the second most common cancer in 15-34 year-olds in the UK, increasing by 49% in 1991—2000. The UK government prioritized skin cancer in 1992 in their public health strategy The Health of the Nation, and set the target for reducing the yearly rise in skin cancer incidence by 2005. In 1998 in the Saving Lives: Our Healthier Nation strategy, targets were set to reduce the death rate from cancer, including skin cancer, by 20% by 2010. As a consequence of these targets, since the mid-1990s public health campaigns to reduce sun exposure and skin cancer incidence in the UK have used specific interventions for at-risk groups and the mass media to reach the general population. Evidence indicates a shift in knowledge, with further work required to increase change in behaviour and attitudes.

An associate health problem is vitamin D deficiency, which is prevalent across certain UK population groups. The main childhood health problem associated with vitamin D deficiency is the development of rickets, with evidence indicating those at high risk are exclusively breastfed dark-skinned infants, the elderly, those with dark skin pigmentation, and certain cultural groups that cover their bodies in clothing. Adolescents are the group with the highest incidence of low vitamin D status in the UK, with children of Asian descent at higher risk than Caucasian children. Increasing the outdoor activity levels of children in winter and during the cooler hours in summer is one way of increasing safe sun exposure. It is imperative to educate the general public on the risk of vitamin D deficiency, and offer advice on safe sun exposure, dietary sources of vitamin D, and dietary supplements. More research is required on recommendations for daily vitamin D supplements to determine optimal vitamin D levels in different population groups. There also needs to be reliable and accessible evidence on the links between vitamin D deficiency and lack of sun exposure, with sun safe messages adjusted accordingly.

Melanoma incidence and mortality in Scotland 1979-2003

We studied 12,450 cases of invasive melanoma diagnosed in Scotland in 1979-2003, by thickness, pathological type, and body site at ages under 40, 40-59, and 60 years and over. Melanoma incidence trebled in males from 3.57 to 10.93/10(5) per year, and increased 2.3-fold in females from 5.60 to 12.96/10(5) per year. The rate of increase fell in each successive 5-year period. The greatest increase was in males aged 60 years and over at diagnosis. Significant incidence increases were seen in melanomas < 1 mm in all three age groups, but those > 4 mm only increased significantly at ages 60 years and over. All histological types increased significantly at ages 60 years and over, and in this age group the greatest increase was seen on the head and neck. Five-year disease-free survival improved steadily. Survival figures for 1994-1998 ranged from 93.6% for males and 95.8% for females with tumours < 1 mm, to 52.4 and 48.3%, respectively, for those with tumours > 4 mm. Over the 25 years, melanoma mortality doubled in males from 1.1 to 2.4/10(5) per year, but was unchanged in females at 1.5/10(5) per year. Public education on melanoma is required both for primary prevention and earlier diagnosis, particularly for older males.

Cutaneous melanoma: a population-based epidemiology report with 989 patients in Hong Kong

Studies in white populations have confirmed advanced age as a risk factor for cutaneous melanoma, but in nonwhite populations, its role is less clear. To clarify a possible association in our local population, comprising 94.9% Chinese, a retrospective epidemiological study of 20 years of data on cutaneous melanoma between 1983 and 2002 from a central cancer registry in Hong Kong was conducted. There were 989 new cases and 378 death cases registered, and analysis showed that both the incidence and mortality rate of cutaneous melanoma increase with increasing age. Advanced age is thus confirmed as a risk factor for cutaneous melanoma in our local population. In an ageing population, the estimated future incidence and mortality rate of cutaneous melanoma are likely to increase.

Quantitative discrimination of pigmented lesions using three-dimensional high-resolution ultrasound reflex transmission imaging

High-resolution ultrasound-reflex transmission imaging is a non-invasive method that can be performed in vivo. We have adapted and refined this technique for skin imaging. Scans can be analyzed to produce objective parameters. Previous work has highlighted sonographic differences between benign and malignant lesions. The aim of this study was to produce and test numerical parameters from ultrasound skin images that would quantify the acoustic differences between common pigmented lesions, which may aid their discrimination from melanoma. We report our findings for randomly selected patients referred from primary care with suspected melanoma. Those subsequently classified as malignant melanoma (MM), seborrheic keratosis (SK), and benign nevi by a consultant dermatologist (n=87) were imaged by high-resolution ultrasound-reflex transmission imaging. Using surrounding normal skin as a control, numerical sonographic parameters were derived for each lesion giving a relative measure of surface sound reflectance, intra-lesional sound reflection, total sound attenuation, and the relative uniformity of each parameter across the tumor. Significant quantitative differences existed between benign and malignant pigmented lesions studied. Sufficient discrimination was produced between MM (n=25), SKs (n=24) and other benign-pigmented lesions (n=38) to potentially reduce the referral of benign tumors by 65% without missing melanoma.

Public awareness regarding UV risks and vitamin D--the challenges for UK skin cancer prevention campaigns

Since 1970s, incidence rates for malignant melanoma have been among the fastest rising of all cancers in the UK. Compared to other cancers, melanoma affects disproportionately more young people, and non-melanoma skin cancers are the most commonly diagnosed, with over 100,000 new cases estimated in the UK annually. Government targets to reduce skin cancer incidence have led working groups and prevention campaigns to be set up in the belief that moderating UV exposure will help. An increased awareness of skin cancer has clearly played a role in curbing mortality from the disease, but translating knowledge into behaviour change in this context is a slow and complex process, and campaigns need to be sustained if they are to impact on incidence. A growing body of literature suggesting a cancer protective role for vitamin D and sun exposure presents further challenges for skin cancer prevention campaigns, no more so than when exaggerated claims for the health benefits of sunbathing make the media spotlight. The UK population tend to need little encouragement to make the most of sunshine, and this is especially true for the younger generation who most need to take care. Public health messages to avoid the midday sun, not to burn and to protect children should not adversely affect outdoor activity or population vitamin D levels, but it is important that they are targeted to those most at risk and are consistent. More research is required to establish optimal levels of vitamin D and how to safely achieve them in a heterogeneous population. In the meantime, hasty alterations of public health messages are likely to prove counterproductive.

Sunscreens and melanoma: the future looks bright

BACKGROUND

Meta-analyses of observational case-control studies have demonstrated no association between sunscreen use and the development of malignant melanoma.

OBJECTIVES

To examine whether this observation is to be expected given the period during which the case-control studies were conducted, the sunscreens prevalent at that time, and how sunscreen is used and applied in practice. To predict whether modern sunscreens are likely to be effective as a preventative agent in melanoma.

METHODS

The protection against solar ultraviolet radiation delivered by sunscreens available prior to the early 1990s (when the data used in most published case-control studies were collected) was estimated by combining their absorption properties with the amount applied in a way reflecting common usage. Similar estimates were made for the protection offered by modern sunscreens.

RESULTS

It is not surprising that case-control studies have failed to find any association between sunscreen use and the risk of melanoma when consideration is given to the sunscreens in common usage at the time and the way in which sunscreen is applied in practice. Modern high Sun Protection Factor, broad-spectrum sunscreens, on the other hand, can be expected to be an effective measure in helping to prevent melanoma compared with sunscreens typical of those used 10-20 years ago.

CONCLUSIONS

It is reasonable to suppose that the improvement in performance of modern sunscreens will lead to a worthwhile benefit as a preventative agent against melanoma, although these benefits may not be seen for several decades.