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Council ML, Sheinbein DM. Common Skin Cancers in Older Adults Approach to Diagnosis and Management. Clin Geriatr Med 2024; 40:25-36. [PMID: 38000861 DOI: 10.1016/j.cger.2023.09.001] [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] [Indexed: 11/26/2023]
Abstract
Skin cancers are the most common malignancies to affect older adults. The most common skin cancers, basal and squamous cell carcinoma, can usually be cured with surgery. Although less common, melanoma can be deadly when not caught in its earliest stages.
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Affiliation(s)
- Martha Laurin Council
- Department of Medicine (Dermatology), Washington University School of Medicine in St. Louis, 969 North Mason Road, Suite 200, St Louis, MO 63141, USA.
| | - David M Sheinbein
- Department of Medicine (Dermatology), Washington University School of Medicine in St. Louis, 969 North Mason Road, Suite 200, St Louis, MO 63141, USA
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Navarro-Bielsa A, Gracia-Cazaña T, Almagro M, De la Fuente-Meira S, Flórez Á, Yélamos O, Montero-Vilchez T, González-Cruz C, Diago A, Abadías-Granado I, Fuentelsaz V, Colmenero M, Bañuls J, Arias-Santiago S, Buendía-Eisman A, Almenara-Blasco M, Gil-Pallares P, Gilaberte Y. The Influence of the Exposome in the Cutaneous Squamous Cell Carcinoma, a Multicenter Case-Control Study. Cancers (Basel) 2023; 15:5376. [PMID: 38001636 PMCID: PMC10670280 DOI: 10.3390/cancers15225376] [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: 10/06/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism's biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. OBJECTIVES To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. MATERIALS AND METHOD A multicenter case-control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. RESULTS A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). CONCLUSIONS The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC.
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Affiliation(s)
- Alba Navarro-Bielsa
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Tamara Gracia-Cazaña
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Manuel Almagro
- Department of Dermatology, Complejo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain
| | | | - Ángeles Flórez
- Department of Dermatology, University Hospital of Pontevedra, 36162 Pontevedra, Spain
| | - Oriol Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Trinidad Montero-Vilchez
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Instituto de Investigación IBS, 18012 Granada, Spain
| | - Carlos González-Cruz
- Department of Dermatology, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
| | - Adrián Diago
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | | | | | - María Colmenero
- Department of Dermatology, Hospital Costa del Sol, 29603 Marbella, Spain
| | - José Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante, ISABIAL, 03010 Alicante, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Instituto de Investigación IBS, 18012 Granada, Spain
| | | | - Manuel Almenara-Blasco
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Pedro Gil-Pallares
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Universidad de Santiago de Compostela, 15705 A Coruña, Spain
| | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, 50009 Zaragoza, Spain
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Naeser Y, Mikiver R, Ingvar C, Lambe M, Ullenhag GJ. Survival in patients diagnosed with melanoma in situ compared to the general population. A Swedish population-based matched cohort study. EClinicalMedicine 2023; 65:102284. [PMID: 38106551 PMCID: PMC10725068 DOI: 10.1016/j.eclinm.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 12/19/2023] Open
Abstract
Background The incidence of melanoma in situ (MIS) is increasing even more rapidly than the incidence of cutaneous malignant melanoma (CMM). No previous studies have in detail investigated the survival in individuals diagnosed with MIS compared to the general population. Methods This population-based study included individuals with MIS diagnosed in Sweden between 2001 and 2010 and randomly selected MIS-free comparators matched on age, sex and county of residence. Exclusion criterion was a previous CMM. Data on socioeconomic status (SES) including educational level, income and marital status, comorbidity and cause of death were obtained from population-based registers. Overall survival (OS) was estimated by the Kaplan-Meier method. The mortality risk adjusted for SES and comorbidity was assessed by multivariable Cox regression analyses. Findings The survival analyses included 7963 cases and 39,662 comparators. Median age at MIS diagnosis were 63 (IQR 50-75) and 67 (IQR 57-76) years in women and men respectively. Median follow-up time was 120 months (IQR 102-152 months). In individuals with MIS, the ten-year OS was 77% (95% CI 0.76-0.78) compared to 72% (95% CI 0.72-0.73) in comparators. The MIS patients had a higher SES and lower comorbidity burden than the comparators. In a fully adjusted multivariable analysis, including 7772 cases and 38,103 comparators, the mortality was significantly lower in women with MIS (HR 0.88, 95% CI 0.82-0.94) compared to the background population. The corresponding estimate in men was HR 0.94 (95% CI 0.88-1.0). The risk of melanoma-related deaths during the study period was ten-fold higher in MIS patients. Interpretation Despite being at increased risk of developing CMM, MIS patients had a better OS compared to their matched comparators from the background population, findings which could not fully be explained by differences in SES and comorbidity. Our results are reassuring and should be communicated to patients who have been diagnosed with MIS. Funding Stiftelsen Onkologiska Klinikens i Uppsala Forskningsfond, Mats and Stefan Paulsson Trust, Medicon Village, Lund and Uppsala University Hospital (ALF).
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Affiliation(s)
- Ylva Naeser
- Department of Oncology, Uppsala University Hospital, Entrance 101, 751 85, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
| | - Rasmus Mikiver
- Regional Cancer Center South-East, Kungsgatan 23, 582 18, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, 581 83, Linköping, Sweden
| | - Christian Ingvar
- Department of Clinical Sciences, Surgery, Lund University, 221 84, Lund, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
- Regional Cancer Center Central Sweden, 751 85, Uppsala, Sweden
| | - Gustav J. Ullenhag
- Department of Oncology, Uppsala University Hospital, Entrance 101, 751 85, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
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Johnston L, Starkey S, Mukovozov I, Robertson L, Petrella T, Alhusayen R. Surveillance After a Previous Cutaneous Melanoma Diagnosis: A Scoping Review of Melanoma Follow-Up Guidelines. J Cutan Med Surg 2023; 27:516-525. [PMID: 37489919 PMCID: PMC10617001 DOI: 10.1177/12034754231188434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/30/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Cutaneous melanoma accounts for more than 70% of all skin cancer deaths. Follow-up surveillance is an integral part of melanoma patient care, to facilitate early detection of recurrences and subsequent primary melanomas. The purpose of this scoping review is to provide an overview of recently published melanoma surveillance guidelines from regional and national melanoma working groups. METHODS A systematic search for relevant studies in MEDLINE and Embase was conducted in September 2022 and was limited to publications from 2010 or later. RESULTS A total of 1047 articles were retrieved, and after abstract and full text review, 26 articles from 19 different organizations met inclusion criteria. Life-long annual skin surveillance with a physician was recommended by 53% (9/17) of guidelines. Routine laboratory investigations were recommended by 7/19 guidelines. Regional lymph node ultrasound was recommended by 9/16 guidelines, most often in stage IB or higher, and was optional in 7/16 for patients who met specific criteria. Surveillance with PET-CT or CT and MRI was recommended by 15 and 11 guidelines, respectively, most commonly in stage IIC or higher, with a variable frequency and total duration. Five out of 9 guidelines indicated a preference for skin surveillance to be completed with a dermatologist. CONCLUSION Guidelines were highly variable for many aspects of melanoma surveillance, which may be partly attributed to regional differences in healthcare workforce distribution and availability of imaging technologies. Further high-level studies are recommended to provide more evidence on the most effective clinical and imaging follow-up surveillance protocols.
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Affiliation(s)
- Leah Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Samantha Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Lynne Robertson
- Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Teresa Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, Canada
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Canada
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Win Myint TT, Selak V, Elwood M. The risk of subsequent invasive melanoma after a primary in situ or invasive melanoma in a high incidence country (New Zealand). SKIN HEALTH AND DISEASE 2023; 3:e116. [PMID: 37013115 PMCID: PMC10066759 DOI: 10.1002/ski2.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022]
Abstract
Background Patients with invasive melanoma are at increased risk of developing subsequent invasive melanoma, but the risks for those with primary in situ melanoma are unclear. Objectives To assess and compare the cumulative risk of subsequent invasive melanoma after primary invasive or in situ melanoma. To estimate the standardized incidence ratio (SIR) of subsequent invasive melanoma compared to population incidence in both cohorts. Methods Patients with a first diagnosis of melanoma (invasive or in situ) between 2001 and 2017 were identified from the New Zealand national cancer registry, and any subsequent invasive melanoma during follow-up to the end of 2017 identified. Cumulative risk of subsequent invasive melanoma was estimated by Kaplan-Meier analysis separately for primary invasive and in situ cohorts. Risk of subsequent invasive melanoma was assessed using Cox proportional hazard models. SIR was assessed, allowing for age, sex, ethnicity, year of diagnosis and follow up time. Results Among 33 284 primary invasive and 27 978 primary in situ melanoma patients, median follow up time was 5.5 and 5.7 years, respectively. A subsequent invasive melanoma developed in 1777 (5%) of the invasive and 1469 (5%) of the in situ cohort, with the same median interval (2.5 years) from initial to first subsequent lesion in both cohorts. The cumulative incidence of subsequent invasive melanoma at 5 years was similar in the two cohorts (invasive 4.2%, in situ 3.8%); the cumulative incidence increased linearly over time in both cohorts. The risk of subsequent invasive melanoma was marginally higher for primary invasive compared to in situ melanoma after adjustment for age, sex, ethnicity and body site of the initial lesion (hazard ratio 1.11, 95% CI 1.02-1.21). Compared to population incidence, the SIR of invasive melanoma was 4.6 (95% CI 4.3-4.9) for the primary invasive and 4 (95% CI 3.7-4.2) for the primary in situ melanoma cohorts. Conclusions The risk of subsequent invasive melanoma is similar whether patients present with in situ or invasive melanoma. Thus follow-up surveillance for new lesions should be similar, although patients with invasive melanoma require more surveillance for recurrence.
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Affiliation(s)
- Thu Thu Win Myint
- Department of Biostatistics and EpidemiologyUniversity of AucklandAucklandNew Zealand
| | - Vanessa Selak
- Department of Biostatistics and EpidemiologyUniversity of AucklandAucklandNew Zealand
| | - Mark Elwood
- Department of Biostatistics and EpidemiologyUniversity of AucklandAucklandNew Zealand
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Ulanja MB, Beutler BD, Antwi-Amoabeng D, Cohen PR, Moody AE, Rahman GA, Djankpa FT, Gullapalli N, Boampong-Konam K, Macaire JK, Bowman AT, Baral S, Bowles DW. Second primary malignancies in patients with melanoma in situ: Insights from the surveillance, epidemiology, and end results program. Cancer Epidemiol 2021; 72:101932. [PMID: 33773145 DOI: 10.1016/j.canep.2021.101932] [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: 11/21/2020] [Revised: 02/28/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Melanoma in situ (MIS) is among the most frequently diagnosed cancers in the United States. Emerging data suggest that MIS is associated with an increased risk of developing a second primary malignancy (SPM). OBJECTIVES To determine trends in MIS-associated SPMs and identify MIS-specific features that increase SPM risk. METHODS In this retrospective population-based study, we identified 90,075 patients who were diagnosed with MIS between 1973 and 2015 from the Surveillance, Epidemiology, and End Results database. The risk of developing an SPM among these individuals was compared to individuals without a diagnosis of MIS. The risk of developing an SPM among patients with a diagnosis of MIS was also increased over time. RESULTS Patients with a diagnosis of MIS had an increased relative risk (RR) of developing an SPM as compared to the general population with an identical age, sex, race, and follow-up period. The RR of a metachronous malignancy in MIS patients also increased over time, as follows: 1.16 (95 % CI: 1.07-1.26), 1.19 (95 % CI: 1.14-1.23), 1.30 (95 % CI: 1.27-1.33), and 1.52 (95 % CI: 1.49-1.56) in 1973-1982, 1983-1992, 1993-2002, and 2003-2015, respectively (P < 0.05). In addition, there was a direct correlation between the number of MIS lesions and SPM risk; ≥1, ≥2, and ≥3 tumors portended a 1.5-2, 2-3, and 4-5-fold increased risk of developing an SPM, respectively. CONCLUSIONS MIS is associated with an increased risk of developing an SPM and therefore individuals with a history of MIS may benefit from close medical surveillance.
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Affiliation(s)
- Mark B Ulanja
- University of Nevada, Reno School of Medicine, Department of Internal Medicine, Reno, NV, USA
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Department of Radiology, Los Angeles, CA, USA.
| | - Daniel Antwi-Amoabeng
- University of Nevada, Reno School of Medicine, Department of Internal Medicine, Reno, NV, USA
| | - Philip R Cohen
- Touro University California College of Osteopathic Medicine, Department of Dermatology, Vallejo, CA, USA; San Diego Family Dermatology, National City, CA, USA
| | - Alastair E Moody
- University of Utah School of Medicine, Department of Anesthesiology, Salt Lake City, UT, USA
| | - Ganiyu A Rahman
- Department of Surgery, University of Cape Coast, School of Medical Sciences, Cape Coast, Ghana
| | - Francis T Djankpa
- Department of Physiology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Ghana
| | - Nageshwara Gullapalli
- University of Nevada, Reno School of Medicine, Department of Internal Medicine, Reno, NV, USA
| | | | - Jessica K Macaire
- Department of Surgery, University of Cape Coast, School of Medical Sciences, Cape Coast, Ghana
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniel W Bowles
- University of Colorado School of Medicine, Department of Medical Oncology, Aurora, CO, USA; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
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Helgadottir H, Isaksson K, Fritz I, Ingvar C, Lapins J, Höiom V, Newton-Bishop J, Olsson H. Multiple Primary Melanoma Incidence Trends Over Five Decades: A Nationwide Population-Based Study. J Natl Cancer Inst 2021; 113:318-328. [PMID: 32577730 PMCID: PMC7936055 DOI: 10.1093/jnci/djaa088] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Over the past decades, many regions have experienced a steady increase in the incidence of cutaneous melanoma. Here, we report on incidence trends for subsequent primary melanoma. METHODS In this nationwide population-based study, patients diagnosed with a first primary cutaneous melanoma reported to the Swedish Cancer Registry were followed for up to 10 years for a diagnosis of subsequent primary melanoma. Patients were grouped with patients diagnosed with first melanoma in the same decade (1960s, 1970s, 1980s, 1990s, and 2000s, respectively). Frequencies, incidence rates (IRs), standardized incidence ratios (SIRs), and 95% confidence intervals (CIs) for second melanomas were calculated. All tests of statistical significance were 2-sided. RESULTS Of patients with melanoma, 54 884 were included and 2469 were diagnosed, within 10 years, with subsequent melanomas. Over the 5 decades, there was a statistically significant steady increase in the frequency, IR, and SIR for second primary melanoma. For example, in the 1960s cohort, less than 1% (IR = 1.0, 95% CI = 0.5 to 1.7, and IR = 1.1, 95% CI = 0.5 to 1.9 per 1000 person-years in women and men, respectively) had second primary melanoma, and this rose to 6.4% (IR = 7.5, 95% CI = 6.8 to 8.3, per 1000 person-years) in the women and 7.9% (IR = 10.3, 95% CI = 9.3 to 11.2, per 1000 person-years) in the men in the 2000s cohort. This rise was seen independent of age, sex, invasiveness, or site of the melanoma. Further, in patients diagnosed with a second melanoma, the frequency of those having more than 2 melanomas increased statistically significantly and was 0.0% in the 1960s and rose to 18.0% in the 2000s (P < .001). CONCLUSIONS This is the first study to evaluate and report on a rising trend for subsequent primary melanoma. Additional primary melanomas worsen the patients' survival, and precautions are needed to turn this steep upgoing trend.
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Affiliation(s)
- Hildur Helgadottir
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karolin Isaksson
- Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden
- Department of Surgery, Central Hospital Kristianstad, Kristianstad, Sweden
| | - Ildiko Fritz
- Department of Cancer Epidemiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Christian Ingvar
- Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden
| | - Jan Lapins
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Veronica Höiom
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Julia Newton-Bishop
- Section of Epidemiology and Biostatistics, Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Håkan Olsson
- Department of Cancer Epidemiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden
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Tokez S, Wakkee M, Louwman M, Noels E, Nijsten T, Hollestein L. Assessment of Cutaneous Squamous Cell Carcinoma (cSCC) In situ Incidence and the Risk of Developing Invasive cSCC in Patients With Prior cSCC In situ vs the General Population in the Netherlands, 1989-2017. JAMA Dermatol 2021; 156:973-981. [PMID: 32609322 DOI: 10.1001/jamadermatol.2020.1988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The incidence rates of keratinocyte cancer are increasing globally; however, the incidence rates of cutaneous squamous cell carcinoma (cSCC) in situ and the risk of developing subsequent invasive cSCC remain unknown. Objective To estimate annual population-based age-standardized incidence rates of histopathologically confirmed cSCC in situ stratified by sex, age, and body site and to assess the risk of developing invasive cSCC among patients with cSCC in situ compared with the general population. Design, Setting, and Participants This nationwide epidemiological population-based cohort study used cancer registry data to identify all patients with a first incident of histopathologically confirmed cSCC in situ between January 1, 1989, and December 31, 2017. In addition, all patients with cSCC in situ who subsequently had a first incident of invasive cSCC were identified up to June 11, 2019. Data were analyzed between March 18 and November 12, 2019. Main Outcomes and Measures Age-standardized incidence rates per year for cSCC in situ, standardized to the 2013 edition of the European Standard Population, were calculated by sex, age, and body site. Cumulative risks, standardized incidence ratios, and absolute excess risks were calculated to assess the risk of invasive cSCC in patients with cSCC in situ compared with the general population. Results In this population-based cohort study of 88 754 patients with a first incident of cSCC in situ between January 1, 1989, and December 31, 2017, 58.8% were women; the median age was 75 years (interquartile range [IQR], 67-82 years) for women and 73 years (IQR, 65-80 years) for men. Increasing incidence rates were observed, with the highest incidence rates in 2017 among women in general (71.7 cases per 100 000 person-years) and among men 80 years and older (540.9 cases per 100 000 person-years). The most common body site among women was the face (15.9 cases per 100 000 person-years) and among men was the scalp and/or neck (12.3 cases per 100 000 person-years). After 5 years of follow-up, among patients with cSCC in situ, the cumulative risk of developing an invasive cSCC at any anatomic location was 11.7% (95% CI, 11.6%-11.9%) in men and 6.9% (95% CI, 6.8%-7.0%) in women (P < .001). The standardized incidence ratio was highest in the first year of follow-up among both men (16.6; 95% CI, 15.7-17.5) and women (15.1; 95% CI, 14.2-16.1). Conclusions and Relevance This study reports the first nationwide incidence rates of cSCC in situ to date. The increasing incidence rates of cSCC in situ and the high risk of developing invasive cSCC among patients with cSCC in situ may increase the health care burden associated with precursors of keratinocyte cancer and highlight the need to include cutaneous skin cancer precursor lesions when exploring policies to address skin cancer care.
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Affiliation(s)
- Selin Tokez
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marieke Louwman
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Eline Noels
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Loes Hollestein
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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Pastor-Tomás N, Martínez-Franco A, Bañuls J, Peñalver JC, Traves V, García-Casado Z, Requena C, Kumar R, Nagore E. Risk factors for the development of a second melanoma in patients with cutaneous melanoma. J Eur Acad Dermatol Venereol 2020; 34:2295-2302. [PMID: 32163215 DOI: 10.1111/jdv.16341] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous melanoma patients have an increased risk of developing other neoplasms, especially cutaneous neoplasms and other melanomas. Identifying factors associated with an increased risk might be useful in the development of melanoma guidelines. OBJECTIVES To identify risk factors related to the development of a second primary melanoma in a series of patients diagnosed with sporadic melanoma and to establish the estimated incidence rate. METHODS A longitudinal study based on prospective follow-up information of patients diagnosed with sporadic cutaneous melanoma at our centre from 2000 to 2015 was performed. Cumulative incidence was estimated based on competing risk models, and the association of characteristics with the risk of a second melanoma was performed by Cox proportional hazard models. RESULTS Out of 1447 patients included in the study, after a median follow-up of 61 months, 55 patients (3.8%) developed a second melanoma. Fair hair colour, more than 100 common melanocytic nevi and the presence of more than 50 cherry angiomas were independently associated with the development of a second melanoma. The site and the histological subtype of the first and second melanomas were not consistent. The second melanomas were thinner than the first ones. CONCLUSIONS Fair-haired and multiple-nevi patients might benefit from more intensive prevention measures. The finding of cherry angiomas as a risk factor suggests that these lesions could be markers of skin sun damage in the setting of certain degree of genetic susceptibility.
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Affiliation(s)
- N Pastor-Tomás
- Department of Dermatology, Hospital General Universitario de Elda, Alicante, Spain.,Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - A Martínez-Franco
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - J Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain.,Departament of Medicina Clínica, Universidad Miguel Hernández. Sant Joan D'Alacant, Alicante, Spain
| | - J C Peñalver
- Department of Thoracic Surgery, Instituto Valenciano de Oncología, València, Spain
| | - V Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Z García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - C Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - R Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - E Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain.,Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
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10
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Coroiu A, Moran C, Bergeron C, Drapeau M, Wang B, Kezouh A, Ernst J, Batist G, Körner A. Short and long-term barriers and facilitators of skin self-examination among individuals diagnosed with melanoma. BMC Cancer 2020; 20:123. [PMID: 32059700 PMCID: PMC7023754 DOI: 10.1186/s12885-019-6476-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Melanoma can be lethal if not detected early and treated. Early detection can be facilitated via skin self-examination (SSE) and as such, SSE is part of melanoma follow-up care for individuals with a prior history, who face a life-long risk of reoccurrence. The objective of the current study was to identify short- and long-term predictors of SSE among melanoma survivors to inform future prevention interventions in high-risk groups. Method This is an observational study with longitudinal assessments conducted with adult melanoma patients in active follow-up care. Primary outcome measures Behavioral outcomes, comprehensive SSE (checking up to 5 body areas in the last 3 months) and optimal SSE (checking the entire body at least monthly in the last 3 months) were assessed at 3, 12, and 24 months post a dermatological educational session on skin cancer prevention. T tests and chi square analyses were used to examine changes in outcomes from 3 to 12 and 24 months. Linear and logistic regression models were used to examine the association between predictors and the primary outcomes. Results Comprehensive SSE did not decrease significantly from 3 (M = 2.7, SD = 1.1) to 12 (M = 2.6, SD = 1.2) and 24 months (M = 2.4, SD = 1.2) post the education session, with the stronger predictor at all timepoints being intentions to perform SSE. Optimal SSE was higher at 3 months (59%) compared to 12 (46%) and 24 months (34%), with key predictors including self-efficacy and intentions to perform SSE and male sex at 3 months post; self-efficacy and reliance on medical advice at 12 months; and (lower) education and self-efficacy at 24 months. Conclusions The key findings of this study are that 1) survivors maintain SSE behaviour over time, but rates of SSE performed in agreement with medical recommendations are higher immediately post standard dermatological education (i.e. usual care) and decrease somewhat over a 24-month period; and 2) the strongest psycho-social predictors of SSE are intentions and self-efficacy to perform the behavior, which are highly modifiable, for example via motivational interviewing and goal setting health interventions.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Martin Drapeau
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada.,Department of Psychiatry, McGill University, Montréal, Canada
| | - Beatrice Wang
- Gerald Bronfman Department of Oncology, McGill University Health Center, Montréal, Canada
| | - Abbas Kezouh
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
| | - Gerald Batist
- Department of Medicine, McGill University, Montréal, Canada.,Department of Oncology, Sir Mortimer B. Davis-Jewish General Hospital, Montréal, Canada.,Department of Oncology, McGill University, Montréal, Canada.,Segal Cancer Centre, Montréal, Canada.,Centre for Translational Research in Cancer, McGill University, Montréal, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada.,Department of Oncology, McGill University, Montréal, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada.,Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Montreal, Canada.,Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
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11
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Dimitriou F, Mangana J, Curioni-Fontecedro A, Rechsteiner M, Turko P, Braun RP, Dummer R, Cheng PF. Melanoma patients with additional primary cancers: a single-center retrospective analysis. Oncotarget 2019; 10:3373-3384. [PMID: 31164959 PMCID: PMC6534365 DOI: 10.18632/oncotarget.26931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Recent progress in the diagnosis and treatment of primary and metastatic cutaneous melanoma (CM) has led to a significant increase in the patients` expectancy of life. The development of additional primary tumors (APT) other than CM represents an important survival issue. Results: Of a total of 1764 CM patients, 80 (4.5%) patients developed APT. For tumors diagnosed after CM, there was a 2.7 fold excess risk for APT compared to the swiss german population. A significantly increased risk was noted for female breast (SIR, 2.46), male larynx (SIR, 76.92), male multiple myeloma (SIR, 11.2), male oesophagus (SIR, 10.8) and thyroid on males (SIR, 58.8) and females (SIR, 38.1). All thyroid cancer cases had a common papillary histological subtype and a high rate of BRAFV600E mutation. Melanoma was the primary cause of death in the vast majority of patients. Methods: We used the cancer registry from the Comprehensive Cancer Center Zurich (CCCZ) and retrospectively analyzed patients with CM and APT between 2008 and 2018. We calculated the risk of APT compared to the swiss german population using the standardized incidence ratio (SIR). Conclusions: Patients with CM have an increased risk for hematologic and solid APT. Long-term follow-up is indicated.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Alessandra Curioni-Fontecedro
- Department of Hematology and Oncology, Division of Oncology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Markus Rechsteiner
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, Zurich, Switzerland
| | - Patrick Turko
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Ralph P Braun
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
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12
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Müller C, Wendt J, Rauscher S, Sunder-Plassmann R, Richtig E, Fae I, Fischer G, Okamoto I. Risk Factors of Subsequent Primary Melanomas in Austria. JAMA Dermatol 2019; 155:188-195. [PMID: 30566178 PMCID: PMC6439543 DOI: 10.1001/jamadermatol.2018.4645] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022]
Abstract
Importance Information on risk factors of subsequent melanomas would be helpful to identify patients at risk after the diagnosis of their first melanomas. Objective To determine risk factors of subsequent melanomas. Design, Setting, and Participants In this retrospective case-control study, 1648 participants with histologically verified cutaneous melanoma diagnosed from January 1, 1968, though March 16, 2015, were recruited from a tertiary referral center as part of the Molecular Markers of Melanoma study. CDKN2A was sequenced in 514 and MC1R in 953 participants. Data were analyzed from March 7, 2008, through March 25, 2015. Main Outcomes and Measures Phenotypic traits and internal and external risk factors for the development of a second, third, or fourth melanoma. Results In total, 1648 patients (53.6% men; mean [SD] age, 54 [15] years) were enrolled, including 1349 with single and 299 with multiple primary melanoma. Mean (SD) age at recruitment was 57 (15) years for the single-melanoma and 62 (14) years for the multiple-melanoma groups. From the internal risk factors, family history (odds ratio [OR], 1.76; 95% CI, 1.22-2.55; P = .006), CDKN2A high-risk mutations (OR, 4.03; 95% CI, 1.28-12.70; P = .02), and high numbers of nevi as a phenotypic risk factor (ORs, 2.23 [95% CI, 1.56-3.28, P < .001] for 20-30 smaller nevi and 2.56 [95% CI, 1.50-4.36; P = .003] for 20-30 larger nevi) were significantly associated with the risk of developing a subsequent primary melanoma using multivariate logistic regression analysis. Nonmelanoma skin cancer (OR, 2.57; 95% CI, 1.84-3.58; P < .001) and signs of actinic skin damage, particularly on the back (ORs, 1.91 [95% CI, 1.12-3.25; P = .04] for freckling and 1.92 [95% CI, 1.29-3.08; P = .007] for solar lentigines), additionally increased risk of a subsequent melanoma. All those factors were also associated with an earlier development of the second melanoma. Patients with 3 melanomas developed their second melanoma earlier than patients with only 2 melanomas (mean [SD] age, 55 [15] years for those with 2 primary melanomas; 52 [15] years for those with 3 primary melanomas). Time spent outdoors, solarium use, outdoor occupation, and hair color had no significant associations in these models. Conclusions and Relevance According to the results of this study, internal factors (family history and genetic variants), number of nevi, and actinic damage on the back are more relevant for the development of subsequent melanomas than skin phototype or hair color. Patients with many nevi were younger at the time of the diagnosis of their first melanoma. This finding could help to identify persons at increased risk of developing multiple primary melanomas.
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Affiliation(s)
- Christoph Müller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Judith Wendt
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sabine Rauscher
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Raute Sunder-Plassmann
- Clinical Institute for Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Erika Richtig
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Ingrid Fae
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Gottfried Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Ichiro Okamoto
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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13
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Gassenmaier M, Stec T, Keim U, Leiter U, Eigentler T, Metzler G, Garbe C. Incidence and characteristics of thick second primary melanomas: a study of the German Central Malignant Melanoma Registry. J Eur Acad Dermatol Venereol 2018; 33:63-70. [DOI: 10.1111/jdv.15194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/12/2018] [Indexed: 01/02/2023]
Affiliation(s)
- M. Gassenmaier
- Department of Dermatology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
| | - T. Stec
- Department of Dermatology Center for Dermatooncology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
| | - U. Keim
- Department of Dermatology Center for Dermatooncology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
| | - U. Leiter
- Department of Dermatology Center for Dermatooncology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
| | - T.K. Eigentler
- Department of Dermatology Center for Dermatooncology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
| | - G. Metzler
- Department of Dermatology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
| | - C. Garbe
- Department of Dermatology Center for Dermatooncology Eberhard‐Karls‐University of Tuebingen Tuebingen Germany
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14
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van der Leest R, Hollestein L, Liu L, Nijsten T, de Vries E. Risks of different skin tumour combinations after a first melanoma, squamous cell carcinoma and basal cell carcinoma in Dutch population-based cohorts: 1989-2009. J Eur Acad Dermatol Venereol 2017; 32:382-389. [DOI: 10.1111/jdv.14587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R.J.T. van der Leest
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - L.M. Hollestein
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Research; Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht The Netherlands
| | - L. Liu
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Statistics; European Organization for Research and Treatment of Cancer (EORTC); Brussels Belgium
| | - T. Nijsten
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - E. de Vries
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Clinical Epidemiology and Biostatistics; Faculty of Medicine; Pontificia Universidad Javeriana; Bogotá Colombia
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15
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Glenn BA, Chen KL, Chang LC, Lin T, Bastani R. Skin Examination Practices Among Melanoma Survivors and Their Children. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:335-343. [PMID: 26856594 PMCID: PMC4980284 DOI: 10.1007/s13187-016-0998-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Many professional organizations recommend skin self-examination (SSE) as a tool for early detection of malignancy among melanoma survivors, a growing population that is at increased risk for new or recurrent melanoma. This study examined the frequency and correlates of SSE use among melanoma survivors. Additionally, we assessed skin exam use among children of survivors, who are at elevated lifetime risk for the disease. The California Cancer Registry was used to identify melanoma survivors, who were contacted, screened for eligibility, and invited to participate in a survey. The survey, administered by mail, web, or telephone, assessed a broad range of topics related to melanoma prevention in high-risk families. The present study focuses on skin examination practices of survivors and their children and potential correlates of these practices. Among a sample of 316 melanoma survivors, fewer than one in five participants performed monthly skin self-exams, a lower rate than that observed in previous studies. Although greater family history of melanoma, use of skin protection strategies, and the perceived severity of melanom were associated with more frequent use of skin self-exams, these relationships disappeared in adjusted analyses. Participants reported unexpectedly frequent use of skin examinations for their children despite the lack of professional guidelines for this practice. Interventions are needed to improve skin self-examination practices among melanoma survivors and to counsel parents about optimal melanoma prevention strategies for their children.
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Affiliation(s)
- Beth A Glenn
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA, 90095-6900, USA.
| | - Katherine L Chen
- David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - L Cindy Chang
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA, 90095-6900, USA
| | - Tiffany Lin
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Roshan Bastani
- Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 650 Charles Young Dr. South, Room A2-125, CHS, Los Angeles, CA, 90095-6900, USA
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16
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Schuurman M, de Waal A, Thijs E, van Rossum M, Kiemeney L, Aben K. Risk factors for second primary melanoma among Dutch patients with melanoma. Br J Dermatol 2017; 176:971-978. [DOI: 10.1111/bjd.15024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M.S. Schuurman
- Netherlands Comprehensive Cancer Organisation (IKNL); PO Box 19079 3501 DB Utrecht the Netherlands
| | - A.C. de Waal
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - E.J.M. Thijs
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - M.M. van Rossum
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
| | - L.A.L.M. Kiemeney
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Urology; Radboud University Medical Center; Nijmegen the Netherlands
| | - K.K.H. Aben
- Netherlands Comprehensive Cancer Organisation (IKNL); PO Box 19079 3501 DB Utrecht the Netherlands
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
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17
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Jones MS, Torisu-Itakura H, Flaherty DC, Schoellhammer HF, Lee J, Sim MS, Faries MB. Second Primary Melanoma: Risk Factors, Histopathologic Features, Survival, and Implications for Follow-Up. Am Surg 2016. [DOI: 10.1177/000313481608201034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas ( P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients ( P < 0.0001 and 0.0001, respectively) at a median follow-up of 142.37 months. Patients with cutaneous melanoma are at high risk for development of SPM, but the development of SPM does not seem to impair survival.
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Affiliation(s)
- Maris S. Jones
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Hitoe Torisu-Itakura
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Devin C. Flaherty
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Hans F. Schoellhammer
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Jihey Lee
- Department of Biostatistics, Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California; and
| | - Myung-Shim Sim
- Department of Biostatistics, Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California; and
| | - Mark B. Faries
- Department of Melanoma Research, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
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18
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Tran JM, Schwartz R, Fung K, Rochon P, Chan AW. Comprehensive capture of cutaneous melanoma by the Ontario Cancer Registry: validation study using community pathology reports. Cancer Causes Control 2016; 27:137-42. [PMID: 26537120 DOI: 10.1007/s10552-015-0690-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 10/26/2015] [Indexed: 11/27/2022]
Abstract
Melanoma is often managed outside hospital settings, creating the potential for underreporting to cancer registries. To our knowledge, completeness of melanoma capture in cancer registries has not been assessed using external data sources since the 1980s. We evaluated the melanoma capture rate from 1993 to 2009 in a provincial cancer registry. We identified all melanoma diagnoses in pathology reports from a major community laboratory in Ontario, Canada. Pathologically confirmed diagnoses were linked to Ontario Cancer Registry (OCR) records using health insurance numbers. We calculated capture rates as the proportion of patients with melanoma confirmed by a pathology report, with a corresponding melanoma diagnosis in OCR. OCR captured 3,798 of 4,275 (88.8, 95 % confidence interval: 87.9, 89.8 %) invasive melanoma diagnoses over the 17-year period. Annual capture rates of 94 % or higher were found for over half the study period. Among all 29,133 melanoma diagnoses in OCR, 27.6 % were registered based on a pathology report alone, compared with 3.4 % for non-cutaneous malignancies. This suggests that comprehensive capture of melanoma cases by a provincial cancer registry is achievable using source data from community laboratories. There is a need for ongoing validation to ensure data remain accurate and complete to reliably inform clinical care, research, and policy.
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Affiliation(s)
- Jennifer M Tran
- Division of Dermatology, Department of Medicine, University of Toronto, 790 Bay St, Suite 735, Toronto, ON, Canada.
| | - Rodrigo Schwartz
- Department of Dermatology, Clinica Las Condes, Santiago, Chile
- Faculty of Medicine, University of Chile, Santiago, Chile
| | - Kinwah Fung
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Paula Rochon
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - An-Wen Chan
- Division of Dermatology, Department of Medicine, University of Toronto, 790 Bay St, Suite 735, Toronto, ON, Canada.
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
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19
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Krajewski AC, Hart DR, Hieken TJ. Multiple primary melanoma in the elderly. Am J Surg 2015; 211:84-8. [PMID: 26303880 DOI: 10.1016/j.amjsurg.2015.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few data exist regarding surveillance for multiple primary melanoma (MPM) in elderly patients or whether the incidence and risk factors are the same as for younger patients. Thus, we studied the frequency and characteristics of MPM in the elderly melanoma patients. METHODS From our prospective melanoma registry, we studied 222 consecutive patients aged 65 years or older at their initial melanoma diagnosis. Mean follow-up was 65 ± 3 months. RESULTS Median age was 76 years. Twenty-two patients (10%) developed a second primary melanoma and 8 (4%) of 3 or more primaries. 82% of second primaries (18 of 22) were the same or thinner than the index melanoma, yet 50% of third primary melanomas (4 out of 8) were thicker. Only prior dysplastic nevi (P <. 0001) were a significant risk factor for MPM. CONCLUSIONS These data suggest elderly melanoma patients have a significant risk of MPM that warrants careful surveillance to facilitate prompt detection and treatment. Patients with dysplastic nevi merit special scrutiny.
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Affiliation(s)
- Adam C Krajewski
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Donna R Hart
- Department of Surgery, NorthShore University HealthSystem Skokie Hospital, 9600 Gross Point Road, Skokie, IL 60076, USA; Rush University Medical Center, 1653 Congress Parkway, Chicago, IL 60612, USA; Rush Medical College, 600 South Paulina Street, Chicago, IL 60612, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Surgery, NorthShore University HealthSystem Skokie Hospital, 9600 Gross Point Road, Skokie, IL 60076, USA; Rush University Medical Center, 1653 Congress Parkway, Chicago, IL 60612, USA; Rush Medical College, 600 South Paulina Street, Chicago, IL 60612, USA.
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20
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Pomerantz H, Huang D, Weinstock MA. Risk of subsequent melanoma after melanoma in situ and invasive melanoma: a population-based study from 1973 to 2011. J Am Acad Dermatol 2015; 72:794-800. [PMID: 25769192 DOI: 10.1016/j.jaad.2015.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with melanoma in situ are at an increased risk of subsequent melanoma compared with the general population, but the risk of subsequent melanoma after initial melanoma in situ versus after initial invasive melanoma is not known. OBJECTIVE We sought to compare the risk of subsequent melanoma in the cohort whose first cancer was melanoma in situ to the risk in the cohort whose first cancer was invasive melanoma. METHODS In this cohort study, we identified individuals whose first cancer was either melanoma in situ or invasive melanoma from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2011 and used Cox proportional hazards models for comparison. RESULTS Compared with the invasive melanoma cohort, the melanoma in situ cohort was more likely to develop subsequent melanoma of any stage after 2 years, subsequent invasive melanoma after 10 years, and subsequent melanoma in situ at all the time points (P < .001, P = .003, P < .001, respectively). LIMITATIONS Underreporting of melanomas, particularly melanoma in situ cases, and missing cases of subsequent melanomas as a result of patient migration from the SEER registry areas could affect results. CONCLUSION Given the increased long-term risk of subsequent melanoma in the melanoma in situ cohort, the patients with melanoma in situ diagnosis may benefit from a long-term surveillance for subsequent melanomas.
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Affiliation(s)
- Hyemin Pomerantz
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island.
| | - David Huang
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island; Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island
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21
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Holterhues C, Hollestein LM, Nijsten T, Koomen ER, Nusselder W, de Vries E. Burden of disease due to cutaneous melanoma has increased in the Netherlands since 1991. Br J Dermatol 2014; 169:389-97. [PMID: 23551191 DOI: 10.1111/bjd.12346] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The burden of disease, describing loss of health and death due to a disease, has not been fully studied for melanoma in the general population over time. OBJECTIVES To determine the burden of disease due to melanoma in the Netherlands. METHODS Age- and sex-specific incidence data from all patients with melanoma in the Netherlands between 1991 and 2010 were obtained from the Netherlands Cancer Registry. Melanoma-specific mortality and life expectancy data were obtained from Statistics Netherlands. Melanoma duration was calculated using the DISMOD software from the World Health Organization. The years of life lived with disability (YLD) and years of life lost (YLL) due to melanoma were calculated using Dutch disability weights, incidence and mortality of melanoma, and the life expectancy from the general population. The number of disability-adjusted life-years (DALYs) was estimated by adding YLD and YLL. RESULTS The world-standardized incidence rates of melanoma have more than doubled for both men (7·1 per 100 000 inhabitants in 1991 to 17·0 in 2010) and women (9·4 per 100 000 inhabitants in 1991 to 19·8 in 2010). Likewise, the burden of melanoma to society has increased rapidly. The YLD for men increased from 4795 (1991-4) to 12 441 (2007-10), and for women from 7513 (1991-4) to 16 544 (2007-10). In 2007-10 the total YLL due to melanoma was 30 651 for men and 26 244 for women compared with 17 238 and 16 900, respectively, in 1991-4. The DALYs increased by 96% for men, from 22 033 (1991-4) to 43 092 (2007-10), and by 75% for women, from 24 413 (1991-4) to 42 788 (2007-10). CONCLUSIONS Melanoma is becoming a great burden to Dutch society.
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Affiliation(s)
- C Holterhues
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zimmer L, Haydu LE, Menzies AM, Scolyer RA, Kefford RF, Thompson JF, Schadendorf D, Long GV. Incidence of New Primary Melanomas After Diagnosis of Stage III and IV Melanoma. J Clin Oncol 2014; 32:816-23. [DOI: 10.1200/jco.2013.49.5572] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose New primary melanomas (NPMs) have developed in some patients with metastatic melanoma treated with BRAF inhibitors. We sought to determine the background incidence of spontaneous NPMs after a diagnosis of American Joint Committee on Cancer/International Union Against Cancer stage III or IV melanoma in patients not treated with a BRAF inhibitor. Patients and Methods Patients diagnosed with stage III or IV melanoma at Melanoma Institute Australia between 1983 and 2008 were analyzed, and those who received a BRAF inhibitor were excluded. Results Two hundred twenty-nine (5%) of 4,215 patients with stage III melanoma and 43 (1%) of 3,563 patients with stage IV melanoma had at least one NPM after diagnosis of stage III or IV disease. The 6-month, 1-year, and 10-year cumulative incidence rates of developing an NPM after stage III melanoma were 1.2% (95% CI, 0.86% to 1.51%), 1.8% (95% CI, 1.44% to 2.26%), and 5.9% (95% CI, 5.08% to 6.74%), respectively. The 3-month, 6-month, and 1-year cumulative incidence rates of NPM after diagnosis of stage IV melanoma were 0.2% (95% CI, 0.07% to 0.36%), 0.3% (95% CI, 0.15% to 0.51%), and 0.4% (95% CI, 0.25% to 0.7%), respectively. In both patients with stage III and stage IV melanoma, male patients and patients with a prior history of multiple primaries had a higher incidence of NPM. Conclusion Patients with stage III and stage IV melanoma remain at risk for development of further primary melanomas, particularly if they have a history of multiple primary melanomas before stage III or IV disease. The incidence rates are lower than those reported in patients receiving BRAF inhibitors. However, the results must be compared with caution because dermatologic assessment is more frequent in BRAF inhibitor trials.
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Affiliation(s)
- Lisa Zimmer
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - Lauren E. Haydu
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - Alexander M. Menzies
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - Richard A. Scolyer
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - Richard F. Kefford
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - John F. Thompson
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - Dirk Schadendorf
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
| | - Georgina V. Long
- Lisa Zimmer and Dirk Schadendorf, University Hospital, University Duisburg-Essen, Essen, Germany; Lauren E. Haydu, Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, John F. Thompson, and Georgina V. Long, Melanoma Institute Australia; Alexander M. Menzies, Richard A. Scolyer, Richard F. Kefford, and Georgina V. Long, Sydney Medical School, The University of Sydney; Richard A. Scolyer and John F. Thompson, Royal Prince Alfred Hospital; Lauren E. Haydu and John F. Thompson, The University of
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Daniëls LA, Krol ADG, Schaapveld M, Putter H, Jansen PM, Marijt EWA, van Leeuwen FE, Creutzberg CL. Long-term risk of secondary skin cancers after radiation therapy for Hodgkin's lymphoma. Radiother Oncol 2013; 109:140-5. [PMID: 23932152 DOI: 10.1016/j.radonc.2013.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/13/2013] [Accepted: 06/15/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Survivors of Hodgkin's lymphoma (HL) are at risk of secondary tumors. We investigated the risk of secondary skin cancers after radiotherapy compared to treatment without radiation and to an age-matched population. MATERIAL AND METHODS We conducted a retrospective cohort study of 889 HL patients treated between 1965 and 2005. Data on secondary skin cancers and treatment fields were retrieved. Incidence rates were compared to observed rates in the Dutch population. RESULTS 318 skin cancers were diagnosed in 86 patients, showing significantly higher risks of skin cancers, the majority being BCC. The standardized incidence ratio (SIR) of BCC in HL survivors was significantly increased (SIR 5.2, 95% CI 4.0-6.6), especially in those aged <35 years at diagnosis (SIR 8.0, 95% CI 5.8-10.7). SIR increased with longer follow-up to 15.9 (95% CI 9.1-25.9) after 35 years, with 626 excess cases per 10,000 patients per year. Most (57%) skin cancers developed within the radiation fields, with significantly increased risk in patients treated with radiotherapy compared to chemotherapy alone (p=0·047, HR 2·75, 95% CI 1·01-7.45). CONCLUSION Radiotherapy for HL is associated with a strongly increased long-term risk of secondary skin cancers, both compared to the general population and to treatment with chemotherapy alone.
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Affiliation(s)
- Laurien A Daniëls
- Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
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Flohil SC, van der Leest RJ, Arends LR, de Vries E, Nijsten T. Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma: A systematic review and meta-analysis. Eur J Cancer 2013; 49:2365-75. [DOI: 10.1016/j.ejca.2013.03.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/27/2013] [Accepted: 03/05/2013] [Indexed: 11/25/2022]
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van der Leest R, Nijsten T, de Vries E. Screening for second primary melanomas: is it efficient? Reply from authors. Br J Dermatol 2013; 168:1135. [DOI: 10.1111/bjd.12139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geurts S, van Dijck J, Bonenkamp J, Soetekouw P, Verbeek A. Screening for second primary melanomas: is it efficient? Br J Dermatol 2013; 168:1133-5. [DOI: 10.1111/bjd.12138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Council ML. Common skin cancers in older adults: approach to diagnosis and management. Clin Geriatr Med 2013; 29:361-72. [PMID: 23571033 DOI: 10.1016/j.cger.2013.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Skin cancer is one of the most common malignancies to affect the elderly, and the incidence of cutaneous neoplasia is rising. The purpose of this article is to review the most common and deadly forms of skin cancer: malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. Epidemiology, clinical diagnosis, staging, and treatment are discussed for each of these malignancies.
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Affiliation(s)
- M Laurin Council
- Center for Dermatologic and Cosmetic Surgery, Department of Internal Medicine, Washington University School of Medicine, 969 North Mason Road, Suite 200, St Louis, MO 63141, USA.
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