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Abstract
OBJECTIVES We aimed to systematically identify and scrutinise published empirical evidence about overdiagnosis in malignant melanoma and examine how frequent overdiagnosis of melanoma is and whether this is related to different types of interventions or diagnostic technologies. DESIGN AND SETTING Empirical studies that discussed overdiagnosis in malignant melanoma were eligible, including qualitative and quantitative studies in any type of population, age group and geographical location. We excluded studies that did not include empirical data, studies that only mentioned 'overdiagnosis' without addressing it further and studies that used the term overdiagnosis for cases of misdiagnosis or false positives.We developed the search strategy in cooperation with an information specialist. We searched five databases on 21 April 2022: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Library.This scoping review adheres to The JBI methodology and Prefered Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping reviews (PRISMA-ScR). Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data from the included studies. The data extracted include study characteristics, population details, research question, the context and the study's main results. RESULTS Our search resulted in 1134 potentially relevant studies. 35 studies were included: 29 register studies, 3 cohort studies, 1 case-control study, 1 survey study and 1 randomised controlled trial. Most register studies examined trends in melanoma incidence and/or mortality and found a significant increase in incidence between 0.39% and 6.6% annually and a little or no increase in mortality. Three cohort studies and one case-control study showed that skin screening was associated with increased detection of melanoma; especially in situ or thin invasive melanoma. Three studies estimated the degree of overdiagnosis which ranged from 29% to 60%. CONCLUSIONS Epidemiological data suggest a high degree of overdiagnosis in malignant melanoma. Studies that examined the association between skin screening and malignant melanoma all found increased detection of melanomas, mostly thin and in situ melanomas, which raises concern about overdiagnosis.
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Affiliation(s)
- Mille Falk Bjørch
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emma Grundtvig Gram
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
| | - John Brandt Brodersen
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Health Care Research Unit, Region Zealand, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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2
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Berlin A, Ramotar M, Santiago AT, Liu Z, Li J, Wolinsky H, Wallis CJD, Chua MLK, Paner GP, van der Kwast T, Cooperberg MR, Vickers AJ, Urbach DR, Eggener SE. The influence of the "cancer" label on perceptions and management decisions for low-grade prostate cancer. J Natl Cancer Inst 2023; 115:1364-1373. [PMID: 37285311 PMCID: PMC10637044 DOI: 10.1093/jnci/djad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Grade Group 1 (GG1) prostate cancer should be managed with active surveillance (AS). Global uptake of AS remains disappointingly slow and heterogeneous. Removal of cancer labels has been proposed to reduce GG1 overtreatment. We sought to determine the impact of GG1 disease terminology on individual's perceptions and decision making. METHODS Discrete choice experiments were conducted on 3 cohorts: healthy men, canonical partners (partners), and patients with GG1 (patients). Participants reported preferences in a series of vignettes with 2 scenarios each, permuting key opinion leader-endorsed descriptors: biopsy (adenocarcinoma, acinar neoplasm, prostatic acinar neoplasm of low malignant potential [PAN-LMP], prostatic acinar neoplasm of uncertain malignant potential), disease (cancer, neoplasm, tumor, growth), management decision (treatment, AS), and recurrence risk (6%, 3%, 1%, <1%). Influence on scenario selection were estimated by conditional logit models and marginal rates of substitution. Two additional validation vignettes with scenarios portraying identical descriptors except the management options were embedded into the discrete choice experiments. RESULTS Across cohorts (194 healthy men, 159 partners, and 159 patients), noncancer labels PAN-LMP or prostatic acinar neoplasm of uncertain malignant potential and neoplasm, tumor, or growth were favored over adenocarcinoma and cancer (P < .01), respectively. Switching adenocarcinoma and cancer labels to PAN-LMP and growth, respectively, increased AS choice by up to 17%: healthy men (15%, 95% confidence interval [CI] = 10% to 20%, from 76% to 91%, P < .001), partners (17%, 95% CI = 12% to 24%, from 65% to 82%, P < .001), and patients (7%, 95% CI = 4% to 12%, from 75% to 82%, P = .063). The main limitation is the theoretical nature of questions perhaps leading to less realistic choices. CONCLUSIONS "Cancer" labels negatively affect perceptions and decision making regarding GG1. Relabeling (ie, avoiding word "cancer") increases proclivity for AS and would likely improve public health.
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Affiliation(s)
- Alejandro Berlin
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre; TECHNA Institute, University Health Network, Toronto, ON, Canada
| | - Matthew Ramotar
- Department of Radiation Oncology, University of Toronto; Radiation Medicine Program, Princess Margaret Cancer Centre; TECHNA Institute, University Health Network, Toronto, ON, Canada
| | - Anna T Santiago
- Department of Biostatistics, Princess Margaret Cancer Centre; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joyce Li
- The University of Western Ontario, London, ON, Canada
| | - Howard Wolinsky
- AnCan Active Surveillance Virtual Support Group; The Active Surveillor Newsletter, Chicago, IL, USA
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, University of Toronto, Mount Sinai Hospital, and University Hospital Network, Toronto, ON, Canada
| | - Melvin L K Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore; Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Gladell P Paner
- Departments of Pathology and Surgery, University of Chicago. Chicago, IL, USA
| | | | - Matthew R Cooperberg
- Departments of Urology and Epidemiology and Biostatistics, University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Urbach
- Institute for Clinical Evaluative Sciences (ICES), Department of Surgery, University of Toronto; Perioperative Services, Women’s College Hospital and Research Institute, Toronto, ON, Canada
| | - Scott E Eggener
- Section of Urology, Department of Surgery, The University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
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3
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Barnhill RL, Elder DE, Piepkorn MW, Knezevich SR, Reisch LM, Eguchi MM, Bastian BC, Blokx W, Bosenberg M, Busam KJ, Carr R, Cochran A, Cook MG, Duncan LM, Elenitsas R, de la Fouchardière A, Gerami P, Johansson I, Ko J, Landman G, Lazar AJ, Lowe L, Massi D, Messina J, Mihic-Probst D, Parker DC, Schmidt B, Shea CR, Scolyer RA, Tetzlaff M, Xu X, Yeh I, Zembowicz A, Elmore JG. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement. JAMA Netw Open 2023; 6:e2250613. [PMID: 36630138 PMCID: PMC10375511 DOI: 10.1001/jamanetworkopen.2022.50613] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose. OBJECTIVE To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG). EVIDENCE REVIEW Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0. FINDINGS The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma. CONCLUSIONS AND RELEVANCE The implementation of the newly revised MPATH-Dx version 2.0 schema into clinical practice is anticipated to provide a robust tool and adjunct for standardized diagnostic reporting of melanocytic lesions and management of patients to the benefit of both health care practitioners and patients.
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Affiliation(s)
- Raymond L Barnhill
- Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris, Paris, France
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle
- Dermatopathology Northwest, Bellevue, Washington
| | | | - Lisa M Reisch
- Department of Biostatistics, University of Washington School of Medicine, Seattle
| | - Megan M Eguchi
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Boris C Bastian
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Willeke Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcus Bosenberg
- Departments of Dermatology, Pathology, and Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Carr
- Cellular Pathology, South Warwickshire NHS Trust, Warwick, United Kingdom
| | - Alistair Cochran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Martin G Cook
- Department of Histopathology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Arnaud de la Fouchardière
- Department of Biopathology, Centre Léon Bérard, Lyon, France
- University of Lyon, Université Claude Bernard Lyon 1, National Center for Scientific Research, Mixed Research Unit 5286, National Institute of Health and Medical Research U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Iva Johansson
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jane Messina
- Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Birgitta Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher R Shea
- Department of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Richard A Scolyer
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Michael Tetzlaff
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Iwei Yeh
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Artur Zembowicz
- Tufts University, Boston, Massachusetts
- Lahey Clinic, Burlington, Massachusetts
- Dermatopathology Consultations, Needham, Massachusetts
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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Dunn BK, Woloshin S, Xie H, Kramer BS. Cancer overdiagnosis: a challenge in the era of screening. JOURNAL OF THE NATIONAL CANCER CENTER 2022; 2:235-242. [PMID: 36568283 PMCID: PMC9784987 DOI: 10.1016/j.jncc.2022.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/30/2022] Open
Abstract
"Screening" is a search for preclinical, asymptomatic disease, including cancer. Widespread cancer screening has led to large increases in early-stage cancers and pre-cancers. Ubiquitous public messages emphasize the potential benefits to screening for these lesions based on the underlying assumption that treating cancer at early stages before spread to other organs should make it easier to treat and cure, using more tolerable interventions. The intuition is so strong that public campaigns are sometimes launched without conducting definitive trials directly comparing screening to usual care. An effective cancer screening test should not only increase the incidence of early-stage preclinical disease but should also decrease the incidence of advanced and metastatic cancer, as well as a subsequent decrease in cancer-related mortality. Otherwise, screening efforts may be uncovering a reservoir of non-progressive and very slowly progressive lesions that were not destined to cause symptoms or suffering during the person's remaining natural lifespan: a phenomenon known as "overdiagnosis." We provide here a qualitative review of cancer overdiagnosis and discuss specific examples due to extensive population-based screening, including neuroblastoma, prostate cancer, thyroid cancer, lung cancer, melanoma, and breast cancer. The harms of unnecessary diagnosis and cancer therapy call for a balanced presentation to people considering undergoing screening, even with a test of accepted benefit, with a goal of informed decision-making. We also discuss proposed strategies to mitigate the adverse sequelae of overdiagnosis.
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Affiliation(s)
- Barbara K. Dunn
- US National Cancer Institute, Division of Cancer Prevention, Bethesda, Maryland, USA
- Member, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
| | - Steven Woloshin
- The Center for Medicine in the Media, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Director, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
| | - Heng Xie
- Beijing Biostar Pharmaceuticals Co., Ltd, Beijing, China
| | - Barnett S. Kramer
- Member, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
- Rockville, Maryland, USA
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5
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Sadrolashrafi K, Cotter DG. Not Your Mother's Melanoma: Causes and Effects of Early Melanoma Diagnosis. Dermatopathology (Basel) 2022; 9:368-378. [PMID: 36547217 PMCID: PMC9777089 DOI: 10.3390/dermatopathology9040043] [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: 08/24/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
The year 2022 will herald approximately 100,000 new cases of cutaneous melanoma (CM), and over 7000 deaths from CM. Over the past 40 years, CM incidence has increased nearly six-fold; however, annual mortality has remained relatively constant. These trends encapsulate the phenomenon of overdiagnosis. Increased recognition of indolent lesions that appear histologically malignant may be leading to a melanoma epidemic. Enhanced melanoma awareness, screening efforts, physician uncertainty, medical-legal pressures, and diagnostic scrutiny using tools like immunohistochemical staining, mole mapping, dermoscopy, confocal microscopy, and molecular diagnostics contribute to increased CM diagnosis. As a result, current melanoma staging and treatment guidelines are being challenged. Existing standards fail to accurately identify histologically benign lesions that are lethal or, conversely, histologically malignant lesions that are innocuous. Healthcare systems and, more importantly, patients suffer from this diagnostic ambiguity that leads to the over-treatment of innocuous melanomas and under-treatment of aggressive melanomas. As dermatology continues to experience a shift towards earlier diagnosis of melanoma, management strategies must adapt. Herein, we review factors that may contribute to the increased incidence of melanoma, emphasize deficiencies in current staging systems, and provide insights into the future of melanoma management via precision medicine.
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Affiliation(s)
- Kaviyon Sadrolashrafi
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89106, USA
| | - David Graham Cotter
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89106, USA
- Las Vegas Dermatology, Las Vegas, NV 89144, USA
- Correspondence:
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6
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Comment on “An Epidemiologic Analysis of Melanoma Overdiagnosis in the United States, 1975-2017”. J Invest Dermatol 2022; 142:3120-3122. [DOI: 10.1016/j.jid.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022]
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Muzumdar S, Lin G, Kerr P, Grant-Kels JM. Evidence concerning the accusation that melanoma is overdiagnosed. J Am Acad Dermatol 2021; 85:841-846. [PMID: 34116095 DOI: 10.1016/j.jaad.2021.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Melanoma is one of the most commonly diagnosed malignancies in the United States and is responsible for the majority of deaths from skin cancer. OBJECTIVE Since the 1970s, the incidence of melanoma has risen appreciably while melanoma-specific mortality has remained stable. This has raised a debate about potential overdiagnosis of melanoma. Herein, we review temporal trends in melanoma incidence and mortality and explore factors that may contribute to observed trends, including an aging population in the United States, ultraviolet exposure, increased numbers of biopsies by dermatologists and physician extenders, skin cancer screenings, histopathology criteria, and historic underdiagnosis. Additionally, we discuss melanoma overdiagnosis and the extent to which it may contribute to current trends. METHODS The literature was reviewed. RESULTS Several factors may contribute to an increased incidence of melanoma, including an aging population, ultraviolet exposure, increased skin biopsies, skin cancer screenings, histopathologic criteria, historic underdiagnosis, and current overdiagnosis. LIMITATIONS Further studies are required to determine exactly which tumors are being overdiagnosed, and how to improve patient outcomes with adjustment to physician's practice. CONCLUSION The rise in the incidence of melanoma observed since the 1970s is likely multifactorial.
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Affiliation(s)
- Sonal Muzumdar
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Gloria Lin
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Philip Kerr
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut; University of Florida Dermatology Department, Gainesville, Florida.
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Bianconi F, Crocetti E, Grisci C, Primieri C, Stracci F. What has changed in the epidemiology of skin melanoma in central Italy during the past 20 years? Melanoma Res 2020; 30:396-401. [PMID: 30480621 DOI: 10.1097/cmr.0000000000000551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim was to evaluate changes in skin melanoma incidence and mortality at a population level in central Italy over the past two decades. Skin melanoma incidence rate from 1994 to 2014, were retrieved from the Umbrian Cancer Registry (about 900 000 inhabitants). Changes from 1994-1999 to 2010-2014 in tumour and patient characteristics - sex, age (0-44, 45-64, ≥ 65 years), site (head and neck, trunk, limbs), morphology (superficial spreading, nodular, other), thickness (≤ 1, 1-2, 2-4, > 4) and stage I-II, III-IV - were evaluated. Trends in age-standardized incidence and mortality rates were evaluated as annual percent change. During the past two decades, melanoma incidence significantly increased in both sexes (+6%/year among men and +4%/year among women) and in all ages (0-44 years: + 4.7 and + 4.3; 45-64 years: + 6.1 and + 4.4; ≥65 years: + 6.6 and + 1.7), morphologies, except nodular, and stages. Mortality was stable among men and women. In the area, incidence increased for thin and thick melanoma, showing a true increase, whereas mortality did not increase. Therefore, although improvements in treatment and downstaging effect of early diagnosis have to be considered, a certain degree of overdiagnosis cannot be ruled out.
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Affiliation(s)
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto scientifico romagnolo per lo studio e la cura dei tumori (IRST), Meldola, Forlì-Cesena
| | - Chiara Grisci
- School of Specialization in Hygiene and Preventive Medicine
| | | | - Fabrizio Stracci
- Umbria Cancer Registry, Umbria
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
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9
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Clarke LE, Mabey B, Flake Ii DD, Meek S, Cassarino DS, Duncan LM, High WA, Napekoski KM, Prieto VG, Tetzlaff MT, Vitale P, Elder DE. Clinical validity of a gene expression signature in diagnostically uncertain neoplasms. Per Med 2020; 17:361-371. [PMID: 32915688 DOI: 10.2217/pme-2020-0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aim: Evaluate the accuracy of a 23-gene expression signature in differentiating benign nevi from melanoma by comparing test results with clinical outcomes. Materials & methods: Seven dermatopathologists blinded to gene expression test results and clinical outcomes examined 181 lesions to identify diagnostically uncertain cases. Participants independently recorded diagnoses and responses to questions quantifying diagnostic certainty. Test accuracy was determined through comparison with clinical outcomes (sensitivity and percent negative agreement). Results: Overall, 125 cases fulfilled criteria for diagnostic uncertainty (69.1%; 95% CI: 61.8-75.7%). Test sensitivity and percent negative agreement in these cases were 90.4% (95% CI: 79.0-96.8%) and 95.5% (95% CI: 87.3-99.1%), respectively. Conclusion: The 23-gene expression signature has high diagnostic accuracy in diagnostically uncertain cases when evaluated against clinical outcomes.
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Affiliation(s)
- Loren E Clarke
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Brent Mabey
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Darl D Flake Ii
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - Stephanie Meek
- Myriad Genetics, Inc., 320 Wakara Way, Salt Lake City, UT 84108, USA
| | - David S Cassarino
- Kaiser Permanente, Los Angeles Medical Center Bldg., Los Angeles, CA 90027, USA
| | - Lyn M Duncan
- Pathology Associates, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Whitney A High
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Victor G Prieto
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael T Tetzlaff
- Departments of Pathology & Translational & Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia Vitale
- Departments of Dermatology and Pathology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - David E Elder
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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10
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Herbert A, Koo MM, Barclay ME, Greenberg DC, Abel GA, Levell NJ, Lyratzopoulos G. Stage-specific incidence trends of melanoma in an English region, 1996-2015: longitudinal analyses of population-based data. Melanoma Res 2020; 30:279-285. [PMID: 30106842 PMCID: PMC6330074 DOI: 10.1097/cmr.0000000000000489] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to examine temporal trends in overall and stage-specific incidence of melanoma. Using population-based data on patients diagnosed with melanoma in East Anglia, England, 1996-2015, we estimated age-standardized time trends in annual incidence rates for each stage at diagnosis. Negative binomial regression was used to model trends over time adjusted for sex, age group and deprivation, and to subsequently examine variation in stage-specific trends by sex and age group. The age-standardized incidence increased from 14 to 29 cases/100 000 persons (i.e. 4% annually). Increasing incidence was apparent across all stages but was steepest for stage I [adjusted annual increase: 5%, 95% confidence interval (CI): 5-6%, and more gradual for stage II-IV disease (stage II: 3%, 95% CI: 2-4%; stage III/IV: 2%, 95% CI: 1-3%)]. Stage II-IV increase was apparent in men across age groups and in women aged 50 years or older. Increases in incidence were steeper in those aged 70 years or older, and in men. The findings suggest that both a genuine increase in the incidence of consequential illness and a degree of overdiagnosis may be responsible for the observed increasing incidence trends in melanoma in our population during the study period. They also suggest the potentially lower effectiveness of public health awareness campaigns in men and older people.
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Affiliation(s)
- Annie Herbert
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
| | - Minjoung M. Koo
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
| | - Matthew E. Barclay
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| | - David C. Greenberg
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
| | | | - Nick J. Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) research group, Department of Behavioural Sciences and Health, University College London, 1-19 Torrington Place, London, UK
- Public Health England National Cancer Registration and Analysis Service, Victoria House, Capital Park, Fulbourn, Cambridge, UK
- Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Cambridge, UK
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11
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Dixon PR, Tomlinson G, Pasternak JD, Mete O, Bell CM, Sawka AM, Goldstein DP, Urbach DR. The Role of Disease Label in Patient Perceptions and Treatment Decisions in the Setting of Low-Risk Malignant Neoplasms. JAMA Oncol 2020; 5:817-823. [PMID: 30896738 DOI: 10.1001/jamaoncol.2019.0054] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The cancer disease label may lead to overtreatment of low-risk malignant neoplasms owing to a patient's emotional response or misunderstanding of prognosis. Decision making should be driven by risks and benefits of treatment and prognosis rather than disease label. Objective To determine whether disease label plays a role in patient decision making in the setting of low-risk malignant neoplasms and to determine how the magnitude of the disease-label effect compares with preferences for treatment and prognosis. Design, Setting, and Participants A discrete choice experiment conducted using an online survey of 1314 US residents in which participants indicated their preferences between a series of 2 hypothetical vignettes describing the incidental discovery of a small thyroid lesion. Vignettes varied on 3 attributes: disease label (cancer, tumor, or nodule); treatment (active surveillance or hemithyroidectomy); and risk of progression or recurrence (0%, 1%, 2%, or 5%). The independent associations of each attribute with likelihood of vignette selection was estimated with a Bayesian mixed logit model. Main Outcomes and Measures The preference weight of the cancer disease label was compared with preference weights for other attributes. Results In 1068 predominantly healthy respondents (605 women and 463 men) with a median age of 35 years (range, 18-78 years), the cancer disease label played a considerable role in respondent decision making independent of treatment offered and risk of progression or recurrence. Participants accepted a 4-percentage-point increase in risk of progression or recurrence (from 1% to 5%) to avoid labeling their disease as cancer in favor of nodule (marginal rate of substitution [MRS], 1.0; 95% credible interval [CrI], 0.9-1.1). Preference for the nodule label instead of cancer was similar in magnitude to the preference for active surveillance over surgery (MRS, 1.0; 95% CrI, 0.9-1.1). Conclusions and Relevance Disease label plays a role in patient preference independent of treatment risks or prognosis. Raising the threshold for biopsy or removing the word cancer from the disease label may mitigate patient preference for aggressive treatment of low-risk lesions. Health care professionals should emphasize treatment risks and benefits and natural disease history when supporting treatment decisions for potentially innocuous epithelial malignant neoplasms.
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Affiliation(s)
- Peter R Dixon
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jesse David Pasternak
- Department of Surgery, University Health Network, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Anna M Sawka
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, University Health Network, Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
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12
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Gutiérrez-González E, López-Abente G, Aragonés N, Pollán M, Pastor-Barriuso R, Sánchez MJ, Pérez-Gómez B. Trends in mortality from cutaneous malignant melanoma in Spain (1982-2016): sex-specific age-cohort-period effects. J Eur Acad Dermatol Venereol 2019; 33:1522-1528. [PMID: 30868690 DOI: 10.1111/jdv.15565] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mortality from malignant cutaneous melanoma increased alarmingly during the second half of the 20th century in Spain and other European countries. OBJECTIVE The aim was to analyse sex- and age-specific trends in melanoma mortality in Spain in the period 1982-2016. METHODS European age-standardized melanoma mortality rates during the period 1982-2016 were calculated from mortality figures provided by the National Statistics Institute. Joinpoint regressions were used to identify significant points of change in trends and to compute average annual per cent change (AAPC). Age-cohort-period models were fitted to explore the effect of these variables on mortality. RESULTS During the period 1982-2016, age-standardized melanoma mortality rates increased in Spain from 0.90 to 1.80 deaths per 100 000 people in men and from 0.64 to 1.11 per 100 000 in women, rising noticeably from 1982 to 1995 in both sexes and in all age groups. From the mid-90s different trends were observed depending on sex and age: there was a decrease in mortality in the population younger than 45 years (AAPC -2 in both sexes) and aged 45-64 years (AAPC -1 among men and -0.2 among women), but in the group over 64 years rates continued to increase (AAPC 1.7 and 0.2, respectively, for men and women). The mortality sex ratio decreased in the younger population but increased in older individuals. A cohort effect was observed with lower mortality in the cohorts born after 1943 in men and 1956 in women. There was also a period effect with decreased mortality rates at the beginning of the 1990s. CONCLUSIONS Melanoma mortality rates in Spain increased during the last decades of the 20th century; however, later they stabilized in women and began to decrease in younger cohorts and middle-aged men. Promotion of primary and secondary prevention measures should continue, with particular emphasis on males over 65 years.
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Affiliation(s)
- E Gutiérrez-González
- Public Health & Preventive Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - G López-Abente
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer & Environmental Epidemiology Unit, National analyze Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - N Aragonés
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - M Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer & Environmental Epidemiology Unit, National analyze Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - R Pastor-Barriuso
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer & Environmental Epidemiology Unit, National analyze Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - M J Sánchez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria (ibs.GRANADA), University of Granada, Granada, Spain
| | - B Pérez-Gómez
- Public Health & Preventive Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer & Environmental Epidemiology Unit, National analyze Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Cardiovascular & Metabolic Diseases Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
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13
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Gardner LJ, Strunck JL, Wu YP, Grossman D. Current controversies in early-stage melanoma: Questions on incidence, screening, and histologic regression. J Am Acad Dermatol 2019; 80:1-12. [PMID: 30553298 DOI: 10.1016/j.jaad.2018.03.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/03/2023]
Abstract
In the first article in this continuing medical education series we review controversies and uncertainties relating to the epidemiology and initial diagnosis of localized cutaneous melanoma (ie, stage 0, I, or II). Many of these issues are unsettled because of conflicting evidence. Melanoma incidence appears to be increasing, yet its basis has not been fully explained. Despite the advantages of early detection, the US Preventive Services Task Force does not recommend skin screening for the general population. Occasionally, biopsy specimens of melanoma will show histologic regression, but the prognostic importance of this phenomenon is uncertain. Some practitioners recommend obtaining a sentinel lymph node biopsy specimen for thin melanomas showing regression, although this histologic finding is not part of the staging system for thin melanomas. Our goal is to provide the clinician who cares for patients with (or at risk for) melanoma with up-to-date contextual knowledge to appreciate the multiple sides of each controversy so that they will be better informed to discuss these issues with their patients and their families.
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Affiliation(s)
| | | | - Yelena P Wu
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.
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14
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Farah M, Nagarajan P, Torres-Cabala CA, Curry JL, Amaria RN, Wargo J, Tawbi H, Ivan D, Prieto VG, Tetzlaff MT, Aung PP. Metastatic melanoma with balloon/histiocytoid cytomorphology after treatment with immunotherapy: A histologic mimic and diagnostic pitfall. J Cutan Pathol 2018; 45:545-549. [PMID: 29672900 DOI: 10.1111/cup.13263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/05/2018] [Accepted: 04/14/2018] [Indexed: 01/02/2023]
Abstract
Epithelioid cells with foamy cytoplasm (histiocytoid features) are typical histopathologic findings among benign and malignant histiocytic neoplasms such as xanthoma and atypical fibroxanthoma. However, these changes are unusual in melanoma, which is typically composed of nested and variably pigmented atypical epithelioid cells. Here, we report a patient with metastatic melanoma in lymph nodes presenting with prominent balloon cell/histiocytoid features expressing melanocytic markers, after treatment with nivolumab. This report suggests that the spectrum of neoplasms with histiocytoid features should be expanded to include melanoma, a pattern that, to the best of our knowledge, is uncommon, especially in the setting of post-neoadjuvant therapy.
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Affiliation(s)
- Maya Farah
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Carlos A Torres-Cabala
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jennifer Wargo
- Department of Melanoma surgical oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Hussein Tawbi
- Department of Melanoma Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Doina Ivan
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Dermatology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Phyu P Aung
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
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15
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Lo SN, Scolyer RA, Thompson JF. Long-Term Survival of Patients with Thin (T1) Cutaneous Melanomas: A Breslow Thickness Cut Point of 0.8 mm Separates Higher-Risk and Lower-Risk Tumors. Ann Surg Oncol 2018; 25:894-902. [PMID: 29330716 DOI: 10.1245/s10434-017-6325-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Counterintuitively, more deaths from melanoma occur among patients with thin (T1) primary melanomas (≤ 1 mm) than among those with thick primary melanoma because the great majority present with T1 tumors. Therefore, it is important to stratify their risk as accurately as possible to guide their management and follow-up. This study sought to explore the relationship between tumor thickness and prognosis for patients with thin primary melanomas. METHODS A retrospective, single-institution study investigated 6263 patients with cutaneous melanoma (including 2117 T1 cases) who had a minimum follow-up period of 10 years. RESULTS For the entire patient cohort, the 10-year melanoma-specific survival (MSS) rate ranged between 92% for the patients with primary melanomas up to 0.3 mm thick and 32% for those with melanomas thicker than 8 mm. When divided into 25-quantile-thickness groups there was a significant difference in 10-year MSS between the two consecutive groups 0.8 and 0.9 mm; the differences in survival were not significantly different for any other consecutive cut points within the less than or equal to 1 mm thickness range, indicating a biologically-relevant difference in outcome above and below 0.8 mm. For the patients treated initially at the authors' institution, the 10- and 20-year MSS rates for those with tumors up to 0.8 mm thick were respectively 93.4 and 85.7%, and for tumors 0.9 to 1.0 mm, the rates were respectively 81.1 and 71.4%. Only 29.3% of the T1 patients who died of melanoma were deceased within 5 years. CONCLUSIONS A naturally occurring thickness cut point of 0.8 mm predicts higher or lower risk for patients with thin primary cutaneous melanomas. Long-term follow-up assessment of patients with T1 melanoma is important because late mortality due to melanoma is more common than early mortality.
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Affiliation(s)
- Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
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16
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Sontheimer RD. MDA5 autoantibody-another indicator of clinical diversity in dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:160. [PMID: 28480196 DOI: 10.21037/atm.2017.03.94] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Allenbach and colleagues have recently reported for the first time the results of an intriguing study of the histopathologic, immunopathologic and gene expression differences in muscle biopsy tissue from adult dermatomyositis (DM) patients who do and do not have circulating MDA5 autoantibodies (anti-MDA5). Anti-MDA5 were originally identified in a clinically-defined subset of DM patients whose disease was expressed predominately in the skin for unusually long periods of time without accompanying muscle weakness [i.e., "clinically-amyopathic DM" (CADM)] and were at risk for acute, rapidly-progressive form of interstitial lung disease (ILD). As an academic dermatologist in the United States of America (USA) having a career-long interest in the CADM subset, I would like to share my perspective on the results of the work by Allenbach and colleagues and offer some suggestions for additional study in this area. But to do so most effectively, I first would like to review the clinical concept of CADM and its association with anti-MDA5 antibody production and a potentially-fatal form of (ILD).
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17
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Tripp MK, Watson M, Balk SJ, Swetter SM, Gershenwald JE. State of the science on prevention and screening to reduce melanoma incidence and mortality: The time is now. CA Cancer J Clin 2016; 66:460-480. [PMID: 27232110 PMCID: PMC5124531 DOI: 10.3322/caac.21352] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Answer questions and earn CME/CNE Although overall cancer incidence rates are decreasing, melanoma incidence rates continue to increase about 3% annually. Melanoma is a significant public health problem that exacts a substantial financial burden. Years of potential life lost from melanoma deaths contribute to the social, economic, and human toll of this disease. However, most cases are potentially preventable. Research has clearly established that exposure to ultraviolet radiation increases melanoma risk. Unprecedented antitumor activity and evolving survival benefit from novel targeted therapies and immunotherapies are now available for patients with unresectable and/or metastatic melanoma. Still, prevention (minimizing sun exposure that may result in tanned or sunburned skin and avoiding indoor tanning) and early detection (identifying lesions before they become invasive or at an earlier stage) have significant potential to reduce melanoma incidence and melanoma-associated deaths. This article reviews the state of the science on prevention and early detection of melanoma and current areas of scientific uncertainty and ongoing debate. The US Surgeon General's Call to Action to Prevent Skin Cancer and US Preventive Services Task Force reviews on skin cancer have propelled a national discussion on melanoma prevention and screening that makes this an extraordinary and exciting time for diverse disciplines in multiple sectors-health care, government, education, business, advocacy, and community-to coordinate efforts and leverage existing knowledge to make major strides in reducing the public health burden of melanoma in the United States. CA Cancer J Clin 2016;66:460-480. © 2016 American Cancer Society.
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Affiliation(s)
- Mary K Tripp
- Instructor, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meg Watson
- Epidemiologist, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sophie J Balk
- Attending Pediatrician, Children's Hospital at Montefiore, and Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Susan M Swetter
- Professor, Department of Dermatology, and Director, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA
- Professor and Assistant Chief, Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jeffrey E Gershenwald
- Dr. John M. Skibber Professor, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Professor, Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX
- Co-Leader, Melanoma Moon Shot, The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Affiliation(s)
- Joann G Elmore
- From the Department of Medicine, University of Washington School of Medicine, Seattle
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19
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Photothermal cancer therapy by gold-ferrite nanocomposite and near-infrared laser in animal model. Lasers Med Sci 2015; 31:221-7. [PMID: 26694488 DOI: 10.1007/s10103-015-1847-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/30/2015] [Indexed: 01/09/2023]
Abstract
Surface plasmon resonance effect of gold nanostructures makes them good candidates for photothermal therapy (PTT) application. Herein, gold-ferrite nanocomposite (GFNC) was synthesized and characterized as a photothermal agent in PTT. The aim of this study was to investigate the effect of GFNC upon laser irradiation on treatment of cancer in mice bearing melanoma cancer. Thirty mice received 1.5 × 10(6) B16/F10 cells subcutaneously. After 1 week, the mice bearing solid tumor were divided into four groups: control group (without any treatment), laser group (received laser irradiation without GFNC injection), GFNC group (only received intratumorally GFNC), and GFNC + laser group (received intratumorally GFNC upon laser irradiation). In GFNC + laser group, 200 μL of fluid, 1.3 × 10(-7) mol L(-1) gold nanoparticles, was injected intratumorally and immediately the site of tumor was exposed to continuous wave diode laser beam (808 nm, 1.6 W cm(-2)) for 15 min. All mice but four were euthanized 24 h after treatment to compare the necrotic surface area histologically by using measuring graticule. Statistical analyses revealed significant differences in necrosis extent for GFNC + laser group, compared to other groups. Four subjects (control group and GFNC + laser group, two mice each) were kept for longitudinal study. Histological analyses and tumor volume measurements of the four subjects indicated that tumor in GFNC + laser group was controlled appropriately. It was concluded that combining an 808-nm laser at a power density of 1.6 W cm(-2) with GFNC has a destruction effect in melanoma cancer cells in an animal model.
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20
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Crocetti E, Mallone S, Robsahm TE, Gavin A, Agius D, Ardanaz E, Lopez MDC, Innos K, Minicozzi P, Borgognoni L, Pierannunzio D, Eisemann N. Survival of patients with skin melanoma in Europe increases further: Results of the EUROCARE-5 study. Eur J Cancer 2015; 51:2179-2190. [PMID: 26421821 DOI: 10.1016/j.ejca.2015.07.039] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/08/2015] [Accepted: 07/20/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND In Europe skin melanoma (SM) survival has increased over time. The aims were to evaluate recent trends and differences between countries and regions of Europe. METHODS Relative survival (RS) estimates and geographical comparisons were based on 241,485 patients aged 15years and over with a diagnosis of invasive SM in Europe (2000-2007). Survival time trends during 1999-2007 were estimated using the period approach, for 213,101 patients. Age, gender, sub-sites and morphology subgroups were considered. RESULTS In European patients, estimated 5-year RS was 83% (95% confidence interval, CI 83-84%). The highest values were found for patients resident in Northern (88%; 87-88%) and Central (88%; 87-88%) Europe, followed by Ireland and United Kingdom (UK) (86%; 85-86%) and Southern Europe (83%; 82-83%). The lowest survival was in Eastern Europe (74%; 74-75%). Within regions the intercountry absolute difference in percentage points of RS varied from 4% (North) to 34% (East). RS decreased markedly with patients' age and was higher in women than men. Differences according to SM morphology and skin sub-sites also emerged. Survival has slightly increased from 1999 to 2007, with a small improvement in Northern and the most pronounced improvement in Eastern Europe. DISCUSSION SM survival is high and still increasing in European patients. The gap between Northern and Southern and especially Eastern European countries, although still present, diminished over time. Differences in stage distribution at diagnosis may explain most of the geographical differences. However, part of the improvement in survival may be attributed to overdiagnosis from early diagnosis practices.
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Affiliation(s)
- Emanuele Crocetti
- UO Epidemiologia Clinica, Descrittiva e Registri - ISPO, Firenze, Italy.
| | - Sandra Mallone
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queens University, Belfast, Northern Ireland, UK
| | - Domenic Agius
- Malta National Cancer Registry, Department of Health Information and Research, Pieta, Malta
| | - Eva Ardanaz
- Navarra Cancer Registry, Navarra Public Health Institute, Pamplona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Maria-Dolores Chirlaque Lopez
- Servicio de Epidemiología, Department of Epidemiology, Consejería de Sanidad, Murcia Health Authority, Murcia, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Kaire Innos
- Department of Epidemiology and Biostatistics National, Institute for Health Development, Tallinn, Estonia
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenzo Borgognoni
- SC Chirurgia Plastica e Ricostruttiva, Ospedale S.M. Annunziata - Azienda Sanitaria di Firenze Centro di Riferimento Regionale per il Melanoma, Istituto Toscano Tumori, Firenze, Italy
| | - Daniela Pierannunzio
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy
| | - Nora Eisemann
- Institute of Cancer Epidemiology, University of Luebeck, Luebeck, Germany
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21
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Meves A, Nikolova E, Heim JB, Squirewell EJ, Cappel MA, Pittelkow MR, Otley CC, Behrendt N, Saunte DM, Lock-Andersen J, Schenck LA, Weaver AL, Suman VJ. Tumor Cell Adhesion As a Risk Factor for Sentinel Lymph Node Metastasis in Primary Cutaneous Melanoma. J Clin Oncol 2015; 33:2509-15. [PMID: 26150443 DOI: 10.1200/jco.2014.60.7002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Less than 20% of patients with melanoma who undergo sentinel lymph node (SLN) biopsy based on American Society of Clinical Oncology/Society of Surgical Oncology recommendations are SLN positive. We present a multi-institutional study to discover new molecular risk factors associated with SLN positivity in thin and intermediate-thickness melanoma. PATIENTS AND METHODS Gene clusters with functional roles in melanoma metastasis were discovered by next-generation sequencing and validated by quantitative polymerase chain reaction using a discovery set of 73 benign nevi, 76 primary cutaneous melanoma, and 11 in-transit melanoma metastases. We then used polymerase chain reaction to quantify gene expression in a model development cohort of 360 consecutive thin and intermediate-thickness melanomas and a validation cohort of 146 melanomas. Outcome of interest was SLN biopsy metastasis within 90 days of melanoma diagnosis. Logic and logistic regression analyses were used to develop a model for the likelihood of SLN metastasis from molecular, clinical, and histologic variables. RESULTS ITGB3, LAMB1, PLAT, and TP53 expression were associated with SLN metastasis. The predictive ability of a model that included these molecular variables in combination with clinicopathologic variables (patient age, Breslow depth, and tumor ulceration) was significantly greater than a model that only considered clinicopathologic variables and also performed well in the validation cohort (area under the curve, 0.93; 95% CI, 0.87 to 0.97; false-positive and false-negative rates of 22% and 0%, respectively, using a 10% cutoff for predicted SLN metastasis risk). CONCLUSION The addition of cell adhesion-linked gene expression variables to clinicopathologic variables improves the identification of patients with SLN metastases within 90 days of melanoma diagnosis.
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Affiliation(s)
- Alexander Meves
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Ekaterina Nikolova
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joel B Heim
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Edwin J Squirewell
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark A Cappel
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark R Pittelkow
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Clark C Otley
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nille Behrendt
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M Saunte
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Lock-Andersen
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Louis A Schenck
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amy L Weaver
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vera J Suman
- Alexander Meves, Ekaterina Nikolova, Joel B. Heim, Edwin J. Squirewell, Clark C. Otley, Louis A. Schenck, Amy L. Weaver, and Vera J. Suman, Mayo Clinic, Rochester, MN; Mark A. Cappel, Mayo Clinic, Jacksonville, FL; Mark R. Pittelkow, Mayo Clinic, Scottsdale, AZ; and Nille Behrendt, Ditte M. Saunte, and Jorgen Lock-Andersen, Hospital Roskilde, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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van der Leest R, Flohil S, Arends L, de Vries E, Nijsten T. Risk of subsequent cutaneous malignancy in patients with prior melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2014; 29:1053-62. [DOI: 10.1111/jdv.12887] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- R.J.T. van der Leest
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - S.C. Flohil
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - L.R. Arends
- Department of Biostatistics; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Pedagogical and Educational Sciences; Erasmus University Rotterdam; Rotterdam The Netherlands
- Institute of Psychology; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - E. de Vries
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - T. Nijsten
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
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23
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Vollmer RT. The dynamics of death in melanoma. J Cutan Pathol 2012; 39:1075-82. [DOI: 10.1111/cup.12031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 02/29/2012] [Accepted: 03/19/2012] [Indexed: 11/28/2022]
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