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El Zarif T, Machaalani M, Nawfal R, Nassar AH, Xie W, Choueiri TK, Pomerantz M. TERT Promoter Mutations Frequency Across Race, Sex, and Cancer Type. Oncologist 2024; 29:8-14. [PMID: 37462445 PMCID: PMC10769781 DOI: 10.1093/oncolo/oyad208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/23/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Telomerase reverse transcriptase (TERT) gene promoter mutations have been explored, as biomarkers of improved survival for patients with cancer receiving immune checkpoint inhibitors. We sought to investigate their prevalence by race and sex across different cancer types to inform patient selection in clinical trials. RESULTS In this observational study, 31 925 patients with cancer underwent next-generation sequencing of their tumors with 88% (27 970) patients self-reported being Whites, 7.1% (2273) Asians, and 5.3% (1682) Blacks. Examining the distribution of TERT promoter mutations by race, White patients with melanoma harbored more TERT promoter mutations than Asian and Black patients (OR = 25.83; 95%CI, 6.84-217.42; P < .001). In contrast, Asian patients with head and neck cancer (HNC) harbored more TERT promoter mutations compared to White patients (OR = 2.47; 95%CI, 1.39-4.37; P = .004). In addition, the distribution of TERT promoter mutations differed by sex. Males were enriched for TERT gene promoter mutations compared to females with melanoma (OR = 1.82; 95%CI, 1.53-2.16; P < .001), cancer of unknown primary (OR = 1.96; 95%CI, 1.43-2.69; P < .001), hepatobiliary (OR = 3.89; 95%CI, 2.65-5.69; P < .001), and thyroid cancers (OR = 1.42; 95%CI, 1.10-1.84; P = .0087), while females were more enriched for TERT promoter mutations compared to males for HNC (OR = 0.56; 95%CI, 0.39-0.81; P = .0021). CONCLUSIONS The prevalence of TERT gene promoter mutations varies among patients with cancer based on race and sex. These findings inform our understanding of cancer biology and can assist in the design of future clinical trials that leverage drugs targeting TERT promoter dependencies.
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Affiliation(s)
- Talal El Zarif
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Marc Machaalani
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Rashad Nawfal
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Amin H Nassar
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT, USA
| | - Wanling Xie
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark Pomerantz
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Yuan J, Li X, Yu S. Global, Regional, and National Incidence Trend Analysis of Malignant Skin Melanoma Between 1990 and 2019, and Projections Until 2034. Cancer Control 2024; 31:10732748241227340. [PMID: 38227397 DOI: 10.1177/10732748241227340] [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: 01/17/2024] Open
Abstract
BACKGROUND The goal of this study was to evaluate the global burden of malignant skin melanoma (MSM) from 1990 to 2019 using MSM-related data from the Global Burden of Disease study. METHODS The incidences' relationships with the social-demographic index (SDI) and human developmental index (HDI) were investigated. To determine significant changes in incidence trends, the joinpoint regression model was used. To demonstrate trends in MSM mortality rates, an Age-Period-Cohort framework was conducted. For the projection of new cases and the age-standardized incidence rate (ASR) of MSM incidence to 2034, the Nordpred method was used. RESULTS In 2019, the ASR incidence per 100, 000 people for MSM was 3.6 (95% UI, 2.6-4.2). MSM prevalence increased in most countries between 1990 and 2019 (average annual percentage change >0). HDI and annual percentage change (APC) (ρ = .63, P < .001), as well as SDI and ASR, had a positive correlation. The total MSM mortality rate declined globally, with an APC of -.61%. Likewise, the mortality rate for the age group of people with ages <77.5 years declined. Predictive analysis demonstrated a declining trend in ASR incidence and a growing number of MSM. CONCLUSION There are significant differences in ASR incidence among regions and countries. Despite decreases in ASR incidence and fatality, MSM remains one of the leading sources of cancer mortality and morbidity globally. MSM necessitates more primary prevention measures and screening in high-risk areas.
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Affiliation(s)
- Jin Yuan
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Brunsgaard EK, Jensen J, Grossman D. Melanoma in skin of color: Part II. Racial disparities, role of UV, and interventions for earlier detection. J Am Acad Dermatol 2023; 89:459-468. [PMID: 35533770 DOI: 10.1016/j.jaad.2022.04.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
Despite a higher incidence of melanoma among White individuals, melanoma-specific survival is worse among individuals with skin of color. Racial disparities in survival are multifactorial. Decreased skin cancer education focused on people with skin of color, lower rates of screening, increased socioeconomic barriers, higher proportions of more aggressive subtypes, and underrepresentation in research and professional education contribute to delays in diagnosis and treatment. Although high, intermittent UV exposure during childhood has been established as a significant modifiable risk factor for melanoma in individuals with lighter skin phototypes, there are limited data on UV exposure and melanoma risk in people with darker skin phototypes. The second article of this continuing medical education series will examine factors contributing to racial disparities in melanoma-specific survival, discuss the role of UV radiation, and address the need for further research and targeted educational interventions for melanoma in individuals with skin of color.
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Affiliation(s)
- Elise K Brunsgaard
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jakob Jensen
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Communication, University of Utah, Salt Lake City, Utah
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah.
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4
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Gibbs DC, Thomas NE, Kanetsky PA, Luo L, Busam KJ, Cust AE, Anton-Culver H, Gallagher RP, Zanetti R, Rosso S, Sacchetto L, Edmiston SN, Conway K, Ollila DW, Begg CB, Berwick M, Ward SV, Orlow I. Association of functional, inherited vitamin D-binding protein variants with melanoma-specific death. JNCI Cancer Spectr 2023; 7:pkad051. [PMID: 37494457 PMCID: PMC10496570 DOI: 10.1093/jncics/pkad051] [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: 05/07/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND It is unclear whether genetic variants affecting vitamin D metabolism are associated with melanoma prognosis. Two functional missense variants in the vitamin D-binding protein gene (GC), rs7041 and rs4588, determine 3 common haplotypes, Gc1s, Gc1f, and Gc2, of which Gc1f may be associated with decreased all-cause death among melanoma patients based on results of a prior study, but the association of Gc1f with melanoma-specific death is unclear. METHODS We investigated the association of the Gc1s, Gc1f, and Gc2 haplotypes with melanoma-specific and all-cause death among 4490 individuals with incident, invasive primary melanoma in 2 population-based studies using multivariable Cox-proportional hazards regression. RESULTS In the pooled analysis of both datasets, the patients with the Gc1f haplotype had a 37% lower risk of melanoma-specific death than the patients without Gc1f (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.47 to 0.83, P = .001), with adjustments for age, sex, study center, first- or higher-order primary melanoma, tumor site, pigmentary phenotypes, and Breslow thickness. Associations were similar in both studies. In pooled analyses stratified by Breslow thickness, the corresponding melanoma-specific death HRs for those patients with the Gc1f haplotype compared with those without Gc1f were 0.89 (95% CI = 0.63 to 1.27) among participants with tumor Breslow thickness equal to or less than 2.0 mm and 0.40 (95% CI = 0.25 to 0.63) among participants with tumor Breslow thickness greater than 2.0 mm (Pinteraction = .003). CONCLUSIONS Our findings suggest that individuals with the GC haplotype Gc1f may have a lower risk of dying from melanoma-specifically from thicker, higher-risk melanoma-than individuals without this Gc1f haplotype.
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Affiliation(s)
| | - Nancy E Thomas
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Klaus J Busam
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne E Cust
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, CA, USA
| | - Richard P Gallagher
- Cancer Control Research, British Columbia Cancer and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Roberto Zanetti
- Center for Cancer Prevention, Piedmont Cancer Registry, Torino, Italy
- Fondo Elena Moroni for Oncology, Torino, Italy
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Stefano Rosso
- Center for Cancer Prevention, Piedmont Cancer Registry, Torino, Italy
- Fondo Elena Moroni for Oncology, Torino, Italy
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Lidia Sacchetto
- Center for Cancer Prevention, Piedmont Cancer Registry, Torino, Italy
- Fondo Elena Moroni for Oncology, Torino, Italy
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon N Edmiston
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Conway
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - David W Ollila
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Sarah V Ward
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Health disparities are differences in health or disease incidence, prevalence, severity, or disease burden that are experienced by disadvantaged populations. Their root causes are attributed in large part to socially determined factors, including educational level of attainment, socioeconomic status, and physical and social environments. There is an expanding body of evidence documenting differences in dermatologic health status among underserved populations. In this review, the authors highlight inequities in outcomes across 5 dermatologic conditions, including psoriasis, acne, cutaneous melanoma, hidradenitis suppurativa, and atopic dermatitis.
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Affiliation(s)
- Stafford G Brown
- Eastern Virginia Medical School; William & Mary Raymond A. Mason School of Business
| | - Caryn B C Cobb
- Hampton University Skin of Color Research Institute; The Warren Alpert Medical School of Brown University
| | - Valerie M Harvey
- Hampton Roads Center for Dermatology, 860 Omni Boulevard, Suite 114, Newport News, VA 23606, USA.
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ÇELİK BA, KOÇ V. Skin Cancer-Related Health Behavior Interventions in the Context of the Health Belief Model. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1112210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The incidence of skin cancer is increasing around the world every year. Although there are many reasons for the occurrence of skin cancer, UV radiation caused by sunlight is seen as the most important factor. Therefore, reducing exposure to UV radiation should be a top priority for skin cancer prevention. In addition, different demographic features also affect the amount of UV exposure. These include age, gender and professional groups. On the other hand, people can be exposed to UV radiation voluntarily. Sunbathing or using tanning devices can be shown as examples for this. For these reasons, interventions to reduce exposure to UV radiation should focus on demographic features and the desire to tan. At the same time, it is emphasized in the literature that theory-based and systematic interventions are more effective than others. In this context, we think that the Health Belief Model, which is an effective psychosocial model for health behaviors, will be useful in developing sun protection behaviors. In this review, interventions based on the Health Belief Model in the context of tanning behavior, age, gender, and outdoor activities for the prevention of skin cancer and the improvement of sun protection behaviors have been discussed.
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Desai AD, Chinta S, Yeh C, Shah VP, Shah R, Paskhover B, Schwartz RA. An analysis of lactate dehydrogenase (LDH) levels in advanced stage IV melanoma of the skin: prognostic capabilities and demographic variability. Arch Dermatol Res 2022; 315:799-806. [PMID: 36318305 DOI: 10.1007/s00403-022-02425-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/01/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
Despite its limitations, in part due to decreased specificity in advanced disease, serum lactate dehydrogenase (LDH) is one of few serum factors used in cancer staging. This study quantifies the predictive capabilities of LDH in stage IV melanoma of the skin and explores the validity of suggested demographic discrepancies which may exist in its use. The 1975-2017 Surveillance Epidemiology and End Results (SEER) database was queried for stage IV cutaneous melanoma cases. Demographic characteristics were compared between LDH groups using chi-square and t tests. Subsequent Cox multivariable regression was performed to assess survival differences. 334 cases of stage IV cutaneous melanoma (average age: 63.0 years) with measured serum LDH levels were identified. Of these patients, 150 (44.9%) had normal LDH, 112 (33.5%) had LDH < 1.5 × upper limit of normal (ULN), 57 (17.1%) had LDH 1.5-10 × ULN, and 15 (4.5%) had LDH > 10 × ULN. Lower incomes were associated with higher LDH; individuals with incomes < $50,000 had the greatest proportion of LDH 10 × ULN (19.2%; p = 0.0031). LDH > 10 × ULN also had the lowest proportion of White patients (p = 0.04). On Cox multivariable survival analysis, increasing LDH levels showed increased risk of death (LDH < 1.5 × ULN: HR = 2.05, p = 0.01; LDH 1.5-10 × ULN: HR = 1.46, p < 0.001; LDH > 10 × ULN: HR = 5.91, p < 0.001). This study reaffirms the utility of LDH as a significant predictor of mortality with incremental severity, suggesting possible use for mortality projections. We note that Black patients and those with lower incomes may be more likely to have an elevated LDH. Older age groups and presence of ulceration among patients with stage IV melanoma were also associated with a greater risk of mortality.
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Affiliation(s)
- Amar D Desai
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Sree Chinta
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Christopher Yeh
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Vraj P Shah
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Radhika Shah
- Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Boris Paskhover
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Robert A Schwartz
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
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8
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Paradoxical Radiosensitizing Effect of Carnosic Acid on B16F10 Metastatic Melanoma Cells: A New Treatment Strategy. Antioxidants (Basel) 2022; 11:antiox11112166. [PMID: 36358539 PMCID: PMC9686564 DOI: 10.3390/antiox11112166] [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: 09/23/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Carnosic acid (CA) is a phenolic diterpene characterized by its high antioxidant activity; it is used in industrial, cosmetic, and nutritional applications. We evaluated the radioprotective capacity of CA on cells directly exposed to X-rays and non-irradiated cells that received signals from X-ray treated cells (radiation induced bystander effect, RIBE). The genoprotective capacity was studied by in vivo and in vitro micronucleus assays. Radioprotective capacity was evaluated by clonogenic cell survival, MTT, apoptosis and intracellular glutathione assays comparing radiosensitive cells (human prostate epithelium, PNT2) with radioresistant cells (murine metastatic melanoma, B16F10). CA was found to exhibit a genoprotective capacity in cells exposed to radiation (p < 0.001) and in RIBE (p < 0.01). In PNT2 cells, considered as normal cells in our study, CA achieved 97% cell survival after exposure to 20 Gy of X-rays, eliminating 67% of radiation-induced cell death (p < 0.001), decreasing apoptosis (p < 0.001), and increasing the GSH/GSSH ratio (p < 0.01). However, the administration of CA to B16F10 cells decreased cell survival by 32%, increased cell death by 200% (p < 0.001) compared to irradiated cells, and increased cell death by 100% (p < 0.001) in RIBE bystander cells (p < 0.01). Furthermore, it increased apoptosis (p < 0.001) and decreased the GSH/GSSG ratio (p < 0.01), expressing a paradoxical radiosensitizing effect in these cells. Knowing the potential mechanisms of action of substances such as CA could help to create new applications that would protect healthy cells and exclusively damage neoplastic cells, thus presenting a new desirable strategy for cancer patients in need of radiotherapy.
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Upshaw SJ, Jensen JD, Giorgi EA, Pokharel M, Lillie HM, Adams DR, John KK, Wu YP, Grossman D. Developing skin cancer education materials for darker skin populations: crowdsourced design, message targeting, and acral lentiginous melanoma. J Behav Med 2022:10.1007/s10865-022-00362-x. [PMID: 36125669 DOI: 10.1007/s10865-022-00362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Despite decreased susceptibility, darker skin individuals who develop melanoma have worse survival. This disparity in melanoma mortality is the largest for any cancer, and partly driven by a lack of patient education materials targeted to darker skin populations in whom acral lentiginous melanoma (ALM) is the most common subtype. To address this communication disparity, the current study reports a multi-phase design process that leverages crowdsourcing and message testing to develop ALM-focused patient education materials for darker skin populations. Crowdsourced design was utilized to develop a pool of designs (phase 1), the pool was narrowed and thematically analyzed (phase 2), and select designs were evaluated via a message experiment (N = 1877). For darker skin populations, designs that depicted people enhanced knowledge of ALM through message memorability. The current study engages melanoma disparities by providing ALM patient education materials for darker skin populations vetted via a multi-phase process.
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Affiliation(s)
- Sean J Upshaw
- Moody College of Communication, University of Texas-Austin, Austin, TX, USA.
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth A Giorgi
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Manusheela Pokharel
- Department of Communication Studies, Texas State University, San Marcos, TX, USA
| | - Helen M Lillie
- Department of Communication Studies, University of Iowa, Iowa City, IA, USA
| | - Dallin R Adams
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Kevin K John
- School of Communications, Brigham Young University, Provo, UT, USA
| | - Yelena P Wu
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Douglas Grossman
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
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10
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Galiatsatos P, Wilson C, O'Brien J, Gong AJ, Angiolillo D, Johnson J, Myers C, Strout S, Mathai S, Robinson G, Rowan NR, Weiss CR. A lack of race and ethnicity data in the treatment of hereditary hemorrhagic telangiectasia: a systematic review of intravenous bevacizumab efficacy. Orphanet J Rare Dis 2022; 17:220. [PMID: 35698080 PMCID: PMC9195340 DOI: 10.1186/s13023-022-02371-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For extreme hereditary hemorrhagic telangiectasia (HHT) disease, treatments such as intravenous bevacizumab are often utilized. However, whether its efficacy is similar across diverse races and ethnicities is unclear. METHODS In this systematic review, we performed a search for English-language articles identified through PubMed, Embase, and Scopus databases whose research occurred in the United States (US). Search terms related to HHT, epistaxis, and intravenous bevacizumab. We searched specifically for the intervention of intravenous bevacizumab because the term serves as a suitable surrogate to convey a patient who has both a diagnosis of HHT and established care. We focused on number of patients recruited in intravenous bevacizumab trials who were identified by race or ethnicity. RESULTS Our search identified 79 studies, of which four were conducted in the US. These four were selected for our systematic review. In these studies, 58 total patients were evaluated (ranging from 5 to 34 participants), whereby, information on age and gender were included. However, none of the US-based studies shared race or ethnicity data. CONCLUSION Inability to find studies regarding intravenous bevacizumab use in patients with HHT in which race and ethnicity are reported limits our ability to understand the therapy's efficacy in specific populations. Without emphasis on race and ethnicity in such trials, showing the potential of HHT-related diversity in individuals with this disease may reaffirm implicit bias around HHT diagnosis and treatment. Future work on HHT should emphasize sociodemographic data collection and reporting in an effort to understand this disease in diverse populations.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA. .,Office of Diversity, Inclusion, and Health Equity, Baltimore, MD, USA. .,Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 4th Floor, Asthma and Allergy Building, Baltimore, MD, 21224, USA.
| | - Cheri Wilson
- Office of Diversity, Inclusion, and Health Equity, Baltimore, MD, USA
| | - Jaime O'Brien
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, MO, USA
| | - Anna J Gong
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dylan Angiolillo
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 4th Floor, Asthma and Allergy Building, Baltimore, MD, 21224, USA
| | - James Johnson
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 4th Floor, Asthma and Allergy Building, Baltimore, MD, 21224, USA
| | - Carlie Myers
- Division of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sara Strout
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stephen Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gina Robinson
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas R Rowan
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clifford R Weiss
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
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11
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Huh J, Lee KJ, Roldan W, Castro Y, Kshirsagar S, Rastogi P, Kim I, Miller KA, Cockburn M, Yip J. Making of Mobile SunSmart: Co-designing a Just-in-Time Sun Protection Intervention for Children and Parents. Int J Behav Med 2021; 28:768-778. [PMID: 33846955 PMCID: PMC8041475 DOI: 10.1007/s12529-021-09987-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/02/2022]
Abstract
Background In this study, we describe a participatory design process to develop a technology-based intervention for sun protection for children and their parents. Our methodology embraces and leverages the expert knowledge of the target users, children and their parents, about their sun protection practices to directly influence the design of our mobile just-in-time adaptive intervention (JITAI). The objectives of this paper are to describe our research procedures and summarize primary findings incorporated into developing our JITAI modules. Methods We conducted 3 rounds of iterative co-design workshops with design expert KidsTeam UW children (N: 11–12) and subject expert children and their parents from local communities in California (N: 22–48). Iteratively, we thematically coded the qualitative data generated by participants in the co-design sessions to directly inform design specifications. Results Three themes emerged: (1) preference for non-linear educational format with less structure,; (2) situations not conducive for prioritizing sun protection; and (3) challenges, barriers, and ambiguity relating to sun protection to protect oneself and one’s family. Based on the design ideas and iterative participant feedback, three categories of modules were developed: personalized and interactive data intake module, narrative-education module with augmented reality experiment, person/real-time tailored JITAI, and assessment modules. Conclusions This is one of the first projects that maximally engage children and parents as co-designers to build a technology to improve sun protection with iterative and intentional design principles. Our scalable approach to design a mobile JITAI to improve sun protection will lay the foundation for future public health investigators with similar endeavors. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-09987-9.
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Affiliation(s)
- Jimi Huh
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA.
| | - Kung Jin Lee
- Information School, University of Washington, Seattle, WA, USA
| | - Wendy Roldan
- Human Centered Design & Engineering, University of Washington, Seattle, WA 98105, USA
| | - Yasmine Castro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Saurabh Kshirsagar
- School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Pankhuri Rastogi
- School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Ian Kim
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA.,Department of Dermatology, University of Southern California, Los Angeles, CA 90033, USA
| | - Myles Cockburn
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90007, USA.,Department of Dermatology, University of Southern California, Los Angeles, CA 90033, USA
| | - Jason Yip
- Information School, University of Washington, Seattle, WA, USA
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12
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Anaba E. Cutaneous malignant melanoma in skin of color individuals. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Compres E, Holzem K, Ibler E, Bierman JA, Rademaker AW, Kundu RV. A Brief Dermatology Curriculum in Skin Cancer Detection and Prevention to Improve Medical Student Knowledge and Confidence. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11049. [PMID: 33409352 PMCID: PMC7780741 DOI: 10.15766/mep_2374-8265.11049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/17/2020] [Indexed: 05/28/2023]
Abstract
INTRODUCTION While the incidence of skin cancers continues to rise, there remains a disproportionate lack of introductory training on skin cancer screening and identification of modifiable behaviors in medical curricula. Trainees and students have cited low confidence in their ability to counsel patients and lack of instruction as barriers. METHODS To address this need, we created a 1-hour didactic lecture based on a cognitive teaching framework for third-year medical students during their core primary care clerkship. The session highlighted visual identification of different skin cancers, factors increasing individual risk, and photoprotective behaviors. Session content was based on American Academy of Dermatology recommendations for skin cancer prevention. An assessment of knowledge, behaviors, and attitudes given before, immediately following, and at 6 months after the session was used to determine efficacy. RESULTS One hundred eight students before and immediately after the session demonstrated significantly improved knowledge (mean correct: 71% presession vs. 99% postintervention, p < .0001). Based on 39 participants completing 6-month follow-up, knowledge remained improved (mean answered correctly: 80%, p < .0001). Confidence in patient counseling on preventive behaviors, risk assessment, and reported likelihood of counseling significantly increased across the three time points (p < .0001 for all attitude questions). Specific topics included appropriate referral to a dermatologist, sunscreen application, and dangers of indoor tanning bed usage. DISCUSSION Our session on skin cancer screening and prevention demonstrated improvements in medical student knowledge, confidence, and patient counseling likelihood. This introductory curriculum could be adapted for multiple core clerkships or specialties.
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Affiliation(s)
- Elsy Compres
- Fourth-Year Medical Student, Northwestern University Feinberg School of Medicine
| | - Kassandra Holzem
- Resident Physician, Department of Dermatology, Northwestern University Feinberg School of Medicine
| | - Erin Ibler
- Resident Physician, Department of Dermatology, Northwestern University Feinberg School of Medicine
| | - Jennifer A. Bierman
- Associate Professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine
| | - Alfred W. Rademaker
- Professor Emeritus, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Roopal V. Kundu
- Associate Professor, Departments of Dermatology and Medical Education, Northwestern University Feinberg School of Medicine
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14
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Saaiq M, Siddiqui S. Clinical and Demographic Profile of Cutaneous Melanoma: Pakistani Perspective. World J Plast Surg 2020; 9:296-301. [PMID: 33330006 PMCID: PMC7734942 DOI: 10.29252/wjps.9.3.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Cutaneous melanomas (CMs) account for only a small proportion of skin cancers, however these are responsible for most skin cancer deaths. There has been a consistently increasing trend in their incidence across the globe. METHODS This prospective case series study spanned over a period of three years. All patients with histologically confirmed CMs were included. RESULTS There were 31 patients including 28 males and 3 females with the mean age of 58.25±11.33 years. The histological subtypes included 13 cases (41.93%) of nodular melanoma (NM), 11 patients (35.5%) of acral lentiginous melanoma (ALM), 3 cases (9.67%) of superficial spreading melanoma (SSM) and lentigo maligna melanoma (LMM) and one case (3.22%) of desmoplastic melanoma. Two patients (6.45%) presented with stage II, whereas 21 patients had (67.74%) stage III melanoma. There were 8 patients (25.80%) with stage IV. Time interval between onset of the lesion and first presentation to hospital ranged from 6 to 17 weeks with a mean of 12.45±3.2 weeks. The overall median survival for patients with stage III and IV was 8.75 months. The overall survival for stage II at one year was 100%. CONCLUSION CMs more frequently affected males aged ≥58 years. Feet, face, trunk, hands and scalp were the affected anatomical body parts in decreasing order of frequency. NM and ALM were the more common histological subtypes. Majority of patients presented late and advanced stages of melanoma. Awareness about the sinister course of the disease will ensure early presentation with better treatment outcome.
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Affiliation(s)
- Muhammad Saaiq
- Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Saad Siddiqui
- Department of Plastic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
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15
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The ongoing racial disparities in melanoma: An analysis of the Surveillance, Epidemiology, and End Results database (1975-2016). J Am Acad Dermatol 2020; 84:1585-1593. [PMID: 32861710 DOI: 10.1016/j.jaad.2020.08.097] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although most patients with cutaneous melanoma are non-Hispanic whites (NHWs), minorities consistently suffer worse melanoma-specific survival (MSS). Much of the literature comes from analyses of registries from the 1990s and 2000s. OBJECTIVE We sought to evaluate whether and to what degree racial disparity in MSS persists since 2010. METHODS We analyzed 381,035 patients from the Surveillance, Epidemiology, and End Results registry. Race categories included Hispanic, NHW, non-Hispanic black (NHB), non-Hispanic Asian or Pacific Islander (NHAPI), and non-Hispanic American Indian/Alaska Native (NHAIAN). We evaluated the association between MSS and race in 3 time periods: before the year 2000, 2000 to 2009, and 2010 or later. NHW was the reference group for all analyses. RESULTS Racial disparity worsened from before the year 2000 to 2010 or later for Hispanic (P < .001), NHB (P = .024), and NHAPI (P < .001) patients. Across all minority groups, patients with localized disease suffered increasing disparity (P = .010 for Hispanic, P < .001 for NHB, P = .023 for NHAPI, and P = .042 for NHAIAN patients). Among those with regional and distant disease, Hispanic patients were the only minority to experience worsening disparity (P = .001 and P = .019, respectively). LIMITATIONS Lack of immunotherapy and targeted treatment information. CONCLUSIONS Racial disparity in MSS is worsening. Improving postdiagnosis management for minorities with localized disease is imperative to mitigate disparity and improve survival.
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Abstract
BACKGROUND Skin cancer has traditionally been studied in Caucasian skin. Although it does occur with increased relative frequency in Caucasians, patients with skin of color suffer from elevated morbidity and mortality when diagnosed with skin cancer. OBJECTIVE To detail the unique demographic, clinical, and genetic features of melanoma in patients with skin of color, including Hispanic, African American, and Asian patients. MATERIALS AND METHODS A PubMed search was conducted spanning dates 1947 to June 2017. A total of 246 articles were screened, from which 69 were included in this review. RESULTS Relative to Caucasians, melanoma has unique demographic, clinical, and genetic features in African Americans, Hispanics, and Asians that include gender and subtype predominance. CONCLUSION Familiarization with these unique presentations of skin cancer in skin of color is imperative to accurate identification and treatment of cutaneous malignancies in these populations and ultimately to improved disease-related outcomes.
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17
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Afanasiev OK, Tu JH, Chu DH, Swetter SM. Characteristics of melanoma in white and nonwhite children, adolescents, and young adults: Analysis of a pediatric melanoma institutional registry, 1995-2018. Pediatr Dermatol 2019; 36:448-454. [PMID: 30993772 DOI: 10.1111/pde.13836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To characterize clinical differences among nonwhite/multiethnic vs white children, adolescents, and young adults with melanoma or atypical melanocytic neoplasms, including atypical Spitz tumors. PATIENTS AND METHODS A cohort of 55 patients (< 25 years of age) prospectively followed from 1995 to 2018 in the Stanford Pigmented Lesion and Melanoma Program was analyzed for differences in clinical presentation, including skin phototype, race/ethnicity, age, sex, tumor/melanoma characteristics, and outcome. RESULTS Seventeen patients (9 males and 8 females) were classified as nonwhite (predominantly skin phototype IV) and of Hispanic, Asian, or Black/African American ethnicity, and 38 patients (21 males and 17 females) were classified as white (predominantly phototypes I/II). Ages ranged from 6 months to 24 years, and median follow-up was 36 months (range 1-180 months). Melanomas were diagnosed in 87% of whites in our cohort, compared to 65% of nonwhites, with the remainder representing mainly atypical Spitz tumors. Lesions were usually brought to the attention of a health care provider by the patient or family (P < 0.05). Compared with whites, nonwhites were more likely to present at a younger mean age (10.9 years vs 15.4 years, P < 0.05) and with pink/clinically amelanotic tumors (59% vs 24%, P = 0.02). CONCLUSIONS This long-term prospective institutional study showed clinically relevant differences between nonwhite vs white children, adolescents, and young adults diagnosed with melanoma and atypical melanocytic neoplasms. Nonwhite patients presented at a younger age and had more clinically amelanotic melanocytic tumors. Increased recognition of clinical factors and risk of these tumors in nonwhites could result in earlier diagnosis.
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Affiliation(s)
- Olga K Afanasiev
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California
| | - Joanna H Tu
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California
| | - Derek H Chu
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University Medical Center, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Lucile Packard Children's Hospital, Stanford, California.,Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California
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18
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Pozzobon FC, Acosta AE. Epidemiological profile of primary cutaneous melanoma over a 15-year period at a private skin cancer center in Colombia. ACTA ACUST UNITED AC 2019; 20:226-231. [PMID: 30570006 DOI: 10.15446/rsap.v20n2.65616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/08/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe clinical, histopathological and treatment characteristics of melanoma in a private institution of Bogotá, Colombia, and to identify differences regarding sex and age. MATERIALS AND METHODS Observational, retrospective study. 415 medical records between January 1999 and May 2014 were analyzed. RESULTS Out of 415 patients, 244 (58.8%) were females and 171 (41.2%) were males with a mean age of 56.1 ±16.2 SD. Superficial spreading melanoma (SSMM) was the main subtype (n=175, 42.7%). Breslow's thickness ≤1mm was predominant, while phototypes II and III were more frequent (n=87, 69.6%). Melanoma was predominantly localized on the head in men (n=83, 50.3%) and in the lower limbs in women (n=89, 36.8%), with a higher frequency of SSMM pattern among patients aged ≤65. Lentigo maligna (LM) was more frequent in patients aged >65 (p<0.001), with a higher number of ulcerated melanomas (p=0.046). CONCLUSIONS A predominance of thin SSMM and fair skin phototypes were found, unlike previous reports that showed acral lentiginous melanoma (ALM) as predominant, which may be caused by local variations related to mixed ethnicity.
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Affiliation(s)
- Flavia C Pozzobon
- FP: MD. M. Sc. Dermatologist Universidad Nacional de Colombia. Universidad de Barcelona. Instituto Nacional de Cancerología. Bogotá, Colombia.
| | - Alvaro Enrique Acosta
- AA: MD. Oncologist Dermatologist Universidad Nacional de Colombia, Universidad Javeriana. Instituto Nacional de Cancerología. Bogotá, Colombia.
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19
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Danysh HE, Navai SA, Scheurer ME, Hunt R, Venkatramani R. Malignant melanoma incidence among children and adolescents in Texas and SEER 13, 1995-2013. Pediatr Blood Cancer 2019; 66:e27648. [PMID: 30729662 PMCID: PMC6472974 DOI: 10.1002/pbc.27648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Epidemiological knowledge and predictors of melanoma among children and adolescents in multiethnic populations are limited. PROCEDURE Using data from the Texas Cancer Registry (TCR) and the Surveillance, Epidemiology, and End Results (SEER) 13 database, we identified incident melanoma cases diagnosed at 0-20 years old during 1995-2013 in Texas and the United States, respectively. Using negative binomial regression, associations between demographic factors and melanoma incidence rates (IR) were evaluated by calculating incidence rate ratios (IRR) and 95% confidence intervals (CI). Annual percent change in IRs was assessed with joinpoint regression. RESULTS Overall, the melanoma IR was 4.16 (TCR, n = 634) and 4.84 (SEER, n = 1260) per million. Females, adolescents, non-Hispanic (NH) whites, and Hispanics had higher IRs compared with other groups (P < 0.05). In adjusted analyses, Hispanics had a higher incidence of melanoma than NH non-whites (Texas IRR = 2.17; 95% CI, 1.30-3.61; SEER IRR = 2.88; 95% CI, 1.97-4.21). In Texas, NH whites with melanoma were more likely to live in low poverty areas, whereas the opposite trend was observed in Hispanics. Melanoma IRs increased throughout 1995-2004 followed by an average annual decrease of 7.6% (95% CI, -12.6%, -2.2%) in Texas and 6.0% (95% CI, -8.5%, -3.4%) in SEER during 2005-2013 (P < 0.05). However, these decreasing trends were not observed among Hispanics or those <10 years old. CONCLUSION Although the overall melanoma IR in children and adolescents appears to be decreasing, this trend is not evident among Hispanics and young children, implicating the need for further research investigating the etiologies and risk factors in these groups.
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Affiliation(s)
- Heather E. Danysh
- Department of Pediatrics, Hematology-Oncology Section,
Texas Children’s Cancer Center, Dan L. Duncan Comprehensive Cancer Center,
Baylor College of Medicine, Houston, Texas
| | - Shoba A. Navai
- Department of Pediatrics, Hematology-Oncology Section,
Texas Children’s Cancer Center, Dan L. Duncan Comprehensive Cancer Center,
Baylor College of Medicine, Houston, Texas,Center for Cell and Gene Therapy, Texas Children’s
Hospital, Houston Methodist Hospital, Baylor College of Medicine, Houston,
Texas
| | - Michael E. Scheurer
- Department of Pediatrics, Hematology-Oncology Section,
Texas Children’s Cancer Center, Dan L. Duncan Comprehensive Cancer Center,
Baylor College of Medicine, Houston, Texas
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas
Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Rajkumar Venkatramani
- Department of Pediatrics, Hematology-Oncology Section,
Texas Children’s Cancer Center, Dan L. Duncan Comprehensive Cancer Center,
Baylor College of Medicine, Houston, Texas
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20
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Baranowski MLH, Yeung H, Chen SC, Gillespie TW, Goodman M. Factors associated with time to surgery in melanoma: An analysis of the National Cancer Database. J Am Acad Dermatol 2019; 81:908-916. [PMID: 31163238 DOI: 10.1016/j.jaad.2019.05.079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 05/22/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Timely treatment for melanoma may affect survival, and characterizing the predictors of delay may inform intervention strategies. OBJECTIVE To determine characteristics associated with the interval between diagnosis and surgery in melanoma. METHODS The National Cancer Database was used to examine factors associated with the interval between diagnosis and surgery among 213 146 patients with stage I, II, or III cutaneous melanoma. RESULTS Among privately insured patients, time to surgery was longer for patients aged 50 to 70 years (hazard ratio [HR], 0.96) and older than 70 years (HR, 0.83) compared with those younger than 50 years. In contrast, patients without private insurance experienced a shorter surgical wait time if older (HR for age 50-70 years, 1.07; HR for age >70 years, 1.05). Other factors associated with longer surgical interval included nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma location. LIMITATIONS Use of zip code-level data for income and education level. CONCLUSION Patients with melanoma experience disparities in timely receipt of surgery.
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Affiliation(s)
- Marissa L H Baranowski
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Regional TeleHealth Service, Veterans Integrated Services Network 7, Decatur, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Regional TeleHealth Service, Veterans Integrated Services Network 7, Decatur, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia; Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
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21
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Buchanan Lunsford N, Berktold J, Holman DM, Stein K, Prempeh A, Yerkes A. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women. Prev Med Rep 2018; 12:203-209. [PMID: 30364862 PMCID: PMC6199782 DOI: 10.1016/j.pmedr.2018.09.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/30/2018] [Accepted: 09/29/2018] [Indexed: 12/20/2022] Open
Abstract
Black and Hispanic populations perceive their skin cancer risk to be low and are less likely to use sun protection strategies. We conducted formative research to understand knowledge, awareness, beliefs, and behaviors among these groups. In 2017, eighteen focus groups were conducted with black and Hispanic respondents(18-44 years) in four US cities. Groups were segmented by participant characteristics associated with elevated or lower risk for skin cancer, by race/ethnicity, gender, and age. A professional moderator followed a semi-structured discussion guide, and focus group transcripts were analyzed using conventional content analysis and NVIVO 11 Software. Most participants perceived themselves to be at low skin cancer risk due to their "darker skin tone" and/or "lack of family history." Skin cancer signs and symptoms were more inconsistently reported by blacks than Hispanics. Few participants reported regular sun protection behaviors. Those who did used sunscreen, wore protective clothing, and had elevated risk based on sun sensitivity or UV exposure. While most participants recalled family discussions (as youth) about sunscreen and sun protection, the understood intent was to warn against "further skin darkening" or to "prevent aging," not to reduce sun burns or skin cancer risk. Tanning bed use was low across all segments, especially among black respondents. Tailored skin cancer prevention campaigns need to address misperceptions about risks and benefits of skin cancer prevention behaviors among black and Hispanic populations. Families, peer groups, and healthcare providers need to be engaged in the creation of educational interventions and messaging efforts that target these populations.
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Affiliation(s)
- Natasha Buchanan Lunsford
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, United States of America
- Corresponding author at: Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Highway, N.E., MS F76, Atlanta, GA 30341, United States of America.
| | | | - Dawn M. Holman
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Epidemiology and Applied Research Branch, Atlanta, GA, United States of America
| | - Karen Stein
- Westat, Inc, Rockville, MD, United States of America
| | - Adwoa Prempeh
- Westat, Inc, Rockville, MD, United States of America
| | - Adeline Yerkes
- National Association of Chronic Disease Directors, Atlanta, GA, United States of America
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22
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Survival trends among patients with metastatic melanoma in the pretargeted and the post-targeted era: a US population-based study. Melanoma Res 2018; 28:56-60. [PMID: 29023264 DOI: 10.1097/cmr.0000000000000394] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2011, ipilimumab was approved by the US Food and Drug Administration (FDA) for metastatic melanoma. Since its approval, numerous targeted therapies have been approved by the FDA. Population-based studies assessing the survival benefit from these agents are lacking. We therefore carried out this study to compare the 1-year, 2-year, and median overall survival (OS) among metastatic melanoma patients in pretargeted and post-targeted eras. This is a retrospective study that utilized the Surveillance, Epidemiology, and End Results (SEER-18) database, version 8.3.4 (22 March 2017). The patient groups were defined as the pretargeted era (2004-2010) and the post-targeted era (2011-2014) as ipilimumab was approved by the FDA in 2011. The database comprised of 5471 patients (3314 in the pretargeted era and 2157 in the post-targeted era). OS in the post-targeted era was found to be significantly better compared with the pretargeted era by Kaplan-Meier curve (1-year OS: 38.9 vs. 36.8%, 2-year OS: 28.3 vs. 23.5%, and median survival: 8 vs. 7 months, P=0.001 by the log-rank test). The survival was significantly better in the post-targeted era compared with the pretargeted era on multivariate analysis using a Cox proportional hazard model after adjusting for age, sex, race, and metasectomy status (adjusted hazard ratio of 0.889, 95% CI: of 0.832-0.951, P=0.001). There is significant survival benefit in metastatic melanoma patients since the introduction of immune checkpoint-blocking agents.
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Abstract
BACKGROUND Skin cancer has traditionally been studied in Caucasian skin. Although it does occur with increased relative frequency in Caucasians, patients with skin of color suffer from elevated morbidity and mortality when diagnosed with skin cancer. OBJECTIVE To detail the unique demographic and clinical features of nonmelanoma skin cancer (NMSC) in patients with skin of color, including Hispanic, African American, and Asian patients. MATERIALS AND METHODS A complete PubMed search was conducted spanning dates from 1947 to June 2017 yielding a total of 185 manuscripts, from which 45 were included in this review. RESULTS Relative to Caucasians, NMSC, comprised squamous cell carcinoma and basal cell carcinoma, has unique demographic and clinical features in African Americans, Hispanics, and Asians. CONCLUSION Familiarization with these unique presentations of skin cancer in skin of color is imperative to accurate identification and treatment of cutaneous malignancies in these populations and ultimately to improved disease-related outcomes.
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Improving Sun-Protective Behaviors and Self-Skin Examinations Among African Americans: A Randomized Controlled Trial. Dermatol Surg 2018; 44:512-518. [PMID: 29016548 DOI: 10.1097/dss.0000000000001366] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few studies describing sun-protective behaviors, knowledge, and self-efficacy in African Americans exist. Although educational programs targeting Caucasians and Hispanics have been successful in increasing melanoma awareness and knowledge, no such investigation has been applied to African Americans. OBJECTIVE To evaluate the effectiveness of a brochure or video educational intervention on the sun-protective behaviors, knowledge, and self-efficacy regarding melanoma in African Americans. MATERIALS AND METHODS A randomized controlled trial of a presurvey and postsurvey, in an academic outpatient dermatology clinic. Participants were self-identified African Americans, at least 18 years old, fluent, and literate in English. Patients randomized to the brochure-intervention group (n = 72) received a melanoma brochure from the National Cancer Institute. Patients randomized to the video-intervention group (n = 71) received the brochure and watched an online melanoma tutorial. RESULTS Sun-protective behaviors, knowledge, and self-efficacy regarding melanoma all improved equally from pre-to posteducation, in both the brochure- and video-intervention groups. CONCLUSION Melanoma educational interventions similar to those previously demonstrated to be successful in Caucasian and Hispanic populations are also effective among African Americans.
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25
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Hulur I, Skol AD, Gamazon ER, Cox NJ, Onel K. Integrative genetic analysis suggests that skin color modifies the genetic architecture of melanoma. PLoS One 2017; 12:e0185730. [PMID: 28973033 PMCID: PMC5626488 DOI: 10.1371/journal.pone.0185730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022] Open
Abstract
Melanoma is the deadliest form of skin cancer and presents a significant health care burden in many countries. In addition to ultraviolet radiation in sunlight, the main causal factor for melanoma, genetic factors also play an important role in melanoma susceptibility. Although genome-wide association studies have identified many single nucleotide polymorphisms associated with melanoma, little is known about the proportion of disease risk attributable to these loci and their distribution throughout the genome. Here, we investigated the genetic architecture of melanoma in 1,888 cases and 990 controls of European non-Hispanic ancestry. We estimated the overall narrow-sense heritability of melanoma to be 0.18 (P < 0.03), indicating that genetics contributes significantly to the risk of sporadically-occurring melanoma. We then demonstrated that only a small proportion of this risk is attributable to known risk variants, suggesting that much remains unknown of the role of genetics in melanoma. To investigate further the genetic architecture of melanoma, we partitioned the heritability by chromosome, minor allele frequency, and functional annotations. We showed that common genetic variation contributes significantly to melanoma risk, with a risk model defined by a handful of genomic regions rather than many risk loci distributed throughout the genome. We also demonstrated that variants affecting gene expression in skin account for a significant proportion of the heritability, and are enriched among melanoma risk loci. Finally, by incorporating skin color into our analyses, we observed both a shift in significance for melanoma-associated loci and an enrichment of expression quantitative trait loci among melanoma susceptibility variants. These findings suggest that skin color may be an important modifier of melanoma risk. We speculate that incorporating skin color and other non-genetic factors into genetic studies may allow for an improved understanding of melanoma susceptibility and guide future investigations to identify melanoma risk genes.
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Affiliation(s)
- Imge Hulur
- Committee on Genetics, Genomics and Systems Biology, The University of Chicago, Chicago, Illinois, United States of America
| | - Andrew D. Skol
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Eric R. Gamazon
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Nancy J. Cox
- Department of Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Kenan Onel
- Department of Pediatrics, Hofstra Northwell School of Medicine, Hempstead, New York, United States of America
- Department of Genetics and Genomics, The Feinstein Institute for Medical Research, Manhasset, New York, United States of America
- * E-mail:
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26
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Drugge RJ, Drugge ED. Temporal Image Comparison (Serial Imaging) in Assessing Pigmented Lesions. Dermatol Clin 2017; 35:447-451. [DOI: 10.1016/j.det.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rodríguez VM, Shuk E, Arniella G, González CJ, Gany F, Hamilton JG, Gold GS, Hay JL. A Qualitative Exploration of Latinos' Perceptions About Skin Cancer: the Role of Gender and Linguistic Acculturation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:438-446. [PMID: 26687207 PMCID: PMC4916022 DOI: 10.1007/s13187-015-0963-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Latinos have the highest rate of skin cancers among U.S. minorities. Despite a rising incidence of melanoma-the deadliest form of skin cancer-and greater disease burden, Latinos tend to have poor awareness of skin cancer risk factors which may inhibit preventive action. We expanded on prior work by qualitatively examining potential moderators (i.e., gender, acculturation) of skin cancer perceptions among Latinos from El Barrio in Harlem, New York City. Four focus groups stratified by language (English/Spanish) and gender were conducted. Discussions were recorded, transcribed, and coded using thematic analysis. Thirty-eight self-identified Latinos (32 % male) participated. Across groups, median age was 35 years; 50 % completed <high school degree, 82 % had annual incomes ≤$29,999, and 55 % were born in Mexico. Mean acculturation level was 8.5 (SD = 3.9, range = 4-20). Major themes included (1) knowledge of common skin cancer risk factors, (2) acknowledgment of personal risk although lighter-skin individuals are at greater risk, and (3) awareness of effective risk reduction methods, despite the presence of fatalistic beliefs. Compared to males, females discussed tanning norms and appearance-based factors, identified children as vulnerable, highlighted the benefits of sun exposure, and wanted more information. Few linguistic acculturation patterns were noted; English speakers questioned the carcinogenic effect of sunscreen and reported more skin cancer-related physician discussions than Spanish speakers. Despite generally low acculturation, Latinos correctly identified skin cancer risk factors and agreed that it is preventable with engagement in risk-reducing behaviors. Future educational interventions must capitalize upon and reinforce such beliefs and address fatalistic perceptions which may hinder prevention efforts.
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Affiliation(s)
- Vivian M Rodríguez
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA.
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Guedy Arniella
- Harlem Residency in Family Medicine, The Institute for Family Health, New York, NY, USA
| | - C Javier González
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Jada G Hamilton
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
| | - Geoffrey S Gold
- Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY, 10022, USA
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Robinson JK, Penedo FJ, Hay JL, Jablonski NG. Recognizing Latinos' range of skin pigment and phototypes to enhance skin cancer prevention. Pigment Cell Melanoma Res 2017; 30:488-492. [PMID: 28504868 DOI: 10.1111/pcmr.12598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
Abstract
Latinos in the United States may have the mistaken assumption that their natural pigmentation protects them from developing skin cancer that, effectively, serves as a barrier to Latinos receiving education in primary and secondary prevention of skin cancer. Latino adults of Mexican or Puerto Rican heritage attending community health fairs in the greater Chicago area responded to a culturally informed and sensitive measure for sunburn and tan, which was previously adapted to capture skin irritation with tenderness from the sun occurring in darker skin types (n = 350). By self-reported responses and spectrophotometry assessment of constitutive pigmentation, adapted Fitzpatrick skin types (FST) ranged from skin type I-IV in the Mexican American participants and from II to V in the Puerto Rican participants. The objectively measured proportion of adapted FST II skin type was greater than commonly perceived and demonstrated that many Latinos do indeed have sun-sensitive skin.
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Affiliation(s)
- June K Robinson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank J Penedo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nina G Jablonski
- Stellenbosch Institute for Advanced Study, The Pennsylvania State University, University Park, PA, USA
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Rodriguez-Leyva I, Chi-Ahumada E, Mejía M, Castanedo-Cazares JP, Eng W, Saikaly SK, Carrizales J, Levine TD, Norman RA, Jimenez-Capdeville ME. The Presence of Alpha-Synuclein in Skin from Melanoma and Patients with Parkinson's Disease. Mov Disord Clin Pract 2017; 4:724-732. [PMID: 30363411 DOI: 10.1002/mdc3.12494] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/14/2017] [Accepted: 03/19/2017] [Indexed: 12/31/2022] Open
Abstract
Background The misfolding and prion-like propagation of the protein α-synuclein (α-syn) is the leading molecular signature in Parkinson's disease (PD). There is a significant coincidence of PD and melanoma that may suggest a shared pathophysiology. This study compared the presence of α-syn in neural crest-derived tissues, such as nevi, melanoma, skin tags, and skin biopsies from patients with PD and healthy controls. Methods Biopsies from participants with PD were obtained from patients from a tertiary referral center for dermatology and neurology in Mexico and a private dermatopathology center in Florida between January 2015 and March 2016. Biopsies from 7 patients with melanoma, 15 with nevi, 9 with skin tags, 8 with PD, and 9 skin biopsies from healthy volunteers were analyzed for immunohistochemical determination of α-syn and tyrosinase. All analyses were performed by pathologists who were blinded with respect to the clinical diagnosis. Results In healthy controls, positive α-syn status was restricted to scattered cells in the basal layer of the epidermis and accounted for 1 ± 0.8% of the analyzed area. In patients with PD, there was increased staining for α-syn PD (3.3 ± 2.3%), with a higher percentage of positive cells in nevi (7.7 ± 5.5%) and melanoma (13.6 ± 3.5%). There was no increased staining in skin tags compared with healthy controls. Conclusion Patients with PD and melanoma have increased staining for α-syn in their skin. The authors propose that neurons and melanocytes, both derived from neuroectodermal cells, may share protein synthesis and regulation pathways that become dysfunctional in PD and melanoma.
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Affiliation(s)
| | - Erika Chi-Ahumada
- Departamento de Bioquímica Facultad de Medicina Universidad Autónoma de San Luis Potosí San Luis Potosí México
| | - Manuel Mejía
- Departamento de Bioquímica Facultad de Medicina Universidad Autónoma de San Luis Potosí San Luis Potosí México
| | | | - William Eng
- University of Central Florida College of Medicine Orlando Florida USA
| | - Sami K Saikaly
- University of Central Florida College of Medicine Orlando Florida USA
| | - Juan Carrizales
- Departamento de Bioquímica Facultad de Medicina Universidad Autónoma de San Luis Potosí San Luis Potosí México
| | | | - Robert A Norman
- University of Central Florida College of Medicine Orlando Florida USA
| | - Maria E Jimenez-Capdeville
- Departamento de Bioquímica Facultad de Medicina Universidad Autónoma de San Luis Potosí San Luis Potosí México
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Chao LX, Patterson SSL, Rademaker AW, Liu D, Kundu RV. Melanoma Perception in People of Color: A Targeted Educational Intervention. Am J Clin Dermatol 2017; 18:419-427. [PMID: 28035649 DOI: 10.1007/s40257-016-0244-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although melanoma is more common in non-Hispanic Whites, ethnic minorities face a greater risk of melanoma-related mortality, which may be partially attributed to presentation at atypical sites and a lack of awareness. OBJECTIVE Our objective was to assess the effectiveness of a melanoma educational intervention targeted towards people of color. DESIGN Participants received one of two scripted melanoma educational interventions in the summer of 2015. They completed surveys before the intervention, immediately post-intervention, and 2 months post-intervention. SETTING Dermatology clinic at an academic hospital. PARTICIPANTS A consecutive sample of 100 participants who self-identified as African American, Asian, or Hispanic were recruited following their dermatology visit. In total, 70 participants completed the 2-month follow-up questionnaire. INTERVENTION The comparison intervention group received an educational intervention using a conventional pamphlet on the 'ABCDEs' (Asymmetry, Borders, Color, Diameter, Evolution) of melanoma. The targeted intervention group received a modified pamphlet that included a skin of color section, the nomenclature "melanoma skin cancer", and an image of an individual performing a skin self-examination with the help of a friend. MAIN OUTCOMES AND MEASURES Melanoma knowledge, perceived risk for developing melanoma, and skin self-examination practices were assessed through self-reported questionnaires. RESULTS Among the 100 participants, 78% self-identified as African American, 11% as Asian, and 11% as Hispanic. Both groups experienced a similar increase in melanoma knowledge that was retained at 2 months. Perceived personal risk for developing melanoma increased more in the targeted intervention group immediately post-intervention (p = 0.015), but this difference no longer existed between the groups at the 2-month follow-up. The targeted intervention group also demonstrated a greater increase in skin self-examinations (p = 0.048) and knowledge of warning signs to look for when examining the skin (p = 0.002) at the 2-month follow-up. CONCLUSIONS AND RELEVANCE The educational intervention targeted towards people of color resulted in increased skin self-examinations. Educational material that is relevant to ethnic minorities may better promote early detection and help to decrease the disparity in melanoma-related morality rates. TRIAL REGISTRATION Clinicaltrials.gov registration number NCT02437305.
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Affiliation(s)
- Lucy X Chao
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Stavonnie S L Patterson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Alfred W Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dachao Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roopal V Kundu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St, Ste 1600, Chicago, IL, 60611, USA.
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Escobedo LA, Crew A, Eginli A, Peng D, Cousineau MR, Cockburn M. The role of spatially-derived access-to-care characteristics in melanoma prevention and control in Los Angeles county. Health Place 2017; 45:160-172. [PMID: 28391127 PMCID: PMC5470843 DOI: 10.1016/j.healthplace.2017.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 11/05/2016] [Accepted: 01/09/2017] [Indexed: 12/17/2022]
Abstract
Among 10,068 incident cases of invasive melanoma, we examined the effects of patient characteristics and access-to-care on the risk of advanced melanoma. Access-to-care was defined in terms of census tract-level sociodemographics, health insurance, cost of dermatological services and appointment wait-times, clinic density and travel distance. Public health insurance and education level were the strongest predictors of advanced melanomas but were modified by race/ethnicity and poverty: Hispanic whites and high-poverty neighborhoods were worse off than non-Hispanic whites and low-poverty neighborhoods. Targeting high-risk, underserved Hispanics and high-poverty neighborhoods (easily identified from existing data) for early melanoma detection may be a cost-efficient strategy to reduce melanoma mortality.
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Affiliation(s)
- Loraine A Escobedo
- Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, United States.
| | - Ashley Crew
- Keck School of Medicine, University of Southern California, United States
| | - Ariana Eginli
- Keck School of Medicine, University of Southern California, United States
| | - David Peng
- Keck School of Medicine, University of Southern California, United States
| | - Michael R Cousineau
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Myles Cockburn
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, United States
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Mahendraraj K, Sidhu K, Lau CS, McRoy GJ, Chamberlain RS, Smith FO. Malignant Melanoma in African-Americans: A Population-Based Clinical Outcomes Study Involving 1106 African-American Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1988-2011). Medicine (Baltimore) 2017; 96:e6258. [PMID: 28403068 PMCID: PMC5403065 DOI: 10.1097/md.0000000000006258] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Malignant melanoma accounts for 75% of all skin cancer deaths and is potentially curable if identified early. Although melanoma is rare in African-Americans (AA), it is associated with a worse prognosis than in Caucasians. This study examines the demographic, pathologic, and clinical factors impacting AA melanoma outcomes.Data for 1106 AA and 212,721 Caucasian cutaneous melanoma patients were abstracted from the Surveillance, Epidemiology, and End Result (SEER) database (1988-2011). Data were grouped on the basis of histological subtypes: "Superficial Spreading" (SS), "Nodular" (NM), "Lentigo Maligna" (LM), "Acral Lentiginous" (AL), and "Not otherwise specified" (NOS).Cutaneous malignant melanoma occurs most commonly in the sixth and seventh decade of life. Caucasian patients presented most commonly with trunk melanomas (34.5%), while lower extremity melanomas were more common in AAs (56.1%), P < 0.001. AAs presented with deeper tumors, more advanced stage of disease, and higher rates of ulceration and lymph node positivity than Caucasians. Cancer-specific mortality was significantly higher, while 5-year cancer-specific survival was significantly lower among AAs for NM and AL subtypes. Multivariate analysis identified male gender, regional and distant stage, NM and AL subtypes as independently associated with increased mortality among both ethnic groups.AAs present most often with AL melanoma on the lower extremities, and with deeper and more advanced stage lesions. AAs have higher cancer-specific mortality for NM and LM than Caucasians. Melanoma education for AA patients and health care providers is needed to increase disease awareness, facilitate early detection, and promote access to effective treatment.
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Affiliation(s)
| | - Komal Sidhu
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ
| | - Christine S.M. Lau
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ
- Saint George's University School of Medicine, Grenada, West Indies
| | - Georgia J. McRoy
- Saint George's University School of Medicine, Grenada, West Indies
| | - Ronald S. Chamberlain
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ
- Saint George's University School of Medicine, Grenada, West Indies
- Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Franz O. Smith
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ
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Dawes SM, Tsai S, Gittleman H, Barnholtz-Sloan JS, Bordeaux JS. Racial disparities in melanoma survival. J Am Acad Dermatol 2016; 75:983-991. [PMID: 27476974 DOI: 10.1016/j.jaad.2016.06.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Melanoma is a cutaneous malignancy common in the white population but can also occur in other racial groups. OBJECTIVE We sought to evaluate survival across racial groups in patients given a diagnosis of malignant melanoma. METHODS The Surveillance, Epidemiology, and End Results database was used to populate a cohort of 96,953 patients given a diagnosis of cutaneous melanoma as their primary cancer, from 1992 to 2009. RESULTS White patients had the longest survival time (P < .05), followed by Hispanic (P < .05), Asian American/Native American/Pacific Islander (P < .05), and black (P < .05) patients, respectively. Survival stratified by race and stage showed that for stages I and III, blacks had a significantly lower survival (P < .05), and increased hazard ratios (stage I hazard ratio, 3.037 [95% confidence interval, 2.335-3.951]; stage III hazard ratio, 1.864 [95% confidence interval, 1.211-2.87]). The proportion of later stage cutaneous melanoma (stages II-IV) was greater in blacks compared with whites. CONCLUSION Despite higher incidence of cutaneous melanoma in whites, overall survival for cutaneous melanoma in non-whites was significantly lower. Our results suggest that more emphasis is needed for melanoma screening and awareness in non-white populations to improve survival outcomes.
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Affiliation(s)
- Sean M Dawes
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Sheena Tsai
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Haley Gittleman
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio.
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Lyman M, Mills J, Shipman A. A dermatological questionnaire for general practitioners in England with a focus on melanoma; misdiagnosis in black patients compared to white patients. J Eur Acad Dermatol Venereol 2016; 31:625-628. [DOI: 10.1111/jdv.13949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/04/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M. Lyman
- The University of Birmingham; UK
| | | | - A.R. Shipman
- South Warwickshire NHS Foundation Trust; Dept of Dermatology; Warwick Hospital; Warwick UK
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Hamilton EC, Nguyen HT, Chang YC, Eberth JM, Cormier J, Elting LS, Austin MT. Health Disparities Influence Childhood Melanoma Stage at Diagnosis and Outcome. J Pediatr 2016; 175:182-7. [PMID: 27233520 DOI: 10.1016/j.jpeds.2016.04.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 04/20/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify health disparities in pediatric patients with melanoma that affect disease presentation and outcome. STUDY DESIGN This was a retrospective cohort study of all persons aged ≤18 years diagnosed with melanoma and enrolled in the Texas Cancer Registry between 1995 and 2009. Socioeconomic status (SES) and driving distance to the nearest pediatric cancer treatment center were calculated for each patient. Logistic regression was used to determine factors associated with advanced-stage disease. Life table methods and Cox regression were used to estimate survival probability and hazard ratios. RESULTS A total of 185 adolescents (age >10 years) and 50 young children (age ≤10 years) were identified. Hispanics (n = 27; 12%) were 3 times more likely than non-Hispanic whites (n = 177; 75%) to present with advanced disease (OR, 3.8; 95% CI, 1.7-8.8). Young children were twice as likely as adolescents to present with advanced disease (OR, 2.2; 95% CI, 1.1-4.3). Distance to treatment center and SES did not affect stage of disease at presentation. Hispanics and those in the lowest SES quartile had a significantly higher mortality risk (hazard ratios, 3.0 [95% CI, 1.2-7.8] and 4.3 [95% CI, 1.4-13.9], respectively). In the adjusted survival model, only advanced disease was predictive of mortality (P < .001). CONCLUSION Hispanics and young children with melanoma are more likely to present with advanced disease, and advanced disease is the single most important predictor of survival. Heightened awareness among physicians is needed to facilitate early detection of melanoma within these groups.
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Affiliation(s)
- Emma C Hamilton
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hoang T Nguyen
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Yu-Chia Chang
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC; Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC
| | - Janice Cormier
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Linda S Elting
- Department of Health Services Research, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Department of Pediatric Patient Care, Children's Cancer Hospital, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
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Simberg-Danell C, Lyth J, Månsson-Brahme E, Frohm-Nilsson M, Carstensen J, Hansson J, Eriksson H. Prognostic factors and disease-specific survival among immigrants diagnosed with cutaneous malignant melanoma in Sweden. Int J Cancer 2016; 139:543-53. [PMID: 27004457 DOI: 10.1002/ijc.30103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/30/2016] [Accepted: 02/19/2016] [Indexed: 02/03/2023]
Abstract
Little is known about cutaneous malignant melanoma (CMM) among immigrants in Europe. We aimed to investigate clinical characteristics and disease-specific survival among first- and second-generation immigrants in Sweden. This nationwide population-based study included 27,235 patients from the Swedish Melanoma Register diagnosed with primary invasive CMM, 1990-2007. Data were linked to nationwide, population-based registers followed up through 2013. Logistic regression and Cox regression models were used to determine the association between immigrant status, stage and CMM prognosis, respectively. After adjustments for confounders, first generation immigrants from Southern Europe were associated with significantly more advanced stages of disease compared to Swedish-born patients [Stage II vs. I: Odds ratio (OR) = 2.37, 95% CI = 1.61-3.50. Stage III-IV vs I: OR = 2.40, 95% CI = 1.08-5.37]. The ORs of stage II-IV versus stage I disease were increased among men (OR = 1.9; 95% CI = 1.1-3.3; p = 0.020), and women (OR = 4.8; 95% CI = 2.6-9.1; p < 0.001) in a subgroup of immigrants from former Yugoslavia compared to Swedish-born patients. The CMM-specific survival was significantly decreased among women from former Yugoslavia versus Swedish-born women [hazard ratio (HR)=2.2; 95% CI = 1.1-4.2; p = 0.043]. After additional adjustments including stage, the survival difference was no longer significant. No survival difference between the second generation immigrant group and Swedish-born patients were observed. In conclusion, a worse CMM-specific survival in women from former Yugoslavia was associated with more advanced stages of CMM at diagnosis. Secondary prevention efforts focusing on specific groups may be needed to further improve the CMM prognosis.
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Affiliation(s)
- Caroline Simberg-Danell
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Dermatology and Venereology, Södersjukhuset, Stockholm, SE, 118 83, Sweden
| | - Johan Lyth
- Unit of Research and Development in Local Health Care, County of Östergötland, Linköping, Sweden
| | - Eva Månsson-Brahme
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
| | - Margareta Frohm-Nilsson
- Department of Medicine, Unit of Dermatology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
| | - John Carstensen
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Johan Hansson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
| | - Hanna Eriksson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, SE, 171 76, Sweden
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm, SE, 171 76, Sweden
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Garnett E, Townsend J, Steele B, Watson M. Characteristics, rates, and trends of melanoma incidence among Hispanics in the USA. Cancer Causes Control 2016; 27:647-59. [PMID: 27021339 PMCID: PMC4910394 DOI: 10.1007/s10552-016-0738-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study is to describe the epidemiology of melanoma among Hispanics using data that cover nearly 100 % of the US population. METHODS The study used population-based cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology and End Results Program to examine melanoma incidence rates and trends among Hispanics by sex, age, race, histology, anatomic location, stage, and tumor thickness. RESULTS From 2008 to 2012, 6,623 cases of melanoma were diagnosed among Hispanics. Rates were higher among males (4.6) than among females (4.0), but females younger than age 55 had higher rates than males. The most common histologic subtype was superficial spreading melanoma (23 %). Melanomas with poorer outcomes, such as nodular (NM) and acral lentiginous melanoma (ALM), were more common among males. Hispanic females had the highest proportion of melanoma on the lower limb and hip (33.7 %), while Hispanic males had the highest proportion on the trunk (29.9 %). Incidence rates for later-stage diagnosis and thicker tumors were significantly higher among Hispanic men than among women. Incidence rates decreased significantly during 2003-2012 (AAPC = -1.4). CONCLUSIONS Clinicians and public health practitioners will need to reach the growing Hispanic population in the USA with strategies for primary prevention and early diagnosis of melanoma. Results suggest Hispanics and providers need education to increase awareness about the characteristics of melanoma among Hispanics, including types that occur on non-sun-exposed areas (ALM and NM). Skin cancer prevention and awareness interventions targeting Hispanics should be culturally relevant.
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Affiliation(s)
- Erin Garnett
- Advanced Technology Logistics, Inc, Newnan, GA, USA
| | - Julie Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA.
| | - Brooke Steele
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA
| | - Meg Watson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE MS-F76, Atlanta, GA, 30341, USA
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Skin Protection Behaviors among Young Male Latino Day Laborers: An Exploratory Study Using a Social Cognitive Approach. Dermatol Res Pract 2016; 2016:1479637. [PMID: 27019656 PMCID: PMC4785254 DOI: 10.1155/2016/1479637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/26/2015] [Accepted: 12/06/2015] [Indexed: 11/17/2022] Open
Abstract
Latino Day Laborers (LDLs) are employed in occupations where multiple work hazards exist. One such hazard is the overexposure to solar ultraviolet radiation for continuous periods of time. Regular sun exposure can put individuals at increased risk of developing skin cancers, especially without adequate protection. The purpose of this cross-sectional exploratory study was to use a social cognitive framework to assess skin protective behaviors among LDLs. A community-based nonrandom and purposive sample of LDLs was recruited in two states: Mississippi and Illinois. The study sample consisted of 137 male participants, of which the majority were of Mexican ancestry (72%). The average age was 35.40 (SD = 9.89) years. Results demonstrated that a substantial number of LDLs do not adequately practice sun protection behaviors on a regular basis. The skin cancer knowledge scores were very modest. The most frequently indicated barriers towards sun protection were “inconvenient,” “forget to use,” and “not being able to reapply sunscreen.” Overall, LDLs had moderate confidence in their abilities to adopt successful sun protection strategies. This study underscores the need for intervention programs aimed at LDLs to reduce extended time in the sun and increase use of sun protective measures when working outdoors.
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Shaikh WR, Dusza SW, Weinstock MA, Oliveria SA, Geller AC, Halpern AC. Melanoma Thickness and Survival Trends in the United States, 1989 to 2009. J Natl Cancer Inst 2016; 108:djv294. [PMID: 26563354 PMCID: PMC4857148 DOI: 10.1093/jnci/djv294] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/01/2015] [Accepted: 09/22/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With melanoma incidence rising and mortality stable, some question whether the melanoma epidemic is real. Melanoma thickness and survival trends may provide insights, but previous studies have been limited because of missing data on thickness. METHODS With a validated imputation method for missing thickness data, we characterized melanoma thickness and survival trends among men and women in the Surveillance, Epidemiology, and End Results (SEER)-9 registries between 1989 and 2009. A total of 98,498 cases of invasive melanoma were identified. All statistical tests were two-sided. RESULTS Incidence per 100 000 person-years increased (13.94, 95% confidence interval [CI] = 13.65 to 14.23, to 21.87, 95% CI = 21.56 to 22.19, P < .001) between 1989 to 1991 and 2007 to 2009, fatal incidence remained stable (2.32, 95% CI = 2.2 to 2.4, to 2.08, 95% CI = 2.0 to 2.2, P = .20) between 1989 to 1991 and 1998 to 2000, and five-year survival increased (88.29%, 95% CI = 87.60% to 88.95%, to 91.68%, 95% CI = 91.22% to 92.12%, P < .001) between 1989 to 1991 and 2001 to 2003. Increase in incidence occurred across all thickness groups. Median thickness decreased (0.73 to 0.58mm). Geometric mean thickness decreased (0.77 to 0.65mm) 4.6% (95% CI = 4.2% to 5.0%) every three years in multivariable analysis. Thickness decreased among T1/T2 tumors (0.01-1.00 and 1.01-2.00mm) and among all age and sex groups, whites, non-Hispanics, and all body sites. However, thickness increased among T3/T4 tumors (2.01-4.00 and > 4.00mm) and nodular melanomas; acral lentiginous melanomas approached statistical significance. Thickness remained unchanged among some racial minorities. Melanoma-specific survival improved (hazard ratio [HR] = 0.89, 95% CI = 0.88 to 0.91) every three years in multivariable analysis. Improvements in survival occurred across all subgroups except nonblack minorities, and nodular and acral lentiginous subtypes. CONCLUSIONS Increasing incidence across all thickness groups coupled with T3/T4 lesions becoming thicker suggests that the melanoma epidemic is real and not simply an artifact of increased detection pressure of earlier-stage T1/T2 lesions. Survival is generally improving independent of thickness, but improvements in survival have not been experienced by certain minorities, and nodular and acral lentiginous subtypes.
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Affiliation(s)
- Waqas R Shaikh
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA (WRS); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (SWD, SAO, ACH); Center of Dermatoepidemiology, Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Epidemiology, Brown University, Providence, RI (MAW); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (ACF).
| | - Stephen W Dusza
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA (WRS); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (SWD, SAO, ACH); Center of Dermatoepidemiology, Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Epidemiology, Brown University, Providence, RI (MAW); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (ACF)
| | - Martin A Weinstock
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA (WRS); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (SWD, SAO, ACH); Center of Dermatoepidemiology, Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Epidemiology, Brown University, Providence, RI (MAW); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (ACF)
| | - Susan A Oliveria
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA (WRS); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (SWD, SAO, ACH); Center of Dermatoepidemiology, Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Epidemiology, Brown University, Providence, RI (MAW); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (ACF)
| | - Alan C Geller
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA (WRS); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (SWD, SAO, ACH); Center of Dermatoepidemiology, Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Epidemiology, Brown University, Providence, RI (MAW); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (ACF)
| | - Allan C Halpern
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA (WRS); Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (SWD, SAO, ACH); Center of Dermatoepidemiology, Veterans Affairs Medical Center, Providence, RI (MAW); Department of Dermatology, Rhode Island Hospital, Providence, RI (MAW); Departments of Dermatology and Epidemiology, Brown University, Providence, RI (MAW); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (ACF)
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Hamilton JG, Shuk E, Arniella G, González CJ, Gold GS, Gany F, Robson ME, Hay JL. Genetic Testing Awareness and Attitudes among Latinos: Exploring Shared Perceptions and Gender-Based Differences. Public Health Genomics 2015; 19:34-46. [PMID: 26555145 DOI: 10.1159/000441552] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Latinos, whose views are infrequently examined in genomic research, may be at risk of missing out on the benefits of genomic medicine. AIMS To explore this possibility, we conducted a qualitative study of awareness and attitudes about genetic testing among Latinos with lower acculturation in New York City. METHODS We conducted four focus groups (7 English-speaking men, 5 Spanish-speaking men, 13 English-speaking women and 13 Spanish-speaking women) to explore factors that influence the adoption of new innovations through the discussion of genetic testing in general, and a hypothetical vignette describing a genetic test for skin cancer risk, in particular. RESULTS Through inductive thematic text analysis of focus group transcripts, our multidisciplinary team identified themes within knowledge and attitudes, communication and sources of information, anticipated responses, factors that may increase adoption, and barriers to adoption of genetic testing. Specifically, a majority of participants expressed some degree of uncertainty regarding the purpose of genetic tests and information these tests provide, rarely discussed genetic testing with others in their social networks, and expressed concerns about the misuse of and possible adverse emotional responses to genetic information. However, participants also expressed high levels of interest in receiving a skin cancer genetic test in response to the vignette and believed that receiving actionable health information was a primary reason to consider testing. Gender-based differences in perceived barriers to testing emerged. CONCLUSIONS The results highlight beliefs and barriers that future interventions could target to help ensure that Latinos have adequate understanding of and access to genomic medicine advances.
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Affiliation(s)
- Jada G Hamilton
- Behavioral Sciences Service, Memorial Sloan Kettering Cancer Center, New York, N.Y., USA
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Cohen JM, Li YT, Wu S, Han J, Qureshi AA, Cho E. Sleep duration and sleep-disordered breathing and the risk of melanoma among US women and men. Int J Dermatol 2015; 54:e492-5. [PMID: 26276711 PMCID: PMC4609230 DOI: 10.1111/ijd.12904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/30/2014] [Accepted: 11/22/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | - Yunhui T Li
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Shaowei Wu
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jiali Han
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Abrar A Qureshi
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Eunyoung Cho
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI, USA.
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Ultraviolet Radiation-Induced Cytogenetic Damage in White, Hispanic and Black Skin Melanocytes: A Risk for Cutaneous Melanoma. Cancers (Basel) 2015; 7:1586-604. [PMID: 26287245 PMCID: PMC4586785 DOI: 10.3390/cancers7030852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 01/10/2023] Open
Abstract
Cutaneous Melanoma (CM) is a leading cause of cancer deaths, with reports indicating a rising trend in the incidence rate of melanoma among Hispanics in certain U.S. states. The level of melanin pigmentation in the skin is suggested to render photoprotection from the DNA-damaging effects of Ultraviolet Radiation (UVR). UVR-induced DNA damage leads to cytogenetic defects visualized as the formation of micronuclei, multinuclei and polymorphic nuclei in cells, and a hallmark of cancer risk. The causative relationship between Sun exposure and CM is controversial, especially in Hispanics and needs further evaluation. This study was initiated with melanocytes from White, Hispanic and Black neonatal foreskins which were exposed to UVR to assess their susceptibility to UVR-induced modulation of cellular growth, cytogenetic damage, intracellular and released melanin. Our results show that White and Hispanic skin melanocytes with similar levels of constitutive melanin are susceptible to UVR-induced cytogenetic damage, whereas Black skin melanocytes are not. Our data suggest that the risk of developing UVR-induced CM in a skin type is correlated with the level of cutaneous pigmentation and its ethnic background. This study provides a benchmark for further investigation on the damaging effects of UVR as risk for CM in Hispanics.
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Harvey VM, Patel H, Sandhu S, Wallington SF, Hinds G. Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes. Cancer Control 2015; 21:343-9. [PMID: 25310216 DOI: 10.1177/107327481402100411] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. METHODS We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. RESULTS African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. CONCLUSIONS Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.
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Affiliation(s)
- Valerie M Harvey
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
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Miller KA, Langholz BM, Ly T, Harris SC, Richardson JL, Peng DH, Cockburn MG. SunSmart: evaluation of a pilot school-based sun protection intervention in Hispanic early adolescents. HEALTH EDUCATION RESEARCH 2015; 30:371-379. [PMID: 25801103 PMCID: PMC4434952 DOI: 10.1093/her/cyv011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/12/2015] [Indexed: 06/04/2023]
Abstract
The incidence of melanoma is rising among Hispanic populations in the United States. The purpose of this study is to evaluate the impact of a pilot sun safety educational intervention conducted from 2006 to 2012 on Hispanic early adolescents in a high ultraviolet environment. Nineteen schools with high Hispanic enrollment were recruited from urban neighborhoods in Los Angeles. The analytic sample was restricted to students identifying as Hispanic or Latino (n = 777). A mixed effects linear model was used to test mean changes from pre- to posttest on students' sun protection knowledge, attitudes and behaviors. Significant improvements were observed across several cognitive outcomes related to sun protection, including knowledge of and attitudes toward sun protection and self-efficacy to wear sunscreen. However, changes in sun protective behaviors were not achieved. Although some improvements were observed, future studies should identify the factors that motivate sun protection in this population and develop tailored prevention strategies, as improving the sun safe behaviors of Hispanic youths may aid in reducing the risk of melanoma in adulthood in this population.
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Affiliation(s)
- K A Miller
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - B M Langholz
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - T Ly
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - S C Harris
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - J L Richardson
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - D H Peng
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
| | - M G Cockburn
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Joint Educational Project, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California and Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90032, USA
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Lucas RM, Norval M, Neale RE, Young AR, de Gruijl FR, Takizawa Y, van der Leun JC. The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochem Photobiol Sci 2015; 14:53-87. [DOI: 10.1039/c4pp90033b] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ozone depletion, climate and human health.
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Affiliation(s)
- R. M. Lucas
- National Centre for Epidemiology and Population Health
- The Australian National University
- Canberra 2601
- Australia
- Telethon Kids Institute
| | - M. Norval
- Biomedical Sciences
- University of Edinburgh Medical School
- Edinburgh EH8 9AG
- UK
| | - R. E. Neale
- QIMR Berghofer Medical Research Institute
- Brisbane 4029
- Australia
| | - A. R. Young
- King's College London (KCL)
- St John's Institute of Dermatology
- London SE1 9RT
- UK
| | - F. R. de Gruijl
- Department of Dermatology
- Leiden University Medical Centre
- NL-2300 RC Leiden
- The Netherlands
| | - Y. Takizawa
- Akita University Graduate School of Medicine
- Akita Prefecture
- Japan
- National Institute for Minamata Diseases
- Kumamoto Prefecture
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Amber KT, Ledon JA, Savas JA, Dusseault SK, Nouri K. Visual identification of skin cancer in beachgoers: a need for improved education on non-melanoma skin cancer in the general population and melanoma in the African-American population. Int J Dermatol 2014; 54:e85-7. [PMID: 25515041 DOI: 10.1111/ijd.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kyle T Amber
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
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Tarwate M, Benchikhi H, Adarmouch L, Benider A, Amine M, Zamiati S, Boukind EH. [Thick cutaneous melanoma: mortality factors and occurrence of metastases]. Pan Afr Med J 2014; 18:44. [PMID: 25368733 PMCID: PMC4215361 DOI: 10.11604/pamj.2014.18.44.2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 12/12/2013] [Indexed: 12/02/2022] Open
Abstract
Au Maroc peu d’études ont été menées concernant les facteurs pronostiques du mélanome. L'objectif de cette étude était d'identifier les facteurs de survenue de métastases viscérales à distance à 1an et de mortalité à 2ans chez des patients atteints de mélanome cutané épais. Ont été colligés rétrospectivement tous les cas de mélanomes suivis au service de dermatologie et d'oncologie du CHU de Casablanca de 2006 à 2010. On été inclus les patients qui présentaient un mélanome à localisation cutanée et/ou muqueuse buccogénitale, confirmés histologiquement ayant un Breslow>2mm. Ont été exclus les patients présentant des métastases viscérales à distance au moment du diagnostic. Les données socio-démographiques, cliniques et thérapeutiques ont été recueillies au niveau des dossiers; celles relatives à l’évolution ont été complétées par contact téléphonique. L'analyse statistique était de type uni et bivarié. Soixante patients ont été inclus:41hommes et19femmes (sexe ratio de 2,15). La moyenne d’âge était de 60 ans (17-96). L'indice de Breslow était en moyenne de10mm+/-7et78%des patients(32) avaient un Breslow>4mm. Vingt trois patients (38,3%) avaient des adénopathies régionales. Quatorze patients ont présenté des métastases à distance après 1an (23,3%) et13patients étaient décédés après 2ans d’évolution (21,7%). Les facteurs associés à la survenue de métastases à distance étaient l'indice de Breslow. Des métastases à 1an ont été retrouvées chez 61,5%des patients avec un Breslow >10mm contre18,8% avec un Breslow
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Affiliation(s)
- Mariam Tarwate
- Service de dermatologie vénérologie CHU Ibn Rochd Casablanca
| | | | | | | | - Mohamed Amine
- Département de médecine communautaire CHU Mohamed VI Marrakech
| | | | - El Hassan Boukind
- Service de chirurgie plastique et réparatrice CHU Ibn Rochd Casablanca
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Clairwood M, Ricketts J, Grant-Kels J, Gonsalves L. Melanoma in skin of color in Connecticut: an analysis of melanoma incidence and stage at diagnosis in non-Hispanic blacks, non-Hispanic whites, and Hispanics. Int J Dermatol 2014; 53:425-33. [PMID: 23968545 DOI: 10.1111/j.1365-4632.2012.05713.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The incidence of melanoma is increasing in Caucasians and in Hispanic subgroups in California and Florida. There is a paucity of information regarding melanoma incidence, stage at diagnosis, and other patient and tumor factors among minority subgroups in the northeast USA. This report examines melanoma in non-Hispanic white, non-Hispanic black, and Hispanic residents of Connecticut. METHODS Trends in age-adjusted melanoma incidence rates (1992-2007) and the corresponding annual percentage changes in rates were calculated for Connecticut residents by race and Hispanic ethnicity. The racial/ethnic variation was evaluated for a number of patient and tumor characteristics: gender, age at diagnosis, marital status, anatomic site, histology, ulceration, Breslow thickness, and stage at diagnosis. Statistical significance at the 95% level was assessed using confidence intervals (95% CIs) and Pearson's chi-squared tests. RESULTS Between 1992 and 2007, melanoma incidence increased by 4.1% per year in non-Hispanic whites in Connecticut (95% CI 3.1-5.1%; P<0.05). Melanoma incidence remained relatively stable for Hispanics and non-Hispanic blacks over the same period. A significantly higher proportion of advanced (regional and distant) melanomas were diagnosed in non-Hispanic blacks (19.1%) and Hispanics (17.1%) than in non-Hispanic whites (8.7%) (P<0.001). CONCLUSIONS A significantly higher proportion of advanced melanomas were diagnosed in non-Hispanic blacks and Hispanics than in non-Hispanic whites. There is a growing need to educate patients and healthcare providers of the necessity for skin cancer surveillance regardless of the race of the patient.
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Affiliation(s)
- MariMeg Clairwood
- Department of Dermatology, University of Connecticut School of Medicine, CT, USA
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Abstract
Melanoma remains among the deadliest cancers in the USA, ranking presently as the leading cause of death from skin disease in this country. The present analysis presents national statistics on the health burden (mortality) and productivity losses attributable to this cancer over a 19-year period. Melanoma-related deaths and mortality rates from 1990 through 2008 were identified and calculated using multiple-cause-of-death data and data from the 2000 US Census. Productivity losses were estimated using previously published methods that accounted for life expectancy, labor force participation, productivity growth, and the imputed values of caregiving and housekeeping activities. A total of 155,571 melanoma-related deaths occurred during 1990-2008, resulting in 1,811,701 years of potential life lost. Age-adjusted mortality rates stratified by sex and race/ethnicity revealed differences: whites had the highest rate (3.55 per 100 000 population; 95% confidence interval 3.54, 3.57) and male individuals were 2.21 times more likely than female individuals to succumb to the disease. Cumulatively, the numbers of death for blacks, Hispanics, Asian/Pacific Islanders, and American Indians/Alaskan Natives exceeded 6000 deaths. The total productivity losses attributable to melanoma-related mortality during the sampled period were ∼$66.9 billion. The burden and economic consequences of melanoma-related deaths in the USA are not inconsequential. Understanding the mortality trends and productivity losses attributed to this skin cancer is important for evaluating the feasibility and trade-offs of public health and behavioral counseling interventions that focus on promoting skin cancer prevention.
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