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Laughter MR, Maymone MBC, Karimkhani C, Rundle C, Hu S, Wolfe S, Abuabara K, Hollingsworth P, Weintraub GS, Dunnick CA, Kisa A, Damiani G, Sheikh A, Singh JA, Fukumoto T, Desai R, Grada A, Filip I, Radfar A, Naghavi M, Dellavalle RP. The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017. JAMA Dermatol 2021; 156:874-881. [PMID: 32520352 DOI: 10.1001/jamadermatol.2020.1573] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making. Objective To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017. Design, Setting, and Participants For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020. Main Outcomes and Measures Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017. Results Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66]). Conclusions and Relevance Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.
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Affiliation(s)
- Melissa R Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Chante Karimkhani
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Chandler Rundle
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Sophia Hu
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Sophia Wolfe
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco
| | - Parker Hollingsworth
- Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gil S Weintraub
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway.,Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio.,Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Jasvinder A Singh
- Medicine Service, Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham.,Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham
| | - Takeshi Fukumoto
- Kobe University Graduate School of Medicine, Division of Dermatology, Department of Internal Related, Kobe, Japan.,Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Ayman Grada
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando
| | - Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, Seattle
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver
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Abstract
The goal of this study was to identify a relevant and inclusive list of quality of life issues among long-term survivors of melanoma. Individuals diagnosed with stage I-III cutaneous melanoma and had survived 1-5 years, ages 18-65 years at diagnosis, were recruited. Five focus groups were conducted with 33 participants in total. Discussions centered on participants' experiences at diagnosis, as well as ongoing physical, emotional, and social concerns, and behavioral changes since diagnosis. The majority of participants reported shock, fear, and feeling overwhelmed at the time of diagnosis. Some reported lingering physical concerns, including pain, numbness, and lymphedema, while a few reported no lasting issues. Emotional concerns were common, with most reporting anxiety. Several also noted feeling lonely and isolated. Social concerns included alteration of activities to avoid sun exposure, issues with family communication, and frustration with the lack of appreciation of the seriousness of melanoma by others. Finally, while many participants reported changes to their sun exposure and UV-protection behaviors, some reported little to no change. The shared experiences among participants in this study confirm the unique nature of melanoma and the need for interventions designed to improve the health and quality of life of melanoma survivors.
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Vogel RI, Strayer LG, Engelman L, Nelson HH, Blaes AH, Anderson KE, Lazovich D. Sun Exposure and Protection Behaviors among Long-term Melanoma Survivors and Population Controls. Cancer Epidemiol Biomarkers Prev 2017; 26:607-613. [PMID: 28254810 DOI: 10.1158/1055-9965.epi-16-0854] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/30/2016] [Accepted: 11/30/2016] [Indexed: 01/21/2023] Open
Abstract
Introduction: Melanoma is considered a generally preventable cancer, with excessive ultraviolet radiation (UVR) exposure being a strong causal factor. UVR exposure following a melanoma diagnosis can be modified to reduce risk of second primary melanomas. The goal of this study was to compare measures of UVR exposure and protection behaviors between long-term melanoma survivors and controls.Methods: Participants from a previously conducted case-control study were recruited for a cross-sectional survey. Melanoma cases were 25 to 59 years old at diagnosis; controls were age and sex matched. Participants were asked about UVR exposure and protection measures used in the past year, and comparisons between melanoma survivors and controls were conducted using logistic regression models, adjusting for potential confounders.Results: A total of 724 (62.0%) long-term melanoma survivors and 660 (59.9%) controls completed the follow-up survey. Melanoma survivors were significantly less likely to report high sun exposure on a typical weekday [OR, 0.72 (0.55-0.94)], sunburns [OR, 0.40 (0.30-0.53)], or indoor tanning [OR, 0.20 (0.09-0.44)] than controls; however, high sun exposure on a typical weekend day was similar. Report of optimal sun protection behaviors was higher in melanoma survivors compared with controls. However, a few melanoma survivors reported indoor tanning, 10% reported intentionally seeking sun to tan, and 20% reported sunburns.Conclusions: Although long-term melanoma survivors reported healthier UVR exposure and protection behaviors compared with controls, a sizeable proportion still reported elevated sun exposure, sunburns, and suboptimal UVR protection behaviors.Impact: Opportunities remain for improving sun protection to reduce future melanoma risk among melanoma survivors. Cancer Epidemiol Biomarkers Prev; 26(4); 607-13. ©2017 AACR.
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Affiliation(s)
- Rachel Isaksson Vogel
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota. .,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lori G Strayer
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Leah Engelman
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Heather H Nelson
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Anne H Blaes
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Hematology and Oncology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kristin E Anderson
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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Gamble RG, Jensen D, Suarez AL, Hanson AH, McLaughlin L, Duke J, Dellavalle RP. Outpatient Follow-up and Secondary Prevention for Melanoma Patients. Cancers (Basel) 2010; 2:1178-97. [PMID: 24281112 PMCID: PMC3835125 DOI: 10.3390/cancers2021178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 02/07/2023] Open
Abstract
Health care providers and their patients jointly participate in melanoma prevention, surveillance, diagnosis, and treatment. This paper reviews screening and follow-up strategies for patients who have been diagnosed with melanoma, based on current available evidence, and focuses on methods to assess disease recurrence and second primary occurrence. Secondary prevention, including the roles of behavioral modification and chemoprevention are also reviewed. The role of follow-up dermatologist consultation, with focused physical examinations complemented by dermatoscopy, reflectance confocal microscopy, and/or full-body mapping is discussed. Furthermore, we address the inclusion of routine imaging and laboratory assessment as components of follow-up and monitoring of advanced stage melanoma. The role of physicians in addressing the psychosocial stresses associated with a diagnosis of melanoma is reviewed.
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Affiliation(s)
- Ryan G. Gamble
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
| | - Daniel Jensen
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
| | - Andrea L. Suarez
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
| | - Anne H. Hanson
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA; E-Mail:
| | - Lauren McLaughlin
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA; E-Mail:
| | - Jodi Duke
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
- School of Pharmacy, University of Colorado, Aurora, CO, USA; E-Mail:
| | - Robert P. Dellavalle
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA; E-Mail: (R.G.G.); (J.D.J.)
- Dermatology Service, Denver Veterans Affairs Medical Center, Denver, CO, USA
- Epidemiology Department, Colorado School of Public Health, Aurora, CO, USA
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