Skin cancer screening campaign in the German speaking Community of Belgium

Value of Teledermoscopy in Primary Healthcare Centers: Preliminary Results of the TELESPOT Project in Belgium

INTRODUCTION

Teledermoscopy using smartphone-based applications is becoming more and more important in a setting of increasing frequency of skin cancer and difficult access to specialized care. The TELESPOT project aimed to provide rapid diagnosis and speed up patient flow between primary healthcare centers and a tertiary care center in Belgium. The aim of the present study is to describe the development of an in-house smartphone-based dermoscopy application, evaluate its real-life value in a series of primary healthcare centers, and present preliminary diagnostic data.

METHODS

Modified Likert scales were used to assess patient and general practitioner (GP) satisfaction rates for the system. Furthermore, a total of 105 photographic and dermoscopic images were acquired in a series of 80 patients at participating centers.

RESULTS

Overall, patient and GP satisfaction levels were 89% and 94%, respectively. High-priority management was recommended in 7.6% of cases (8/105: 3 basal cell carcinoma, 1 primary cutaneous B-cell lymphoma, 1 Spitz melanocytic nevus, 1 congenital nevus, 1 in situ melanoma, and 1 invasive melanoma, proven by histology).

CONCLUSIONS

The primary healthcare centers were highly satisfied with the TELESPOT project in terms of user-friendliness, efficacy, and reliability as well as in providing a reinforced image of first-line medicine efforts in combating skin cancer.

Screening for skin cancer: a pilot study in tehran, iran

BACKGROUND

Early detection of skin cancers by screening could be very beneficial to decrease their morbidity or mortality. There is limited study about skin cancer screening in Iran.

AIM

This essay was planned as a pilot skin cancer screening campaign in Tehran, Iran to evaluate its profit and failure and further design large-scale screening program more definitely.

MATERIALS AND METHODS

Thirty one public health centers of Shahid Beheshti Medical University were selected in different areas of Tehran. The project was announced via media and invited all the people above 40 years old to come for the whole-body skin examination in a one-week period. Patients with any suspected lesions were referred to the dermatology clinics of the university.

RESULTS

1314 patients, 194 males (14.8%) and 120 females (85.2%), with mean age of 51.81 ± 10.28 years participated in this screening campaign. Physicians found suspected lesions in 182 (13.85%) of participants. The diagnosis of skin cancer was confirmed in 15 (1.14%) patients. These malignancies included 10 (0.76%) cases of basal cell carcinoma, 2 (0.15%) cases of squamous cell carcinoma and 3 (0.23%) cases of malignant melanoma.

CONCLUSION

Skin cancer screening seems to be valuable to detect skin malignancies in their early course. Regarding the considerable amount of facilities needed to perform skin cancer screening program, it might be more beneficial to perform the targeted screening programs for the high-risk groups or emphasis more on public education of skin cancer risk factors and their early signs.

Patient follow-up after participating in a beach-based skin cancer screening program

Many skin cancer screenings occur in non-traditional community settings, with the beach being an important setting due to beachgoers being at high risk for skin cancer. This study is a secondary analysis of data from a randomized trial of a skin cancer intervention in which participants (n = 312) had a full-body skin examination by a clinician and received a presumptive diagnosis (abnormal finding, no abnormal finding). Participants’ pursuit of follow-up was assessed post-intervention (n = 283). Analyses examined: (1) participant’s recall of screening results; and (2) whether cognitive and behavioral variables were associated with follow-up being as advised. Just 12% of participants (36/312) did not correctly recall the results of their skin examination. One-third (33%, 93/283) of participants’ follow-up was classified as being not as advised (recommend follow-up not pursued, unadvised follow-up pursued). Among participants whose follow-up was not as advised, 71% (66/93) did not seek recommended care. None of the measured behavioral and cognitive variables were significantly associated with recall of screening examination results or whether follow-up was as advised. Research is needed to determine what factors are associated with follow-up being as advised and to develop messages that increase receipt of advised follow-up care.

Space-time clustering and seasonality in diagnosing skin cancers in Wallonia (south-east Belgium)

BACKGROUND

In Westernized populations, the number of diagnosed cases of primary cutaneous cancers, particularly malignant melanomas and basal cell carcinomas (BCC), has been previously shown to fluctuate during specific periods of the year.

OBJECTIVE AND METHOD

The aim of the present 6-year study was to explore the seasonality if any in skin cancer detection in Wallonia (south-east Belgium).

RESULTS

For both malignant melanomas and BCC late spring/early summer and mid-autumn were the periods of highest diagnosis prevalence irrespective of gender. The amplitude of this bimodal evolution remained within the range of 2 standard deviations around the monthly means. Similar seasonal variations were also found in non-neoplastic controls consisting of laboratory samplings of onychomycoses and non-infectious onychodystrophies.

CONCLUSION

There is reason to believe that this timing and rhythm is unrelated to any specific cancer chronomics. Rather, the present findings suggest unspecific seasonality in diagnosing skin disorders including malignancies. A variable patient awareness of changing aspects of the skin according to seasons probably represents the major influence of the described space-time clustering of skin cancer diagnosis.

Screening, early detection, and trends for melanoma: Current status (2000-2006) and future directions

In the past 5 years, there have been notable strides toward the earlier recognition and discovery of melanoma, including new technologies to complement and augment the clinical examination and new insights to help clinicians recognize early melanoma. However, incidence and mortality rates throughout most of the developed world have risen over the past 25 years, while education and screening, potentially the best means for reducing the disease, continue to be severely underutilized. Much progress needs to be made to reach middle-aged and older men and persons of lower socioeconomic status who suffer a disproportionate burden of death from melanoma. Worldwide melanoma control must also be a priority, and comprehensive educational and screening programs should be directed to Northern Ireland and a number of Eastern European nations, whose 5-year survival rates range between 53% and 60%, mirroring those of the United States and Australia more than 40 years ago.

LEARNING OBJECTIVE

After completing this learning activity, participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melanoma; and public and professional education programs designed to enhance early detection.

Photodynamic therapy and imiquimod immunotherapy for basal cell carcinomas

Photodynamic therapy (PDT) and topical imiquimod immunotherapy (TII) are two recently introduced treatment modalities for certain types of basal cell carcinomas (BCC). We present a review of the relevant literature and report our own findings regarding the efficacy and tolerance of PDT and TII in the treatment of BCCs. According to published studies, the cure rates range from 75-95% for PDT and 42-100% for TII, depending on treatment modalities and BCC type. In our observations, 13 patients with nodular or superficial BCCs were treated by PDT using two courses of 3-hour topical application of methyl aminolevulinate, followed by 8 minutes illumination (lambda = 634 nm, e = 37J/cm2). Biopsies were taken before and one month after PDT. Side effects including pain and crusting were assessed. Eight patients with superficial BCC were treated by TII using 3 monthly courses each consisting of 3 weekly applications for 3 weeks followed by one week out of treatment. Biopsies were taken before and after 3 months of TII. Adverse reactions including erythema, oozing, ulceration, and crusting were recorded. Clinico-histological cure was obtained in 12/13 PDT cases as assessed after 1 month, and in 6/8 TII cases after 3 months. Minimal pain during illumination and crust formation were observed in 7/13 and 3/13 PDT cases, respectively. Variable erythema, oozing, ulceration, and crusting were observed in all TII-treated lesions. It is concluded that PDT represents an active and well tolerated alternative treatment for both nodular and superficial BCCs. TII also shows activity, although the tolerance may be poor and cure needs a longer time to be obtained. The final cosmetic appearance was fine following both PDT and TII procedures. Both PDT and TII may leave intact neoplastic aggregates inside the skin. They cannot be clinically perceived, leading to unexpected recurrences. It is stressed that the currently available efficacy information about PDT and TII deals with short term follow-up periods. A 5-year follow-up must be awaited before drawing firm conclusions.