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Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Bella F, Carrozzi G, Cascone G, Ferrante M, Michiara M, Musolino A, Tumino R, Usticano A, Allotta A, Pollina Addario S, Lacarrubba F, Stanganelli I, Falcini F. North-south differences in incidence and surveillance of cutaneous malignant melanoma in Italy. TUMORI JOURNAL 2024:3008916241255458. [PMID: 38825831 DOI: 10.1177/03008916241255458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND In Italy, the incidence of cutaneous malignant melanoma is two-fold higher in the north than in the south. This gradient might be associated with differences in incidence trends and disease surveillance. We compared the time trends in incidence rates, mortality rates, dermatologic office visit rates and skin biopsy rates between the Emilia-Romagna Region (northern Italy) and the Sicily Region (southern Italy). METHODS The cancer registries of Parma, Modena, Ferrara and Romagna (current population, 2,606,465) and Catania-Messina-Enna, Siracusa and Ragusa (2,775,019) provided incidence and mortality records for the years 2008-2017. The records of outpatient services delivered in public health facilities were obtained from the two Regional Administrations. Trends in rates were assessed with the estimated average annual percent change. North-south differences were expressed as age-standardised rate ratios. RESULTS In the context of a generalised increasing incidence trend, which was more moderate in the female population of the Sicily Region, the standardised rate ratios were: 5.31 (males) and 5.20 (females) for in situ cutaneous malignant melanoma; 2.10 and 2.07 for invasive cutaneous malignant melanoma, with an excess incidence concentrated in lesions ⩽1.00 mm thick (3.58 and 3.05); 3.00 and 2.44 for dermatologic office visits; and 5.25 and 5.02 for skin biopsies. Mortality was stable in both Regions. CONCLUSIONS In the Emilia-Romagna Region, as compared with the Sicily Region, a higher incidence of cutaneous malignant melanoma -especially of in situ and early invasive cutaneous malignant melanoma- coexisted with a higher level of clinical surveillance. The question of the direction of the cause-effect relationship between increased incidence and increased diagnostic scrutiny remains open.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, Section of Ferrara, Local Health Authority and University of Ferrara, Ferrara, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | - Giuseppe Cascone
- Cancer Registry, Provincial Health Authority (ASP), Ragusa, Italy
| | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Azienda Ospedaliero-Universitaria Policlinico 'Rodolico-San Marco', Catania, Italy
| | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
| | - Antonino Musolino
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosario Tumino
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Italy
| | - Antonella Usticano
- Cancer Registry, Provincial Health Authority (ASP), Ragusa, Italy
- Department of Health Activities and Epidemiological Observatory of Sicily Region, Palermo, Italy
| | - Alessandra Allotta
- Department of Health Activities and Epidemiological Observatory of Sicily Region, Palermo, Italy
| | | | | | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
- Dermatology Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
- Cancer Prevention Unit, Local Health Authority, Forlì, Italy
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Buja A, Rugge M, Cozzolino C, Dossi F, Zorzi M, Vecchiato A, de Luca G, Del Fiore P, Tropea S, dall’Olmo L, Rossi CR, Boccuzzo G, Mocellin S. Could the mitotic count improve personalized prognosis in melanoma patients? PLoS One 2024; 19:e0302309. [PMID: 38626072 PMCID: PMC11020877 DOI: 10.1371/journal.pone.0302309] [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: 09/28/2022] [Accepted: 03/28/2024] [Indexed: 04/18/2024] Open
Abstract
A number of studies have indicated that the mitotic rate may be a predictive factor for poor prognosis in melanoma patients. The aim of this study was to investigate whether the mitotic rate is associated with other prognostic clinical and anatomopathological characteristics. After adjusting for other anatomopathological characteristics, we then verified the prognostic value of the number of mitoses, determining in which population subgroup this variable may have greater prognostic significance on 3-year mortality. The Veneto Cancer Registry (Registro Tumori del Veneto-RTV), a high-resolution population-based dataset covering the regional population of approximately 4.9 million residents, served as the clinical data source for the analysis. Inclusion criteria included all incident cases of invasive cutaneous malignant melanoma recorded in the RTV in 2015 (1,050 cases) and 2017 (1,205 cases) for which the number of mitoses was available. Mitotic classes were represented by Kaplan-Meier curves for short-term overall survival. Cox regression calculated hazard ratios in multivariable models to evaluate the independent prognostic role of different mitotic rate cut-offs. The results indicate that the mitotic rate is associated with other survival prognostic factors: the variables comprising the TNM stage (e.g., tumor thickness, ulceration, lymph node status and presence of metastasis) and the characteristics that are not included in the TNM stage (e.g., age, site of tumor, type of morphology, growth pattern and TIL). Moreover, this study demonstrated that, even after adjusting for these prognostic factors, mitoses per mm2 are associated with higher mortality, particularly in T2 patients. In conclusion, these findings revealed the need to include the mitotic rate in the histological diagnosis because it correlates with the prognosis as an independent factor. The mitotic rate can be used to develop a personalized medicine approach in the treatment and follow-up monitoring of melanoma patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
- Department of Medicine—DIMED, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Claudia Cozzolino
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Francesca Dossi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Giuseppe de Luca
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Directorate General, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Luigi dall’Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
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3
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Nurla LA, Forsea AM. Melanoma epidemiology in Europe: what is new? Ital J Dermatol Venerol 2024; 159:128-134. [PMID: 38650494 DOI: 10.23736/s2784-8671.24.07811-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Every year in Europe over 150,000 new cases of melanoma are reported and over 25,000 lives are lost to this tumor. Incidence has been rising rapidly, faster than for any other cancer, and it is expected to continue to do so in most regions. Mortality also crept up, decades-long, with only few very recent exceptions. Thus, melanoma remains a public health problem that will not go away soon, nor easy. Some notable progress has been made in the last decade in the fight against this tumor. Registration and reporting for skin cancers improved across Europe. Incidence trends have begun to plateau or even to descend in younger age groups, in some countries, and there are encouraging signs that mortality might do the same, after the recent therapeutic breakthroughs. Survival rates are on average above 80% at 5 years for European patients, while diagnosis trends toward ever thinner tumors. Yet this progress is far from uniform across the continent, with many Southern-and Eastern European countries still struggling with sub-optimal cancer reporting, delayed access to innovative treatments, late detection and insufficient healthcare funding, that push survival rates down to harrowing 50%. This article aims to give an updated overview of the epidemiological situation of melanoma in Europe, highlighting the progress but also the persisting disparities in tumor burden, prognosis and access to quality cancer care and surveillance between European countries, as a reminder that relentless efforts must continue in order to tackle this aggressive tumor in an effective and equitable manner.
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Affiliation(s)
- Luana A Nurla
- Department of Oncologic Dermatology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Institute of Doctoral Studies, Doctoral School of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania -
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Tejera-Vaquerizo A, Boada A, Puig S, Nagore E, Fernández-de-Misa R, Ferrándiz L, Conde-Taboada A, Castro E, Richarz NA, Paradela S, Llambrich Á, Salgüero I, Diago A, Samaniego E, Flórez Á, Segura S, Maldonado-Seral C, Coronel-Pérez IM, Tomás-Velázquez A, Rodríguez P, Mayor A, García-Doval I, Grau-Pérez M. Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00184-4. [PMID: 38452890 DOI: 10.1016/j.ad.2024.02.027] [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: 11/06/2023] [Revised: 01/24/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.
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Affiliation(s)
| | - A Boada
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, España
| | - S Puig
- Servicio de Dermatología, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, Barcelona, España; Centro de investigación biomédica en red de enfermedades raras, CIBERER, Barcelona, España
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - R Fernández-de-Misa
- Servicio de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología médico-quirúrgico, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Conde-Taboada
- Servicio de Dermatología, Hospital Clínico San Carlos, Madrid, España
| | - E Castro
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - N A Richarz
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, España
| | - S Paradela
- Servicio de Dermatología, Complexo Hospitalario A Coruña, A Coruña, España
| | - Á Llambrich
- Servicio de Dermatología, Hospital Universitario Son Llàtzer, Palma de Mallorca, España
| | - I Salgüero
- Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - E Samaniego
- Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
| | - Á Flórez
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, Instituto de Investigación Sanitaria Galicia Sur, SERGAS-UVIGO, Pontevedra, España
| | - S Segura
- Servicio de Dermatología, Hospital del Mar de Barcelona, Barcelona, España
| | - C Maldonado-Seral
- Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - I M Coronel-Pérez
- Servicio de Dermatología, Hospital Universitario Virgen de Valme de Sevilla, Sevilla, España
| | - A Tomás-Velázquez
- Servicio de Dermatología, Clínica Universidad de Navarra, Madrid, España
| | - P Rodríguez
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, España; Servicio de Dermatología, Hospital Ruber Internacional, Madrid, España
| | - A Mayor
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - I García-Doval
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, España
| | - M Grau-Pérez
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, España; Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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Karponis D, Stratigos IA, Joshy J, Craig PJ, Mistry K, van Bodegraven B, Venables ZC, Levell NJ. Lentigo maligna: a review. Clin Exp Dermatol 2024; 49:218-225. [PMID: 37966718 DOI: 10.1093/ced/llad394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
Lentigo maligna (LM) is a melanoma in situ with distinct clinical features and histology. It commonly affects men after the sixth decade of life. Incidence rates of LM have increased based on early 21st century data from different countries; however, data are suboptimal. Data from England show a plateauing crude incidence between 2013 and 2019. By comparison, invasive melanoma and other types of melanoma in situ commonly appears in younger age groups (median age 58 and 67 years old, respectively) and incidence is rising. The most important risk factors for LM include fair skin and cumulative ultraviolet solar radiation exposure. Although LM is limited to the epidermis and connected skin adnexa, it may progress to invasive LM melanoma. The reported rate of malignant progression varies, reflecting a challenge for LM epidemiology research as often lesions are removed on diagnosis. LM poses a challenge in diagnosis and management. Although it can be diagnosed clinically or dermoscopically, histopathological assessment of biopsied skin tissue remains the gold standard. Reflectance confocal microscopy allows for better appreciation of the complexity of LM at a cellular level, often progressing beyond clinical margins. Management of LM may involve Mohs micrographic surgery or excision, although recurrence may occur even with 5 mm clinical margins. Imiquimod cream may be effective, but incomplete treatment and recurrence has been reported. Conservative management with observation or radiotherapy may be used in selected patients' cases. Five-year net survival rates are excellent. This paper reviews the natural history, epidemiology, aetiology, pathogenesis, diagnosis and management of LM.
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Affiliation(s)
- Dimitrios Karponis
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Jilse Joshy
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul J Craig
- Cellular Pathology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Khaylen Mistry
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Birgitta van Bodegraven
- British Association of Dermatologists, London, UK
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Zoe C Venables
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- National Disease Registration Service, Data and Analytics, NHS England, UK
| | - Nick J Levell
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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6
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Mavor ME, Hanna TP, Asai Y, Langley H, Look Hong NJ, Wright FC, Nguyen P, Groome PA. Factors associated with the melanoma diagnostic interval in Ontario, Canada: a population-based study. Br J Cancer 2024; 130:483-495. [PMID: 38102225 PMCID: PMC10844321 DOI: 10.1038/s41416-023-02518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Protracted times to diagnosis of cancer can lead to increased patient anxiety, and in some cases, disease progression and worse outcomes. This study assessed the time to diagnosis for melanoma, and its variability, according to patient-, disease-, and system-level factors. METHODS This is a descriptive, cross-sectional study in Ontario, Canada from 2007-2019. We used administrative health data to measure the diagnostic interval (DI)-and its two subintervals-the primary care subinterval (PCI) and specialist care subinterval (SCI). Multivariable quantile regression was used. RESULTS There were 33,371 melanoma patients. The median DI was 36 days (interquartile range [IQR]: 8-85 days), median PCI 22 days (IQR: 6-54 days), and median SCI 6 days (IQR: 1-42 days). Increasing comorbidity was associated with increasing DI. Residents in the most deprived neighbourhoods and those in rural areas experienced shorter DIs and PCIs, but no differences in SCI. There was substantial variation in the DI and SCI across health regions, but limited differences in the PCI. Finally, patients with a history of non-melanoma skin cancer, and those previously established with a dermatologist experienced significantly longer DI, PCI, and SCI. DISCUSSION This study found variability in the melanoma DI, notably by system-level factors.
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Affiliation(s)
- Meaghan E Mavor
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada.
| | - Timothy P Hanna
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- ICES at Queen's University, Kingston, ON, Canada
| | - Yuka Asai
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Hugh Langley
- Department of Oncology, Queen's University, Kingston, ON, Canada
- South East Regional Cancer Program, Kingston, ON, Canada
| | - Nicole J Look Hong
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Frances C Wright
- Surgical Oncology, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Surgical Oncology Program, Cancer Care Ontario - Ontario Health, Toronto, ON, Canada
| | - Paul Nguyen
- ICES at Queen's University, Kingston, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston, ON, Canada
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Manneschi G, Caldarella A, Caini S, Checchi S, Intrieri T, Chiarugi A, Nardini P, Masala G. The Burden of Thin Melanomas in Tuscany, Italy, 1985-2017: Age- and Sex-Specific Temporal Trends in Incidence and Mortality. Cancers (Basel) 2024; 16:536. [PMID: 38339287 PMCID: PMC10854552 DOI: 10.3390/cancers16030536] [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: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
A steady increase in the incidence and mortality burden correlated to thin melanomas (≤1 mm) has been reported in recent years in some international studies, but there is currently a paucity of data from the Mediterranean area. We aimed to describe the epidemiological characteristics of thin melanoma in Tuscany, Central Italy. A total of 6002 first cutaneous invasive melanomas occurring from 1985 to 2017 were selected for analysis; data were retrieved from the local population-based cancer registry. The standardized incidence rate was 15.0 per 100,000 in the population, higher among men than women (16.5 vs. 14.1). Incidence rates tended to increase over time across all age group-specific population strata, with annual percent changes moderately higher among men (+8.0%) than women (+6.9%), especially among the elderly. Among both sexes and in each age group, the trend toward increasing incidence rates was particularly strong for thin melanomas. Survival was better among women than men across all categories of thickness. Approximately 15% of deaths occurred among patients with thin lesions, with no major temporal changes in recent years. This study contributes to an improved understanding of melanoma epidemiology in Tuscany and underscores the need for primary prevention strategies tackling the growing burden of thin melanomas.
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Affiliation(s)
- Gianfranco Manneschi
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
| | - Adele Caldarella
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy
| | - Saverio Checchi
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, 50144 Florence, Italy;
| | - Teresa Intrieri
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
| | - Alessandra Chiarugi
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), 50139 Florence, Italy; (A.C.); (P.N.)
| | - Paolo Nardini
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), 50139 Florence, Italy; (A.C.); (P.N.)
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
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8
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Buja A, De Luca G, Zorzi M, Bovo E, Mocellin S, Trevisiol C, Bronte V, Guzzinati S, Rugge M. Thirty-two-year trends of cancer incidence by sex and cancer site in the Veneto Region from 1987 to 2019. Front Public Health 2024; 11:1267534. [PMID: 38259775 PMCID: PMC10800396 DOI: 10.3389/fpubh.2023.1267534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Background This observational study considers the sex-specific incidence of the most incident cancers as recorded in the population-based Veneto Regional Cancer Registry over a period of more than 30 years (1987-2019). Methods The Veneto Regional Cancer Registry collected data for the time interval 1987-2019. Significant changes in incidence trends calculated on age-standardized incidence rates (Annual Percent Change-APC) were identified by join point regression analysis. Results Overall, the incidence trend for all cancers decreased in males and remained stable in females. In nine cancer sites, the incidence trends showed consistent differences by sex (oral cavity, esophagus, colon rectum and anus, liver, larynx, lung, cutaneous malignant melanoma, bladder, and thyroid gland). Other malignancies did not show significant sex-related differences (stomach, pancreas, biliary tract, kidney/urinary tract, central nervous system, multiple myeloma, non-Hodgkin lymphoma, and leukemia). Conclusion In the period 1987-2019, this study revealed sex-related differences in cancer incidence trends. Over time, cancer incidence remained higher in males, with a decreasing epidemiological impact, plausibly resulting from prevention campaigns against environmental cancer risk factors, as tobacco and alcohol. Conversely, a significant decrease was not observed in the incidence trend in females. These findings contribute essential insights for profiling the epidemiological map of cancer in a large Italian population, allowing comparison with other European cancer epidemiology studies and providing updated data supporting sex-related primary and secondary cancer prevention strategies.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe De Luca
- Department of Cardiological, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum, and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology – DISCOG, University of Padova, Padua, Italy
| | - Chiara Trevisiol
- Soft-Tissue, Peritoneum, and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | | | | | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
- Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
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9
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Bucchi L, Mancini S, Crocetti E, Dal Maso L, Baldacchini F, Vattiato R, Giuliani O, Ravaioli A, Zamagni F, Bella F, Bidoli E, Caldarella A, Candela G, Carone S, Carrozzi G, Cavallo R, Ferrante M, Ferretti S, Filiberti RA, Fusco M, Gatti L, Gili A, Iacovacci S, Magoni M, Mangone L, Mazzoleni G, Michiara M, Musolino A, Piffer S, Piras D, Rizzello RV, Rosso S, Rugge M, Scala U, Stracci F, Tagliabue G, Toffolutti F, Tumino R, Biggeri A, Masini C, Ridolfi L, Villani S, Palmieri G, Stanganelli I, Falcini F. The descriptive epidemiology of melanoma in Italy has changed - for the better. Ital J Dermatol Venerol 2023; 158:483-492. [PMID: 38015485 DOI: 10.23736/s2784-8671.23.07653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
A recent research project using data from a total of 40 cancer registries has provided new epidemiologic insights into the results of efforts for melanoma control in Italy between the 1990s and the last decade. In this article, the authors present a summary and a commentary of their findings. Incidence increased significantly throughout the study period in both sexes. However, the rates showed a stabilization or a decrease in men and women aged below 35 years. The risk of disease increased for successive cohorts born until 1973 (women) and 1975 (men) while subsequently tending to decline. The trend towards decreasing tumor thickness and increasing survival has continued, but a novel favorable prognostic factor has emerged since 2013 for patients - particularly for males - with thick melanoma, most likely represented by molecular targeted therapies and immune checkpoint inhibitors. Due to this, the survival gap between males and females has been filled out. In the meanwhile, and despite the incidence increase, dermatologists have not lowered their threshold to perform skin biopsy. Skin biopsy rate has increased because of the increasingly greater volume of dermatologic office visits, but the proportion of skin biopsies out of dermatologic office visits has remained constant. In summary, an important breakthrough in melanoma control in Italy has taken place. Effective interventions have been implemented across the full scope of care, which involve many large local populations - virtually the whole national population. The strategies adopted during the last three decades represent a valuable basis for further steps ahead in melanoma control in Italy.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy -
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Azienda Sanitaria Provinciale (ASP), Siracusa, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Department of Prevention, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Taranto Cancer Registry, Unit of Statistics and Epidemiology, ASL Taranto, Taranto, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Rodolico-San Marco Polyclinic University Hospital, Catania, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry - Section of Ferrara, ASL Ferrara, University of Ferrara, Ferrara, Italy
| | - Rosa A Filiberti
- Liguria Cancer Registry, San Martino Polyclinic Hospital IRCCS, Genoa, Italy
| | | | - Luciana Gatti
- Mantova Cancer Registry, Epidemiology Unit, Agenzia di Tutela della Salute (ATS) della Val Padana, Mantua, Italy
| | - Alessio Gili
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Michele Magoni
- Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, Brescia, Italy
| | - Lucia Mangone
- Epidemiology Unit, AUSL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, Parma University Hospital, Parma, Italy
| | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit and Cancer Registry, Parma University Hospital, Parma, Italy
| | - Silvano Piffer
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute (ATS), Sassari, Italy
| | - Roberto V Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Trento, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Fabrizio Stracci
- Umbria Cancer Registry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giovanna Tagliabue
- Lombardy Cancer Registry of Varese Province, Cancer Registry Unit, Department of Research, National Cancer Institute IRCCS Foundation, Milan, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Pordenone, Italy
| | - Rosario Tumino
- Cancer Registry, Department of Histopathology, Provincial Health Authority (ASP), Ragusa, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carla Masini
- Unit of Oncological Pharmacy, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Laura Ridolfi
- Department of Immunotherapy, Cell Therapy and Biobank, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Giuseppe Palmieri
- Department of Immuno-oncology and Targeted Oncologic Biotherapies, University of Sassari, Sassari, Italy
- Unit of Tumor Genetics, IRGB-CNR, Sassari, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì-Cesena, Italy
- Cancer Prevention Unit, ASL Forlì, Forlì-Cesena, Italy
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10
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Vikström S, Mikiver R, Lapins J, Nielsen K, Vassilaki I, Lyth J, Isaksson K, Eriksson H. Increasing melanoma incidence and survival trend shifts with improved melanoma-specific survival between 1990 and 2020 in Sweden. Br J Dermatol 2023; 189:702-709. [PMID: 37463416 DOI: 10.1093/bjd/ljad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Melanoma-specific survival (MSS) is heterogenous between stages and is highly dependent on the T stage for primary localized disease. New systemic therapies for metastatic cutaneous melanoma (CM) have been introduced since 2012 in Sweden. OBJECTIVES To analyse the incidence and MSS time trends between 1990 and 2020 in Sweden. METHODS Nationwide, population-based and prospectively collected clinico-pathological data on invasive CM from the Swedish Melanoma Registry (SweMR) were analysed for survival trends between 1990 and 2020 using Kaplan-Meier curves and Cox proportional hazard ratios (HRs). RESULTS In total, 77 036 primary invasive CMs were diagnosed in 70 511 patients in Sweden between 1990 and 2020. The 5-year MSS [95% confidence interval (CI)] was 88.9% (88.3-89.4) for 1990-2000, 89.2% (88.7-89.6) for 2001-2010 and 93.0% (92.7-93.9) for 2011-2020. The odds ratios for being diagnosed with nodular melanoma (vs. superficial spreading melanoma) was significantly reduced by 20% (2001-2010) and by 46% (2011-2020) vs. the reference period 1990-2000. Overall, the MSS improved over both diagnostic periods (2001-2010 and 2011-2020) vs. the reference period 1990-2000 among men and women, respectively [HRmen: 2001-2010: 0.89 (95% CI 0.82-0.96) and 2011-2020: 0.62 (95% CI 0.56-0.67); HRwomen: 2001-2010: 0.82 (95% CI 0.74-0.91) and 2011-2020: 0.62 (95% CI 0.56-0.70)]. The risk of death from CM was significantly lower in all age groups for both men and women in the most recent diagnostic period (2011-2020 vs.1990-2000). CONCLUSIONS The results emphasize the improved MSS among men and women in Sweden. The MSS improvements, specifically for the period 2011-2020, may be correlated to the introduction of new systemic therapies and are here shown for the first time in detail for Sweden.
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Affiliation(s)
- Sofi Vikström
- Department of Oncology-Pathology
- Department of Pathology and Cancer Diagnostics, Radiumhemmet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rasmus Mikiver
- Department of Clinical and Experimental Medicine
- Regional Cancer Centre Southeast Sweden, Linköping, Sweden
| | - Jan Lapins
- Department of Medicine, Unit of Dermatology, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology
| | - Kari Nielsen
- Dermatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
- Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - Ismini Vassilaki
- Department of Pathology and Cancer Diagnostics, Radiumhemmet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Johan Lyth
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Karolin Isaksson
- Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Hanna Eriksson
- Department of Oncology-Pathology
- Cancer Theme, Unit of Head-Neck-, Lung-, and Skin Cancer, Skin Cancer Centre, Karolinska University Hospital, Stockholm, Sweden
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11
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Naeser Y, Mikiver R, Ingvar C, Lambe M, Ullenhag GJ. Survival in patients diagnosed with melanoma in situ compared to the general population. A Swedish population-based matched cohort study. EClinicalMedicine 2023; 65:102284. [PMID: 38106551 PMCID: PMC10725068 DOI: 10.1016/j.eclinm.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 12/19/2023] Open
Abstract
Background The incidence of melanoma in situ (MIS) is increasing even more rapidly than the incidence of cutaneous malignant melanoma (CMM). No previous studies have in detail investigated the survival in individuals diagnosed with MIS compared to the general population. Methods This population-based study included individuals with MIS diagnosed in Sweden between 2001 and 2010 and randomly selected MIS-free comparators matched on age, sex and county of residence. Exclusion criterion was a previous CMM. Data on socioeconomic status (SES) including educational level, income and marital status, comorbidity and cause of death were obtained from population-based registers. Overall survival (OS) was estimated by the Kaplan-Meier method. The mortality risk adjusted for SES and comorbidity was assessed by multivariable Cox regression analyses. Findings The survival analyses included 7963 cases and 39,662 comparators. Median age at MIS diagnosis were 63 (IQR 50-75) and 67 (IQR 57-76) years in women and men respectively. Median follow-up time was 120 months (IQR 102-152 months). In individuals with MIS, the ten-year OS was 77% (95% CI 0.76-0.78) compared to 72% (95% CI 0.72-0.73) in comparators. The MIS patients had a higher SES and lower comorbidity burden than the comparators. In a fully adjusted multivariable analysis, including 7772 cases and 38,103 comparators, the mortality was significantly lower in women with MIS (HR 0.88, 95% CI 0.82-0.94) compared to the background population. The corresponding estimate in men was HR 0.94 (95% CI 0.88-1.0). The risk of melanoma-related deaths during the study period was ten-fold higher in MIS patients. Interpretation Despite being at increased risk of developing CMM, MIS patients had a better OS compared to their matched comparators from the background population, findings which could not fully be explained by differences in SES and comorbidity. Our results are reassuring and should be communicated to patients who have been diagnosed with MIS. Funding Stiftelsen Onkologiska Klinikens i Uppsala Forskningsfond, Mats and Stefan Paulsson Trust, Medicon Village, Lund and Uppsala University Hospital (ALF).
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Affiliation(s)
- Ylva Naeser
- Department of Oncology, Uppsala University Hospital, Entrance 101, 751 85, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
| | - Rasmus Mikiver
- Regional Cancer Center South-East, Kungsgatan 23, 582 18, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, 581 83, Linköping, Sweden
| | - Christian Ingvar
- Department of Clinical Sciences, Surgery, Lund University, 221 84, Lund, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
- Regional Cancer Center Central Sweden, 751 85, Uppsala, Sweden
| | - Gustav J. Ullenhag
- Department of Oncology, Uppsala University Hospital, Entrance 101, 751 85, Uppsala, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Dag Hammarskjölds väg 20, 751 85, Uppsala, Sweden
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12
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Aebischer V, Abu-Ghazaleh A, Metzler G, Riedl L, Garbe C, Flatz L, Eigentler T, Forchhammer S. Histopathologic abundance of pigmentation correlates with disease-specific survival in malignant melanoma but is not independent of current AJCC pT stage. Pigment Cell Melanoma Res 2023; 36:512-521. [PMID: 37469279 DOI: 10.1111/pcmr.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
The increasing number of melanoma patients makes it necessary to develop best possible strategies for prognosis assessment in order to recommend appropriate therapy and follow-up. The prognostic significance of tumor cell pigmentation has not been fully elucidated. Hematoxylin and eosin (H&E)-stained sections of 775 melanomas diagnosed between 2012 and 2015 were independently assessed for melanin pigment abundance by two investigators, and the impact on melanoma-specific survival was calculated. Unpigmented melanomas (n = 99) had a melanoma-specific survival of 67.7%, melanomas with moderate pigmentation (n = 384) had a melanoma-specific survival of 85.9%, and strongly pigmented melanomas (n = 292) had a melanoma-specific survival of 91.4% (p < .001). In an analysis of melanoma-specific survival adjusted for pT stage and pigmentation, we found a nonsignificant impact of pigmentation abundance with a hazard ratio of 1.277 (p = .74). The study presented here provides evidence in a German cohort that patients with pigmented melanomas have a more favorable prognosis than those diagnosed with nonpigmented melanomas. Moreover, the abundance of pigmentation already seems to provide a first prognostic estimate. However, it does not appear to provide significant additional value for prognostic assessment according to the AJCC 2017 pT classification.
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Affiliation(s)
| | - Amar Abu-Ghazaleh
- Universitäts-Hautklinik, Eberhardt Karls Universität, Tübingen, Germany
| | - Gisela Metzler
- Zentrum für Dermatohistologie und Oralpathologie Tübingen/Würzburg, Tübingen, Germany
| | - Lena Riedl
- Innere Medizin VI, Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Claus Garbe
- Universitäts-Hautklinik, Eberhardt Karls Universität, Tübingen, Germany
| | - Lukas Flatz
- Universitäts-Hautklinik, Eberhardt Karls Universität, Tübingen, Germany
| | - Thomas Eigentler
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Hum-boldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Berlin, Germany
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13
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Martínez-Fernández S, González-Sixto B, Espasandín-Arias M, Soto-García D, Flórez Á. Topical and Intralesional Immunotherapy for Melanoma In Situ: A Review. Cancers (Basel) 2023; 15:4468. [PMID: 37760438 PMCID: PMC10526313 DOI: 10.3390/cancers15184468] [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: 07/29/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The incidence of in situ melanoma (MIS) has increased over the last decades. The mainstay of treatment for MIS, including lentigo maligna (LM), is complete surgical excision with clear margins (0.5 to 1.0 cm). Nevertheless, MIS lesions often affect elderly patients with comorbidities and involve large lesions in cosmetically sensitive areas, which means surgery is not always appropriate. Non-surgical treatments have a role in these cases, and include radiotherapy, cryosurgery, immunotherapy, laser therapy, and other topical medications. This study aims to review the applications of immunotherapy in MIS, either in monotherapy or in combination with other therapeutic alternatives. The main forms of immunotherapy used are imiquimod and, to a lesser extent, intralesional interferon-α (IL-INF-α) and ingenol mebutate (IM). IL-INF-α and IM have not been studied as extensively as imiquimod, whose results in real-life practice are encouraging. The clearance and recurrence rates reported in MIS treated with imiquimod as monotherapy, or as an adjuvant after surgery with affected or narrow margins, make imiquimod a reliable therapeutic alternative in selected cases. Also, its use as a neoadjuvant therapy before surgery was shown to reduce the final surgical defect size required to confirm negative histologic margins. In conclusion, local immunotherapy is frequently used in clinical practice and experience confirms it to be an excellent option for certain patients.
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Affiliation(s)
- Sandra Martínez-Fernández
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Beatriz González-Sixto
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Martina Espasandín-Arias
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Diego Soto-García
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
| | - Ángeles Flórez
- Department of Dermatology, Pontevedra University Hospital, 36001 Pontevedra, Spain; (B.G.-S.); (M.E.-A.); (D.S.-G.); (Á.F.)
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Pontevedra, Spain
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14
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Shamloo S, Kloetgen A, Petroulia S, Hockemeyer K, Sievers S, Tsirigos A, Aifantis I, Imig J. Integrative CRISPR Activation and Small Molecule Inhibitor Screening for lncRNA Mediating BRAF Inhibitor Resistance in Melanoma. Biomedicines 2023; 11:2054. [PMID: 37509693 PMCID: PMC10377043 DOI: 10.3390/biomedicines11072054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
The incidence of melanoma, being one of the most commonly occurring cancers, has been rising since the past decade. Patients at advanced stages of the disease have very poor prognoses, as opposed to at the earlier stages. The conventional targeted therapy is well defined and effective for advanced-stage melanomas for patients not responding to the standard-of-care immunotherapy. However, targeted therapies do not prove to be as effective as patients inevitably develop V-Raf Murine Sarcoma Viral Oncogene Homolog B (BRAF)-inhibitor resistance to the respective drugs. Factors which are driving melanoma drug resistance mainly involve mutations in the mitogen-activated protein kinase (MAPK) pathway, e.g., BRAF splice variants, neuroblastoma RAS viral oncogene homolog (NRAS) amplification or parallel survival pathways. However, those mechanisms do not explain all cases of occurring resistances. Therefore, other factors accounting for BRAFi resistance must be better understood. Among them there are long non-coding RNAs (lncRNAs), but these remain functionally poorly understood. Here, we conduct a comprehensive, unbiased, and integrative study of lncRNA expression, coupled with a Clustered Regularly Interspaced Short Palindromic Repeats/Cas9-mediated activation (CRISPRa) and small molecule inhibitor screening for BRAF inhibitor resistance to expand the knowledge of potentially druggable lncRNAs, their function, and pave the way for eventual combinatorial treatment approaches targeting diverse pathways in melanoma.
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Affiliation(s)
- Sama Shamloo
- Chemical Genomics Centre of the Max Planck Society, 44227 Dortmund, Germany
- Max Planck Institute of Molecular Physiology, 44227 Dortmund, Germany
| | - Andreas Kloetgen
- Department of Pathology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
| | - Stavroula Petroulia
- Chemical Genomics Centre of the Max Planck Society, 44227 Dortmund, Germany
- Max Planck Institute of Molecular Physiology, 44227 Dortmund, Germany
| | - Kathryn Hockemeyer
- Department of Pathology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
| | - Sonja Sievers
- Max Planck Institute of Molecular Physiology, 44227 Dortmund, Germany
- Compound Management and Screening Center, 44227 Dortmund, Germany
| | - Aristotelis Tsirigos
- Department of Pathology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
- Applied Bioinformatics Laboratories, Office of Science and Research, New York University School of Medicine, New York, NY 10016, USA
| | - Ioannis Aifantis
- Department of Pathology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
| | - Jochen Imig
- Chemical Genomics Centre of the Max Planck Society, 44227 Dortmund, Germany
- Max Planck Institute of Molecular Physiology, 44227 Dortmund, Germany
- Department of Pathology, Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, NY 10016, USA
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15
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Patinote C, Raevens S, Baumann A, Pellegrin E, Bonnet PA, Deleuze-Masquéfa C. [1,2,4]triazolo[4,3- a]quinoxaline as Novel Scaffold in the Imiqualines Family: Candidates with Cytotoxic Activities on Melanoma Cell Lines. Molecules 2023; 28:5478. [PMID: 37513350 PMCID: PMC10384284 DOI: 10.3390/molecules28145478] [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: 06/27/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Cutaneous melanoma is one of the most aggressive human cancers and is the deadliest form of skin cancer, essentially due to metastases. Novel therapies are always required, since cutaneous melanoma develop resistance to oncogenic pathway inhibition treatment. The Imiqualine family is composed of heterocycles diversely substituted around imidazo[1,2-a]quinoxaline, imidazo[1,2-a]pyrazine, imidazo[1,5-a]quinoxaline, and pyrazolo[1,5-a]quinoxaline scaffolds, which display interesting activities on a panel of cancer cell lines, especially melanoma cell lines. We have designed and prepared novel compounds based on the [1,2,4]triazolo[4,3-a]quinoxaline scaffold through a common synthetic route, using 1-chloro-2-hydrazinoquinoxaline and an appropriate aldehyde. Cyclization is ensured by an oxidation-reduction mechanism using chloranil. The substituents on positions 1 and 8 were chosen based on previous structure-activity relationship (SAR) studies conducted within our heterocyclic Imiqualine family. Physicochemical parameters of all compounds have also been predicted. A375 melanoma cell line viability has been evaluated for 16 compounds. Among them, three novel [1,2,4]triazolo[4,3-a]quinoxalines display cytotoxic activities. Compounds 16a and 16b demonstrate relative activities in the micromolar range (respectively, 3158 nM and 3527 nM). Compound 17a shows the best EC50 of the novel series (365 nM), even if EAPB02303 remains the lead of the entire Imiqualine family (3 nM).
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Affiliation(s)
- Cindy Patinote
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 F16, (CNRS, ENSCM, Université de Montpellier), 1919 Route de Mende, 34090 Montpellier, France
| | - Sandy Raevens
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 F16, (CNRS, ENSCM, Université de Montpellier), 1919 Route de Mende, 34090 Montpellier, France
| | - Amélie Baumann
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 F16, (CNRS, ENSCM, Université de Montpellier), 1919 Route de Mende, 34090 Montpellier, France
| | - Eloise Pellegrin
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 F16, (CNRS, ENSCM, Université de Montpellier), 1919 Route de Mende, 34090 Montpellier, France
| | - Pierre-Antoine Bonnet
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 F16, (CNRS, ENSCM, Université de Montpellier), 1919 Route de Mende, 34090 Montpellier, France
| | - Carine Deleuze-Masquéfa
- Institut des Biomolécules Max Mousseron (IBMM), UMR 5247 F16, (CNRS, ENSCM, Université de Montpellier), 1919 Route de Mende, 34090 Montpellier, France
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16
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Cinotti E, Cioppa V, Tognetti L, Perrot JL, Rossi R, Gnone M, Cartocci A, Rubegni P, Cortonesi G. Super-High Magnification Dermoscopy in 190 Clinically Atypical Pigmented Lesions. Diagnostics (Basel) 2023; 13:2238. [PMID: 37443632 DOI: 10.3390/diagnostics13132238] [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: 05/18/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Super-high (×400) magnification dermoscopy (D400) is a new non-invasive imaging technique that has been shown to add information for the differential diagnosis of melanocytic lesions in a pilot study. Our study aimed to confirm if D400 can add details for the discrimination of clinically atypical nevus and melanoma. This is a retrospective observational, multicentric study enrolling patients who received ×20 (D20) and ×400 (D400) magnification dermoscopic examinations of pigmented skin lesions. Dermoscopic images were retrospectively evaluated by three observers for the presence/absence of nine D20 and twenty D400 dermoscopic features defined in the previous pilot study. Univariate and multivariate analyses were carried out to find predictors of benign and malignant behaviors. At D20, an atypical pigment network, blue-whitish veil, atypical vascular pattern, regression, and homogenous pattern were more frequent in melanoma than in nevi (p < 0.001). At D400, melanoma showed more frequently than benign lesions, melanocytes with an irregular arrangement and irregular in shape and size (p < 0.001). A network with edged papillae was more frequent in benign lesions than melanomas (p < 0.001). Our study confirms that D400 can identify melanocytes with an irregular arrangement, and irregularities in shape and size in melanomas, adding information to the conventional D20 examination.
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Affiliation(s)
- Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy
| | - Vittoria Cioppa
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy
| | - Jean Luc Perrot
- Department of Dermatology, University Hospital of Saint-Etienne, 42055 Saint-Etienne, France
| | - Renato Rossi
- Department of Dermatology, Skin Center Senigallia, 60019 Ancona, Italy
| | - Matteo Gnone
- Dermatology Private Practice, 16121 Genoa, Italy
| | - Alessandra Cartocci
- Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy
| | - Giulio Cortonesi
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy
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17
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Słowińska M, Czarnecka I, Czarnecki R, Tatara P, Nasierowska-Guttmejer A, Lorent M, Cierniak S, Owczarek W. Clinical, Dermoscopic, and Histological Characteristics of Melanoma Patients According to the Age Groups: A Retrospective Observational Study. Life (Basel) 2023; 13:1369. [PMID: 37374151 DOI: 10.3390/life13061369] [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: 04/16/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Although the role of melanoma risk factors is well documented, their correlation with patients' age is less frequently analyzed. METHOD The analysis was performed among 189 melanoma patients in different age groups, including <30 years, 31-60 years, and >60 years, to investigate the risk factors, topography, and coexistence of morphological features of 209 melanomas (dermoscopic and histopathological). RESULTS Among the youngest age group, no correlation with the presence of estimated risk factors was found. The most common dermoscopic pattern was spitzoid and multicomponent asymmetric. The group of middle-aged patients was the most diverse in terms of the occurrence of risk factors, solar lentiginosis, dermoscopic patterns, topography, histological subtypes, and invasiveness of melanomas. The oldest group characterized a strong correlation between solar lentiginosis, NMSC comorbidity, the prevalence of facial melanomas, the dermoscopic pattern of melanoma arising on chronic sun-damaged skin, and regression. CONCLUSION The findings regarding the presence of age-specific features in melanoma patients, especially in the youngest and middle-aged groups, might be helpful for clinicians and to target secondary prevention efforts.
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Affiliation(s)
- Monika Słowińska
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
- Evimed Medical Centre Ltd., Private Dermatologic Practice, JP Woronicza 16, 02-625 Warsaw, Poland
| | - Iwona Czarnecka
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Robert Czarnecki
- Department of Cardiology, LUX MED Oncology, Limited Liability Company, St. Elizabeth Hospital, Goszczynskiego 1, 02-616 Warsaw, Poland
| | - Paulina Tatara
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Anna Nasierowska-Guttmejer
- Department of Pathomorphology, Central Clinical Hospital of Ministry of Interior and Administration-National Medical Institute, Woloska 137, 02-507 Warsaw, Poland
- Faculty of Medicine, Lazarski University, Swieradowska 43, 02-662 Warsaw, Poland
| | - Małgorzata Lorent
- Department of Pathomorphology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Szczepan Cierniak
- Department of Pathomorphology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
| | - Witold Owczarek
- Department of Dermatology, Central Clinical Hospital Ministry of Defense, Military Institute of Medicine-National Research Institute, Szaserow 128, 04-141 Warsaw, Poland
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18
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Demaerel PG, Leloup A, Brochez L, Van Eycken L, Garmyn M. Impact of the COVID-19 Pandemic on the Incidence and Thickness of Cutaneous Melanoma in Belgium. Biomedicines 2023; 11:1645. [PMID: 37371740 DOI: 10.3390/biomedicines11061645] [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: 05/08/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: COVID-19 had a major impact on cancer diagnostics and treatment. Delays in diagnosis of cutaneous melanoma were particularly feared, given the impact on survival and morbidity that comes with advanced stages. Moreover, its incidence in Belgium has been rapidly increasing in recent decades. This Belgian population-level study quantifies the pandemic effect on the number of melanoma diagnoses and Breslow thickness in 2020 and 2021. (2) Methods: In using an automated algorithm, the number of cutaneous melanoma diagnoses and Breslow thickness were extracted from all pathology protocols from 2017-2021 by the Belgian Cancer Registry. Monthly variations, as well as year-to-year differences, were studied. (3) Results: Annual incidence of cutaneous melanoma fell by 1% in 2020, compared to 2019, mainly due to a diagnostic deficit in March, April, and May 2020. An 8% incidence increase occurred in 2021, primarily reflecting an increase in the number of the thinnest melanomas (≤1 mm). Both the mean and median Breslow thicknesses were higher in spring 2020, resulting from an underrepresentation of thinner tumors. However, no particulars stood out on a full-year basis in either 2020 or 2021. (4) Conclusions: Considering the expected incidence increase, we estimate almost 210 melanoma diagnoses were missed in Belgium in 2020, corresponding to 6% of the expected number. This deficit occurred mainly during the first COVID-19 wave. Despite some rebound, the 2021 total was still 3% short of the expected number, leaving around 325 diagnoses remaining pending in 2020 and 2021, corresponding to a two-year deficit of 4.35%. Fortunately, mainly thin melanomas were missed, without any detectable shift toward thicker tumors later in 2020 and or 2021.
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Affiliation(s)
| | | | - Lieve Brochez
- Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | | | - Marjan Garmyn
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium
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19
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Guo ZX, Zhao XL, Zhao ZY, Zhu QY, Wang ZY, Xu M. Malignant melanoma resection and reconstruction with the first manifestation of lumbar metastasis: A case report. World J Clin Cases 2023; 11:3571-3577. [PMID: 37383908 PMCID: PMC10294206 DOI: 10.12998/wjcc.v11.i15.3571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/05/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Malignant melanoma (MM) has shown an increasing incidence worldwide, and a potential to metastasize to almost any part of the body. Clinically, MM with bone metastasis as the initial manifestation is extremely rare. Spinal metastatic MM can cause spinal cord or nerve root compression, resulting in severe pain and paralysis. Currently, the primary clinical treatments for MM are surgical resection in conjunction with chemotherapy, radiotherapy, and immunotherapy.
CASE SUMMARY Here, we report the case of a 52-year-old male who presented to the clinic with progressive low back pain and limited nerve function. No primary lesion or spinal cord compression was detected from computed tomography and magnetic resonance imaging of the lumbar vertebrae and positron emission tomography scan. A lumbar puncture biopsy confirmed the diagnosis of lumbar spine metastatic MM. Following surgical resection, the patient’s quality of life improved, symptoms were relieved, and comprehensive treatment was initiated, which prevented recurrence.
CONCLUSION Spinal metastatic MM is clinically rare, and may cause neurological symptoms, including paraplegia. Currently, the clinical treatment plan consists of surgical resection in combination with chemotherapy, radiotherapy, and immunotherapy.
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Affiliation(s)
- Zi-Xuan Guo
- Graduate School, Medical School of Chinese PLA, Beijing 100853, China
| | - Xue-Lin Zhao
- Graduate School, Medical School of Chinese PLA, Beijing 100853, China
| | - Zi-Yi Zhao
- Graduate School, Medical School of Chinese PLA, Beijing 100853, China
| | - Qing-Yan Zhu
- Graduate School, Medical School of Chinese PLA, Beijing 100853, China
| | - Zi-Ying Wang
- Graduate School, Medical School of Chinese PLA, Beijing 100853, China
| | - Meng Xu
- Department of Orthopedics, The Forth Medical Center of PLA General Hospital, Beijing 100037, China
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20
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Nikolaou V, Stratigos AJ. Adjuvant treatment in advanced melanoma: How far have we come? J Eur Acad Dermatol Venereol 2023; 37:851-852. [PMID: 37052424 DOI: 10.1111/jdv.19010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/14/2023]
Affiliation(s)
- V Nikolaou
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A J Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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21
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van Niekerk CC, Otten JHDM, van Rossum MM, van den Reek JMPA, Brummelkamp E, Mol M, Groenewoud JHMM, Verbeek ALM. Trends in three major histological subtypes of cutaneous melanoma in the Netherlands between 1989 and 2016. Int J Dermatol 2023; 62:508-513. [PMID: 36539393 DOI: 10.1111/ijd.16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Time trend analysis of cutaneous melanoma (CM) mortality in fair skin populations shows both a gradual decrease and/or an increase. To explain these differences, we analyzed long-term time trends in the incidence of the most common histological subtypes of CM: superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM), and nodular melanoma (NM). METHODS Using data from the Netherlands Cancer Registry and Statistics Netherlands, the number and rates of cases diagnosed with SSM, LLM, and NM from 1989 to 2016 were analyzed by age, calendar period, and birth cohort of people born in successive periods from 1925 to 1973. RESULTS Primary CM was diagnosed in 52,000 men and 66,588 women in the study period. The annual age-standardized incidence rate increased three-fold from 14 to 42 per 100,000 person-years. The most common subtype was SSM (50%), followed by LMM (23%) and NM (14%). Age-specific subtype rates showed an upward trend over time for both men and women. Younger birth cohorts had higher rates of SSM and LMM diagnosis than older birth cohorts. This birth cohort pattern was not observed for NM. CONCLUSIONS We observed a strong increase in the melanoma epidemic curves in the light-skinned Dutch population over the last three decades. This increase is explained by younger generations having higher rates of SSM and LMM than older generations.
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Affiliation(s)
- Catharina C van Niekerk
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - J Hans D M Otten
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Michelle M van Rossum
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erik Brummelkamp
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Martijn Mol
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - J Hans M M Groenewoud
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
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22
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Neale RE, Lucas RM, Byrne SN, Hollestein L, Rhodes LE, Yazar S, Young AR, Berwick M, Ireland RA, Olsen CM. The effects of exposure to solar radiation on human health. Photochem Photobiol Sci 2023:10.1007/s43630-023-00375-8. [PMID: 36856971 PMCID: PMC9976694 DOI: 10.1007/s43630-023-00375-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.
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Affiliation(s)
- R. E. Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,School of Public Health, University of Queensland, Brisbane, QLD Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT Australia
| | - S. N. Byrne
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - L. Hollestein
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - L. E. Rhodes
- Dermatology Research Centre, School of Biological Sciences, University of Manchester, Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - S. Yazar
- Garvan Medical Research Institute, Sydney, NSW Australia
| | | | - M. Berwick
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - R. A. Ireland
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - C. M. Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,Frazer Institute, University of Queensland, Brisbane, QLD Australia
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23
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Troesch A, Magdalena H, Forchhammer S, Del Regno L, Lodde G, Turko P, Cheng PF, Levesque ML, Hadaschik E, Livingstone E, Peris K, Flatz L, Peter K, Dummer R, Dimitriou F. The impact of the COVID-19 pandemic on the diagnosis of cutaneous melanomas: A retrospective cohort study from five European skin cancer reference centres. J Eur Acad Dermatol Venereol 2023; 37:922-931. [PMID: 36785973 DOI: 10.1111/jdv.18953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The COVID-19 lockdown had a dramatic impact on primary care access and resulted in postponed skin cancer screenings. This raises concerns for a diagnostic delay on primary cutaneous melanomas, which can subsequently increase morbidity and mortality. OBJECTIVES The aim of the study was to investigate the impact of the COVID-19-related restrictions on the melanoma diagnosis in five European skin cancer reference centres in Switzerland, Germany, Austria and Italy. METHODS A total of 7865 cutaneous melanoma cases were collected between 01 September 2018 and 31 August 2021. The time period was stratified into pre-COVID (pre-lockdown) and post-COVID (lockdown and post-lockdown) according to the established restrictions in each country. The data collection included demographic, clinical and histopathological data from histologically confirmed cutaneous melanomas. Personal and family history of melanoma, and presence of immunosuppression were used to assess the diagnosis delay in high-risk individuals. RESULTS There was an overall increase of the Breslow tumour thickness (mean 1.25 mm vs. 1.02 mm) during the post-COVID period, as well as an increase in the proportion of T3-T4 melanomas, rates of ulceration and the number of mitotic rates ≥2 (all, p < 0.001). Patients with immunosuppression and personal history of melanoma showed a decrease in the mean log10-transformed Breslow during lockdown and post-COVID. In the multivariate analysis, age at melanoma diagnosis (p < 0.01) and personal history of melanoma (p < 0.01) showed significant differences in the mean Breslow thickness. CONCLUSIONS The study confirms the diagnostic delay in cutaneous melanomas due to the COVID-19 lockdown. High-risk individuals, such as patients with personal history of melanoma and elderly individuals, were more hesitant to restart their regular skin cancer screenings post-COVID. Further studies with longer follow-up are required to evaluate the consequences of this diagnostic delay in long-term outcomes.
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Affiliation(s)
- Alexander Troesch
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Hoellwerth Magdalena
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Laura Del Regno
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Georg Lodde
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patrick Turko
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Mitchell L Levesque
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Eva Hadaschik
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ketty Peris
- Dermatology, Universita' Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Lukas Flatz
- Department of Dermatology, Eberhard Karls University of Tübingen, Tuebingen, Germany
| | - Koelblinger Peter
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
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24
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Bucchi L, Mancini S, Zamagni F, Crocetti E, Dal Maso L, Ferretti S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Biggeri A, Stanganelli I, Falcini F. Patient presentation, skin biopsy utilization and cutaneous malignant melanoma incidence and mortality in northern Italy: Trends and correlations. J Eur Acad Dermatol Venereol 2023; 37:293-302. [PMID: 36181283 PMCID: PMC10092783 DOI: 10.1111/jdv.18635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The global increase in incidence of cutaneous malignant melanoma (CMM) occurring in the past decades has been partly attributed to increased diagnostic scrutiny of early lesions, with a potential phenomenon of overdiagnosis. The reported positive linear relation between skin biopsy rate and incidence of early CMM is compatible with this hypothesis. OBJECTIVES We explored the ecological association between the trends in annual dermatologic office visit rates, skin biopsy rates, incidence rates of in situ and invasive CMM by tumour thickness category, and CMM mortality rates in the Emilia-Romagna Region (northern Italy). METHODS Four cancer registries covering a population of 2,696,000 provided CMM incidence data for the years 2003-2017. Dermatologic office visit rates and skin biopsy rates were calculated using the Regional outpatient care database. All rates were age-standardized. Trends were described with the estimated average annual per cent change (EAAPC). Correlations were tested with the Spearman correlation coefficient. RESULTS Incidence increased significantly. The increase was steeper for in situ CMM (EAAPC: men, 10.2; women, 6.9) followed by CMM <0.8 mm thick (9.1; 5.2), but the rates grew significantly for most subgroups of CMMs ≥0.8 mm thick. Mortality decreased significantly among women (-2.3) and non-significantly among men. For dermatologic office visit rate and skin biopsy rate the EAAPC were, respectively, 1.7 and 1.8 for men and 1.2 and 0.9 for women. Annual dermatologic office visit rate correlated with skin biopsy rate in both sexes. However, the proportion of skin biopsies out of dermatologic office visits was constant across the years (range: men, 0.182-0.216; women, 0.157-0.191). CONCLUSIONS In Italy, the increasing CMM incidence trend is, at least in part, genuine. Overdiagnosis-if any-is due to an increased patient presentation at dermatologic offices and not to a lower dermatologic threshold to perform biopsy.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Federica Zamagni
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Stefano Ferretti
- Romagna Cancer Registry, section of Ferrara, Local Health Authority and University of Ferrara, Ferrara, Italy
| | - Flavia Baldacchini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Orietta Giuliani
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Rosa Vattiato
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della Salute, Viterbo, Italy
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della Salute, Servizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP), Trapani, Italy
| | - Simona Carone
- Registro Tumori di Taranto, Unità Operativa Complessa di Statistica ed Epidemiologia, Azienda Sanitaria Locale, Taranto, Italy
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health Department, Local Health Authority, Modena, Italy
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania-Messina-Enna, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | | | | | - Antonino Musolino
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Medical Oncology Unit and Cancer Registry, University Hospital of Parma, Parma, Italy
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Department of Dermatology, University of Parma, Parma, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy.,Local Health Authority, Cancer Prevention Unit, Forlì, Italy
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Epidemiological transition of primary cutaneous melanoma in a public hospital in Brazil (1999-2019). An Bras Dermatol 2023; 98:89-92. [PMID: 36437140 PMCID: PMC9837634 DOI: 10.1016/j.abd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
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Hirsiger S, Olariu R. Schwannomas mistaken for metastases of melanoma in PET-CT: A diagnostic challenge with consequences. Clin Case Rep 2022; 10:e6753. [PMID: 36583202 PMCID: PMC9794678 DOI: 10.1002/ccr3.6753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/11/2022] [Accepted: 12/01/2022] [Indexed: 12/29/2022] Open
Abstract
The incidence of skin cancer and especially cutaneous malignant melanoma is rising, as are indications for staging examinations to detect metastasis. Schwannomas are common benign nerve tumors, which can be mistaken for metastasis even in highly specialized imaging. Risk of nerve lesion is high in inadvertent biopsy.
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Affiliation(s)
- Stefanie Hirsiger
- Department of Plastic and Hand Surgery, Inselspital University Hospital BernUniversity of BernBernSwitzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital University Hospital BernUniversity of BernBernSwitzerland
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27
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WNT5A-ROR2 axis mediates VEGF dependence of BRAF mutant melanoma. Cell Oncol 2022; 46:391-407. [PMID: 36539575 PMCID: PMC10060292 DOI: 10.1007/s13402-022-00757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose
Despite recent advances, approximately 50% of patient with metastatic melanoma eventually succumb to the disease. Patients with melanomas harboring a BRAF mutation (BRAFMut) have a worse prognosis than those with wildtype (BRAFWT) tumors. Unexpectedly, interim AVAST-M Phase III trial data reported benefit from adjuvant anti-VEGF bevacizumab only in the BRAFMut group. We sought to find mechanisms underpinning this sensitivity.
Methods
We investigated this finding in vitro and in vivo using melanoma cell lines and clones generated by BRAFV600E knock-in on a BRAFWT background.
Results
Compared with BRAFWT cells, isogenic BRAFV600E clones secreted more VEGF and exhibited accelerated growth rates as spheroids and xenografts, which were more vascular and proliferative. Recapitulating AVAST-M findings, bevacizumab affected only BRAFV600E xenografts, inducing significant tumor growth delay, reduced vascularity and increased necrosis. We identified 814 differentially expressed genes in isogenic BRAFV600E/BRAFWT clones. Of 61 genes concordantly deregulated in clinical melanomas ROR2 was one of the most upregulated by BRAFV600E. ROR2 was shown to be RAF-MEK regulated in BRAFV600E cells and its depletion suppressed VEGF secretion down to BRAFWT levels. The ROR2 ligand WNT5A was also overexpressed in BRAFMut melanomas, and in ROR2-overexpressing BRAFV600E cells MEK inhibition downregulated WNT5A and VEGF secretion.
Conclusions
These data implicate WNT5A-ROR2 in VEGF secretion, vascularity, adverse outcomes and bevacizumab sensitivity of BRAFMut melanomas, suggesting that this axis has potential therapeutic relevance.
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Mai JZ, Kitahara CM, Sargen MR, Little MP, Alexander BH, Linet MS, Tucker MA, Cahoon EK. Use of Nonsteroidal Anti-Inflammatory Drugs and Incidence of Melanoma in the United States Radiologic Technologists Study. Cancer Prev Res (Phila) 2022; 15:727-732. [PMID: 35902885 PMCID: PMC9633366 DOI: 10.1158/1940-6207.capr-22-0229] [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: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 01/31/2023]
Abstract
Although NSAIDs have been associated with both reduced and increased cutaneous melanoma risk, few studies have examined these associations by ultraviolet radiation (UVR) or personal sun-sensitivity. We examined the associations between NSAID use and first primary invasive cutaneous melanoma among 58,227 non-Hispanic white participants in the United States Radiologic Technologists cohort study. Poisson regression was used to calculate rate ratios (RR) and 95% likelihood-based confidence intervals (CI), adjusting for attained age, birth cohort, and ambient UVR. No significant association of melanoma was observed for any use of NSAIDs (RR, 0.87; 95% CI, 0.71-1.09). The relative risks of melanoma for the highest categories of aspirin and other NSAID use (≥5 times per month vs. none) were 0.93 (95% CI, 0.74-1.16) and 1.02 (95% CI, 0.83-1.25), respectively. Further analyses did not reveal dose-response for trends in frequency of NSAID use or interactions with sex, UVR, eye and hair color, and skin complexion. In this large nationwide study, NSAID use was not associated with melanoma risk. PREVENTION RELEVANCE NSAIDs have been associated with both reduced and increased melanoma risk. However, few studies have examined the role of UVR or personal sun-sensitivity on these associations. Our findings strengthen the evidence that NSAID use is not associated with melanoma risk, even in sun-sensitive subgroups.
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Affiliation(s)
- Jim Z. Mai
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
| | - Cari M. Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
| | - Michael R. Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
| | - Mark P. Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
| | - Bruce H. Alexander
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
| | - Margaret A. Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
| | - Elizabeth K. Cahoon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services
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29
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Elder DE. Obligate and Potential Precursors of Melanoma. J Natl Cancer Inst 2022; 114:1320-1322. [PMID: 36042556 PMCID: PMC9552272 DOI: 10.1093/jnci/djac139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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30
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Maksimaityte V, Reivytyte R, Milaknyte G, Mickys U, Razanskiene G, Stundys D, Kazenaite E, Valantinas J, Stundiene I. Metastatic multifocal melanoma of multiple organ systems: A case report. World J Clin Cases 2022; 10:10136-10145. [PMID: 36246820 PMCID: PMC9561590 DOI: 10.12998/wjcc.v10.i28.10136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/05/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Malignant melanoma is becoming more common among middle-aged individuals all over the world. Melanoma metastasis can be found in various organs, although metastases to the spleen and stomach are rare. Herein we present a rare metastatic multifocal melanoma, clinically and histologically mimicking lymphoma, with metastases of multiple organs.
CASE SUMMARY A 46-year-old Caucasian male with a history of nodular cutaneous malignant melanoma was presented with nausea, general weakness, shortness of breath, abdominal enlargement, and night sweating. The abdominal ultrasound revealed enlarged liver and spleen with multiple lesions. Computed tomography demonstrated multiple lesions in the lungs, liver, spleen, subcutaneous tissue, bones and a pathological lymphadenopathy of the neck. Trephine biopsy and the biopsy from the enlarged lymph node were taken. Tumor cells showed diffuse or partial positivity for melanocytic markers, such as microphthalmia - associated transcription factor, S100, HMB45 and Melan-A. The tumor harbored BRAF V600E mutation, demonstrated by immunohistochemical labelling for BRAF V600E and detected by real-time polymerase chain reaction test. Having combined all the findings, a diagnosis was made of a metastatic multifocal melanoma of the stomach, duodenum, liver, spleen, lungs, lymph nodes and bones. The patient refused treatment and died a week later.
CONCLUSION This case report highlights the clinical relevance of rare metastatic multifocal melanoma of multiple organ systems.
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Affiliation(s)
- Vaidota Maksimaityte
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Rosita Reivytyte
- Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Gabriele Milaknyte
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ugnius Mickys
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Gintare Razanskiene
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Domantas Stundys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Edita Kazenaite
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Jonas Valantinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ieva Stundiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
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31
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van Sinderen F, Tensen E, Lansink R, Jaspers M, Peute L. Eleven years of teledermoscopy in the Netherlands: A retrospective quality and performance analysis of 18,738 consultations. J Telemed Telecare 2022:1357633X221122113. [PMID: 36052405 DOI: 10.1177/1357633x221122113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Teledermoscopy supports and enhances the early detection of skin lesions by general practitioners in primary practice through remote consultation with dermatologists. Teledermoscopy has been a regular health service in Dutch primary care since February 2009. Teledermoscopy quality and performance outcomes on Dutch general practitioner primary care 11 years after its implementation were assessed. METHODS Dutch primary care teledermoscopy consultation data was retrospectively analysed on timestamps and responses on non-mandatory evaluation questions posed to the general practitioner and teledermatologist during the teledermoscopy consultation process. Anonymized data (February 2009-February 2020) was extracted from a Dutch teledermoscopy service database. The timestamps and evaluation questions data were subject to the teledermoscopy quality and performance outcomes. A limited cost evaluation was performed. RESULTS A total of 18,738 teledermoscopy consultations were sent by 1341 general practitioners (February 2009-February 2020). For 3908 (31.9%) teledermoscopy consultations, the general practitioner requested second opinion advice which led to 712 (18.2%) extra teledermoscopy referrals of patients who would not have been referred without teledermoscopy, including skin cancer teledermoscopy diagnoses. The general practitioner followed the teledermatologists' advice on patient referral for 8813 (88.5%) patients, reported 97.3% of the teledermoscopy consultations as helpful and 95.1% as instructive, referred 68.0% less patients with teledermoscopy availability, referred overall 59.4% less patients, and needed 5.4 minutes (median) for sending a teledermoscopy consultation. Teledermatologist's median answer and response time was 2 minutes and 2.4 hours, respectively. The estimated cost reduction was €144.18 ($164.65) (50.2%) per teledermoscopy patient. DISCUSSION Teledermoscopy is a useful service in general practitioner practice for requesting dermatologist advice in primary care settings to support the detection of skin lesion at an early stage and at lower costs. Teledermoscopy could also decrease the burden of secondary dermatology care since general practitioners reported that they did not refer the majority of patients to a dermatologist after the teledermoscopy consultation compared to their initial referral decision. General practitioners reported the teledermoscopy system as helpful and instructive which could contribute to enhancement of their dermatological knowledge.
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Affiliation(s)
- F van Sinderen
- Department of Medical Informatics, 26066Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
- Ksyos Health Management Research, Amsterdam, the Netherlands
| | - E Tensen
- Department of Medical Informatics, 26066Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
- Ksyos Health Management Research, Amsterdam, the Netherlands
| | - Rab Lansink
- Department of Medical Informatics, 26066Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Mwm Jaspers
- Department of Medical Informatics, 26066Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Lwp Peute
- Department of Medical Informatics, 26066Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
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Di Carlo V, Stiller CA, Eisemann N, Bordoni A, Matz M, Curado MP, Daubisse‐Marliac L, Valkov M, Bulliard J, Morrison D, Johnson C, Girardi F, Marcos‐Gragera R, Šekerija M, Larønningen S, Sirri E, Coleman MP, Allemani C. Does the morphology of cutaneous melanoma help to explain the international differences in survival? Results from 1 578 482 adults diagnosed during 2000-2014 in 59 countries (CONCORD-3). Br J Dermatol 2022; 187:364-380. [PMID: 35347700 PMCID: PMC9542891 DOI: 10.1111/bjd.21274] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND CONCORD-3 highlighted wide disparities in population-based 5-year net survival for cutaneous melanoma during 2000-2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes of cutaneous melanoma. OBJECTIVES We aimed to assess whether the differences in morphology may explain global variation in survival. METHODS Patients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722-8723, 8726-8727, 8730, 8740-8741, 8746, 8761, 8770-8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All-ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death. RESULTS Worldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010-2014, age-standardized 5-year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes. CONCLUSIONS This study provides the broadest picture of distribution and population-based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment. What is already known about this topic? The histopathological features of cutaneous melanoma vary markedly worldwide. The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin. What does this study add? We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined. This study provides, for the first time, international comparisons of population-based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000-2014. This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas. We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | | | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of LübeckRatzeburger Allee160 23538LübeckGermany
| | - Andrea Bordoni
- Ticino Cancer Registry, Dipartimento Sanità e SocialitàDivisione della Salute PubblicaVia Ciseri10 6600LocarnoSwitzerland
| | - Melissa Matz
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | - Maria P. Curado
- Goiânia Cancer Registry, Group of Epidemiology and Statistics on CancerAC Camargo Cancer CenterRua Tamandaré 753 ‐ LiberdadeSP01525‐001São PauloBrazil
| | - Laetitia Daubisse‐Marliac
- Tarn Cancer RegistryInstitut Universitaire du Cancer Toulouse – Oncopole Institut C. Regaud1 Avenue Irène Joliot‐Curie31059ToulouseFrance
| | - Mikhail Valkov
- Northern State Medical UniversityProspekt Troitskiy51 163000ArkhangelskRussian Federation
| | - Jean‐Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
- Neuchâtel and Jura Tumour RegistryNeuchâtelSwitzerland
| | - David Morrison
- Scottish Cancer RegistryGyle Square, 1 South Gyle CrescentEH12 9EBEdinburghUK
| | - Chris Johnson
- Cancer Data Registry of Idaho, 615 North 7th StreetID83701‐1278BoiseUSA
| | - Fabio Girardi
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
- Division of Medical Oncology 2Veneto Institute of Oncology IOV‐IRCCSVia Gattamelata64 35128PadovaItaly
| | - Rafael Marcos‐Gragera
- Epidemiology Unit and Girona Cancer RegistryCatalan Institute of Oncology (ICO), IDIBGI, Oncology Coordination Plan, Department of Health Government of Catalonia17004GironaSpain
- University of Girona (UdG)17004GironaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Mario Šekerija
- Croatian National Cancer RegistryCroatian Institute of Public HealthRockefeller Street7 10000ZagrebCroatia
| | | | - Eunice Sirri
- Epidemiological Cancer Registry of Lower SaxonyOffis Caree GmbHIndustriestr92 6121OldenburgGermany
| | - Michel P. Coleman
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
| | - Claudia Allemani
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
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Olsen CM, Pandeya N, Rosenberg PS, Whiteman DC. Incidence of in Situ vs Invasive Melanoma: Testing the "Obligate Precursor" Hypothesis. J Natl Cancer Inst 2022; 114:1364-1370. [PMID: 36042554 PMCID: PMC9552301 DOI: 10.1093/jnci/djac138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/29/2022] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Melanoma incidence has been rising in populations with predominantly European ancestry (White), speculated to be partly driven by heightened detection of indolent tumors. If in situ melanomas are destined to evolve to invasive cancers, detecting and removing them should deplete the pool of invasive lesions, and people with in situ melanoma should, on average, be younger than those with invasive melanoma. Methods We analyzed long-term incidence trends (1982-2018) for in situ and invasive melanomas in 3 predominantly White populations with high, medium, and low melanoma rates: Queensland (Australia), United States White, and Scotland. We calculated the incidence rate ratio (IRR) of in situ to invasive melanomas and estimated the contributions of age, period, and cohort effects. We compared age at diagnosis of in situ vs invasive melanomas overall and stratified by sex and anatomic site. Results In all 3 populations, the in situ to invasive incidence rate ratio increased statistically significantly from less than 0.3 in 1982 to 1.95 (95% confidence interval [CI] = 1.88 to 2.02) in Queensland, 0.93 (95% CI = 0.90 to 0.96) in the US White population, and 0.58 (95% CI = 0.54 to 0.63) in Scotland in 2018. The mean age at diagnosis of in situ melanomas was the same or higher than invasive melanomas for almost all time periods among men and women and on all body sites except the lower limbs. Conclusions The increasing ratio of in situ to invasive melanoma incidence over time, together with the high (and increasing) mean age at diagnosis of in situ melanomas, is consistent with more indolent lesions coming to clinical attention than in previous eras.
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Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nirmala Pandeya
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - David C Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Nazzaro G, Passoni E, Pozzessere F, Maronese CA, Marzano AV. Dermoscopy Use Leads to Earlier Cutaneous Melanoma Diagnosis in Terms of Invasiveness and Size? A Single-Center, Retrospective Experience. J Clin Med 2022; 11:jcm11164912. [PMID: 36013151 PMCID: PMC9410491 DOI: 10.3390/jcm11164912] [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] [Received: 07/04/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The incidence of cutaneous melanoma has risen in recent years. The aim of this study was to compare cutaneous melanomas diagnosed at the Dermatology Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, from 2006 to 2020 and between two specific biennia, i.e., 2006−2007 and 2019−2020. Methods: Retrospective chart review, with dermoscopic image collection, of cutaneous melanomas diagnosed at the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy, from 1 January 2006 to 31 December 2020 Results: A statistically significant increase was shown in the proportions of in situ melanoma and melanoma measuring less than 6 mm, i.e., small-diameter melanoma (SDM), across the studied period (p < 0.001). Moreover, in the biennium 2006−2007, among 220 melanoma diagnoses, 6 were in situ (2.7%), as compared with 68 melanomas in situ out of a total of 236 (28.8%) melanomas diagnosed in the biennium 2019−2020. A statistically significant difference in the proportion of in situ melanoma between the two biennia was demonstrated (p < 0.001). Furthermore, during the first biennium, 27/220 (12.3%) SDM were identified, as compared with 61/236 (25.9%) in the last. A statistically significant difference was shown in the proportion of SDM between the two (p < 0.001). Conclusions: The percentage of in situ melanomas and those that can be detected at a diameter <6 mm has increased. The latter has been shown to be around one-third of excised lesions, thus undermining the practicality of the ABCD mnemonic. Dermoscopic criteria for SDM are needed to help further refine melanoma diagnosis.
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Affiliation(s)
- Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255034717; Fax: +39-0255035236
| | - Emanuela Passoni
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122 Milan, Italy
| | - Fabio Pozzessere
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
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Eden M, Hainsworth R, Gordon LG, Epton T, Lorigan P, Rhodes LE, Marais R, Green AC, Payne K. Cost-effectiveness of a policy-based intervention to reduce melanoma and other skin cancers associated with indoor tanning. Br J Dermatol 2022; 187:105-114. [PMID: 35141876 PMCID: PMC9541204 DOI: 10.1111/bjd.21046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/27/2022] [Accepted: 02/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The use of indoor tanning devices causes melanoma and other skin cancers with resulting morbidity, mortality and increased healthcare costs. Policymakers require robust economic evidence to inform decisions about a possible ban of such devices to mitigate these burdens. OBJECTIVES To assess the health costs and consequences of introducing a policy-based intervention across England to ban commercial indoor tanning with an accompanying public information campaign. METHODS A cost-effectiveness analysis, adopting a healthcare system perspective, was conducted using a decision model to track a national cohort of 18-year-olds over a lifetime time horizon. A nationwide ban on commercial indoor tanning combined with a public information campaign (the policy-based intervention) was compared with the status quo of availability of commercial indoor tanning. The expected costs (currency, GBP; price year, 2019) and quality-adjusted life-years (QALYs) were calculated. Net monetary benefit (NMB) (net benefit measured in cost compared with an accepted threshold) and net health benefit (NHB) (net gain in QALYs compared with an accepted threshold) of implementation were calculated. A probabilistic sensitivity analysis was used to calculate the probability that the intervention was cost-effective. RESULTS Compared with the current situation, a ban on commercial indoor tanning combined with a public information campaign would result in 1206 avoided cases of melanoma, 207 fewer melanoma deaths and 3987 averted cases of keratinocyte cancers over the lifetime of all 18-year-olds (n = 618 873) living in England in 2019. An additional 497 QALYs would be realized along with healthcare cost-savings of £697 858. This intervention would result in an NMB of £10.6m and an NHB of 530 QALYS. Multiple sensitivity analyses confirmed the robustness of the findings. At a cost-effectiveness threshold of £20 000, there is a 99% likelihood of this policy-based intervention being cost-effective. CONCLUSIONS The implementation of a ban on commercial indoor tanning across England with an accompanying public information campaign would be an effective use of healthcare resources.
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Affiliation(s)
- Martin Eden
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health SciencesThe University of ManchesterManchesterUK
| | - Rob Hainsworth
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health SciencesThe University of ManchesterManchesterUK
| | - Louisa G. Gordon
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
- School of NursingQueensland University of Technology (QUT)BrisbaneAustralia
- School of Public HealthUniversity of QueenslandBrisbaneAustralia
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health SciencesThe University of ManchesterManchesterUK
| | - Paul Lorigan
- The Christie NHS Foundation TrustManchesterUK
- Division of Cancer Sciences, School of Medical SciencesThe University of ManchesterManchesterUK
| | - Lesley E. Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and HealthThe University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - Richard Marais
- Cancer Research UK Manchester InstituteThe University of ManchesterManchesterUK
| | - Adele C. Green
- Population Health DepartmentQIMR Berghofer Medical Research InstituteBrisbaneAustralia
- Cancer Research UK Manchester InstituteThe University of ManchesterManchesterUK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health SciencesThe University of ManchesterManchesterUK
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Zamagni F, Bucchi L, Mancini S, Crocetti E, Dal Maso L, Ferretti S, Biggeri A, Villani S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Stracci F, Tumino R, Masini C, Ridolfi L, Palmieri G, Stanganelli I, Falcini F. The relative contribution of the decreasing trend in tumour thickness to the 2010s increase in net survival from cutaneous malignant melanoma in Italy: a population-based investigation. Br J Dermatol 2022; 187:52-63. [PMID: 35253204 PMCID: PMC9542017 DOI: 10.1111/bjd.21051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The long-term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor. OBJECTIVES To determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy. METHODS Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age-standardized 5-year net survival was calculated. Multivariate analysis of 5-year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. RESULTS Over the study period, tumour thickness was inversely associated with 5-year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003-2007, 0.85 mm in 2008-2012 and 0.75 mm in 2013-2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5-year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013-2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013-2017 vs. 2003-2007 increase from 0.64 [95% confidence interval (CI) 0.51-0.80] to 0.70 (95% CI 0.57-0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58-0.93) to 0.82 (95% CI 0.66-1.02) in 2013-2017. CONCLUSIONS For male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013-2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement.
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Affiliation(s)
- Federica Zamagni
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Lauro Bucchi
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Silvia Mancini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Emanuele Crocetti
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Luigino Dal Maso
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Stefano Ferretti
- Romagna Cancer Registry, Section of FerraraLocal Health Authority and University of FerraraFerraraItaly
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications G. ParentiUniversity of FlorenceFlorenceItaly
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical EpidemiologyUniversity of PaviaPaviaItaly
| | - Flavia Baldacchini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Orietta Giuliani
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Alessandra Ravaioli
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Rosa Vattiato
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della SaluteViterboItaly
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della SaluteServizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP)TrapaniItaly
| | - Simona Carone
- Registro tumori di TarantoUnità operativa complessa di statistica ed epidemiologiaAzienda sanitaria locale TarantoItaly
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health DepartmentLocal Health AuthorityModenaItaly
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania‐Messina‐EnnaAzienda Ospedaliero‐Universitaria Policlinico ‘Rodolico‐San Marco’CataniaItaly
| | | | | | - Antonino Musolino
- Department of Medicine and SurgeryUniversity of Parma; Medical Oncology Unit and Cancer Registry, University Hospital of ParmaParmaItaly
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical EpidemiologyAzienda Provinciale per i Servizi Sanitari (APSS) TrentoItaly
| | - Diego Serraino
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Fabrizio Stracci
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Rosario Tumino
- Former Director Cancer RegistryProvincial Health Authority (ASP)RagusaItaly
| | - Carla Masini
- Unit of Oncological PharmacyIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Laura Ridolfi
- Immunotherapy, Cell Therapy and BiobankIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR)SardegnaSassariItaly
| | - Ignazio Stanganelli
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Department of DermatologyUniversity of ParmaParmaItaly
| | - Fabio Falcini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Cancer Prevention UnitLocal Health AuthorityForlìItaly
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Harvima IT, Harvima RJ. Survival from cutaneous malignant melanoma is improving, but is it because of a trend in decreasing melanoma thickness or the advent of new 'revolutionary' therapeutics? Br J Dermatol 2022; 187:6-7. [PMID: 35415923 PMCID: PMC9542168 DOI: 10.1111/bjd.21583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Linked Article: Zamagni et al. Br J Dermatol 2022; 187:52–63 .
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Affiliation(s)
- Ilkka T. Harvima
- Department of DermatologyUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
| | - Rauno J. Harvima
- Department of DermatologyUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
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Olsen CM, Whiteman DC. Cutaneous Melanoma in White Americans: A Tale of Two Epidemics. J Invest Dermatol 2022; 142:1765-1767. [PMID: 35109987 DOI: 10.1016/j.jid.2021.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - David C Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Del Marmol V. Prevention and screening of melanoma in Europe: 20 years of the Euromelanoma campaign. J Eur Acad Dermatol Venereol 2022; 36 Suppl 6:5-11. [PMID: 35738812 DOI: 10.1111/jdv.18195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/24/2022] [Indexed: 12/01/2022]
Abstract
Euromelanoma is a Europe-wide, dermatologist-led organization that campaigns to have a public, scientific, and political impact on raising awareness of the prevention, early diagnosis, and treatment of skin cancer. The organization raises public awareness of skin cancer by providing practical support to participating countries for the roll out of yearly screening campaigns, and then builds on these campaigns by providing resources via its website to educate the general public on key skin cancer prevention measures, risk factors, and the importance of recognizing abnormal lesions through self-examination. Euromelanoma also provides a valuable platform for the scientific community, facilitating collaborations between countries and coordinating the collection of standardized data on the epidemiology, demographic and clinical characteristics, and risk factors for all forms of skin cancer. As our scientific understanding of skin cancer advances, Euromelanoma plays a key role in ensuring that the importance of skin cancer prevention, treatment, and diagnosis remains at the forefront of European and national healthcare policies. Since its creation in 1999, Euromelanoma has continued to evolve, adapt, and expand its approach to achieve these public, scientific, and political goals: the organization now has networks of dermatologists working in over 30 countries and has screened and gathered skin cancer data from around 420 000 subjects. This review highlights these achievements by providing an outline of the history of Euromelanoma and the benefits of the first decade of action and by describing the evolving approach over the past 20 years. Future Euromelanoma projects, which aim to evaluate skin cancer risk in specific populations (outdoor workers, organ transplant recipients, etc.) are also introduced, and current challenges for the Euromelanoma campaign are discussed, including the need to improve reporting of non-melanoma skin cancer cases and to raise awareness of melanoma subtypes, particularly the more difficult to diagnose nodular melanoma form.
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Affiliation(s)
- V Del Marmol
- Département de Dermatologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
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Olsen CM. International surveillance of trends in melanoma survival: the impact of morphology. Br J Dermatol 2022; 187:284. [PMID: 35609973 DOI: 10.1111/bjd.21651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, QLD, 4006, Australia
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Win Myint TT, Selak V, Elwood M. The risk of subsequent invasive melanoma after a primary in situ or invasive melanoma in a high incidence country (New Zealand). SKIN HEALTH AND DISEASE 2022; 3:e116. [PMID: 37013115 PMCID: PMC10066759 DOI: 10.1002/ski2.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/07/2022]
Abstract
Background Patients with invasive melanoma are at increased risk of developing subsequent invasive melanoma, but the risks for those with primary in situ melanoma are unclear. Objectives To assess and compare the cumulative risk of subsequent invasive melanoma after primary invasive or in situ melanoma. To estimate the standardized incidence ratio (SIR) of subsequent invasive melanoma compared to population incidence in both cohorts. Methods Patients with a first diagnosis of melanoma (invasive or in situ) between 2001 and 2017 were identified from the New Zealand national cancer registry, and any subsequent invasive melanoma during follow-up to the end of 2017 identified. Cumulative risk of subsequent invasive melanoma was estimated by Kaplan-Meier analysis separately for primary invasive and in situ cohorts. Risk of subsequent invasive melanoma was assessed using Cox proportional hazard models. SIR was assessed, allowing for age, sex, ethnicity, year of diagnosis and follow up time. Results Among 33 284 primary invasive and 27 978 primary in situ melanoma patients, median follow up time was 5.5 and 5.7 years, respectively. A subsequent invasive melanoma developed in 1777 (5%) of the invasive and 1469 (5%) of the in situ cohort, with the same median interval (2.5 years) from initial to first subsequent lesion in both cohorts. The cumulative incidence of subsequent invasive melanoma at 5 years was similar in the two cohorts (invasive 4.2%, in situ 3.8%); the cumulative incidence increased linearly over time in both cohorts. The risk of subsequent invasive melanoma was marginally higher for primary invasive compared to in situ melanoma after adjustment for age, sex, ethnicity and body site of the initial lesion (hazard ratio 1.11, 95% CI 1.02-1.21). Compared to population incidence, the SIR of invasive melanoma was 4.6 (95% CI 4.3-4.9) for the primary invasive and 4 (95% CI 3.7-4.2) for the primary in situ melanoma cohorts. Conclusions The risk of subsequent invasive melanoma is similar whether patients present with in situ or invasive melanoma. Thus follow-up surveillance for new lesions should be similar, although patients with invasive melanoma require more surveillance for recurrence.
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Affiliation(s)
- Thu Thu Win Myint
- Department of Biostatistics and Epidemiology University of Auckland Auckland New Zealand
| | - Vanessa Selak
- Department of Biostatistics and Epidemiology University of Auckland Auckland New Zealand
| | - Mark Elwood
- Department of Biostatistics and Epidemiology University of Auckland Auckland New Zealand
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Arnold M, Singh D, Laversanne M, Vignat J, Vaccarella S, Meheus F, Cust AE, de Vries E, Whiteman DC, Bray F. Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040. JAMA Dermatol 2022; 158:495-503. [PMID: 35353115 PMCID: PMC8968696 DOI: 10.1001/jamadermatol.2022.0160] [Citation(s) in RCA: 242] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
Importance Despite many cases being preventable, cutaneous melanoma remains the most serious skin cancer worldwide. Understanding the scale and profile of the disease is vital to concentrate and reinforce global prevention efforts. Objective To examine global patterns of cutaneous melanoma in 2020 and to provide projected estimates of cases and deaths by 2040. Design, Setting, and Participants This population-based study used the GLOBOCAN 2020 database for global epidemiological assessment of new cases and deaths due to invasive melanoma. Main Outcomes and Measures Age-standardized incidence and mortality rates were calculated per 100 000 person-years by country, world region, and 4-tier level of human development. Estimated numbers of cases and deaths were calculated for the year 2040. Results A worldwide total of 325 000 new melanoma cases (174 000 males, 151 000 females) and 57 000 deaths (32 000 males, 25 000 females) was estimated for 2020. Large geographic variations existed across countries and world regions, with the highest incidence rates among males (42 per 100 000 person-years) and females (31 per 100 000 person-years) observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 person-years for females), and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 person-years for females). Melanoma continued to be rare in most African and Asian countries, with incidence rates commonly less than 1 per 100 000 person-years. Mortality rates peaked at 5 per 100 000 person-years in New Zealand, and geographic variations were less pronounced than for incidence. Melanoma was more frequent among males than females in most world regions. If 2020 rates continue, the burden from melanoma is estimated to increase to 510 000 new cases (a roughly 50% increase) and to 96 000 deaths (a 68% increase) by 2040. Conclusions and Relevance This epidemiological assessment suggests that melanoma remains an important challenge to cancer control and public health globally, especially in fair-skinned populations of European descent.
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Affiliation(s)
- Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney with Cancer Council New South Wales, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - David C. Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Forchhammer S, Abu-Ghazaleh A, Metzler G, Garbe C, Eigentler T. Development of an Image Analysis-Based Prognosis Score Using Google's Teachable Machine in Melanoma. Cancers (Basel) 2022; 14:2243. [PMID: 35565371 PMCID: PMC9105888 DOI: 10.3390/cancers14092243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increasing number of melanoma patients makes it necessary to establish new strategies for prognosis assessment to ensure follow-up care. Deep-learning-based image analysis of primary melanoma could be a future component of risk stratification. OBJECTIVES To develop a risk score for overall survival based on image analysis through artificial intelligence (AI) and validate it in a test cohort. METHODS Hematoxylin and eosin (H&E) stained sections of 831 melanomas, diagnosed from 2012-2015 were photographed and used to perform deep-learning-based group classification. For this purpose, the freely available software of Google's teachable machine was used. Five hundred patient sections were used as the training cohort, and 331 sections served as the test cohort. RESULTS Using Google's Teachable Machine, a prognosis score for overall survival could be developed that achieved a statistically significant prognosis estimate with an AUC of 0.694 in a ROC analysis based solely on image sections of approximately 250 × 250 µm. The prognosis group "low-risk" (n = 230) showed an overall survival rate of 93%, whereas the prognosis group "high-risk" (n = 101) showed an overall survival rate of 77.2%. CONCLUSIONS The study supports the possibility of using deep learning-based classification systems for risk stratification in melanoma. The AI assessment used in this study provides a significant risk estimate in melanoma, but it does not considerably improve the existing risk classification based on the TNM classification.
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Affiliation(s)
- Stephan Forchhammer
- Eberhardt Karls Universität, Universitäts-Hautklinik, 72076 Tübingen, Germany; (A.A.-G.); (C.G.)
| | - Amar Abu-Ghazaleh
- Eberhardt Karls Universität, Universitäts-Hautklinik, 72076 Tübingen, Germany; (A.A.-G.); (C.G.)
| | - Gisela Metzler
- Zentrum für Dermatohistologie und Oralpathologie Tübingen/Würzburg, 72072 Tübingen, Germany;
| | - Claus Garbe
- Eberhardt Karls Universität, Universitäts-Hautklinik, 72076 Tübingen, Germany; (A.A.-G.); (C.G.)
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Luisenstrasse 2, 10177 Berlin, Germany;
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Lesage C, Habib-Hadef S, Trétarre B, Lesage FX, Bessaoud F, Varey E, Guillot B, Satgé D. Melanoma and intellectual disability: do prognostic factors at diagnosis differ from general population? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:392-398. [PMID: 35137477 DOI: 10.1111/jir.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/21/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Few melanoma cases are reported in individuals with intellectual disability (ID), and prognostic factors at diagnosis are unknown in this population. This work was designed to investigate whether prognostic factors at diagnostic are different in patients with ID compared with a general population. METHODS Melanoma cases retrieved from Hérault's Tumour Registry (HTR) from 1995 to 2015 were cross-referenced against a list of adult patients with ID, living in Hérault. Major prognostic factors were compared with those in non-ID melanoma patients included in HTR and in patients followed by Montpellier University Hospital and included in the Réseau pour la Recherche et l'Investigation Clinique sur le Mélanome (RIC-Mel) database. RESULTS Ten melanoma cases in individuals with ID were identified and compared with 3804 non-ID melanoma cases in HTR and 1024 non-ID melanoma cases included in RIC-Mel. Mean Breslow thickness at diagnosis was 4.6 mm in melanoma cases among those with ID versus 1.89 mm in HTR (P = 0.109) and 2.36 mm in RIC-Mel (P = 0.156). Stage at diagnosis was superior to stage IIB in 42.9% of ID cases versus 11.4% of non-ID cases in HTR (P < 0.05) and 8.5% in RIC-Mel (P < 0.05). CONCLUSIONS Melanomas in patients with ID had less favourable prognostic factors at diagnosis, including higher Breslow thickness and more advanced stage, than melanomas in non-ID patients. These adverse prognostic factors indicate a later diagnosis in this population, leading to a poorer prognosis. This work underlines the need to improve melanoma screening among individuals with ID.
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Affiliation(s)
- C Lesage
- Department of Dermatology, University Hospital, Montpellier, France
| | | | - B Trétarre
- Registre des Tumeurs de l'Hérault, Montpellier, France
| | - F-X Lesage
- Department of Professional pathologies, University of Montpellier, University Hospital Montpellier, Montpellier, France
| | | | - E Varey
- Réseau pour la Recherche et l'Investigation Clinique sur le Mélanome, Nantes University Hospital, Nantes, France
| | - B Guillot
- Department of Dermatology, University Hospital, Montpellier, France
| | - D Satgé
- ONCODEFI, Montpellier, France
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM Univ. Montpellier, Montpellier, France
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Rosés-Gibert P, Podlipnik S, de la Torre Gomar F, Saenz Aguirre A, Gimeno Castillo J, González Pérez R, Puig S. [Translated article] Incidence of Melanoma in the Basque Province of Álava, Spain, From 2015 to 2018: A Descriptive Study. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rosés-Gibert P, Podlipnik S, de la Torre Gomar F, Saenz Aguirre A, Gimeno Castillo J, González Pérez R, Puig S. Estudio descriptivo de los pacientes diagnosticados de melanoma en la provincia de Álava (País Vasco) entre los años 2015 y 2018. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:178-182. [DOI: 10.1016/j.ad.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022] Open
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Chirpaz E, Warocquier J, Filisetti C, Beylot-Barry M, Bertolotti A, Sultan N. Epidemiology of cutaneous malignant melanoma in Reunion Island. Ann Dermatol Venereol 2022; 149:39-44. [DOI: 10.1016/j.annder.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/13/2021] [Accepted: 05/06/2021] [Indexed: 10/19/2022]
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Gaudy-Marqueste C, Macagno N, Loundou A, Pellegrino E, Ouafik L, Budden T, Mundra P, Gremel G, Akhras V, Lin L, Cook M, Kumar R, Grob JJ, Nagore E, Marais R, Virós A. Molecular characterization of fast-growing melanomas. J Am Acad Dermatol 2022; 86:312-321. [PMID: 34280484 DOI: 10.1016/j.jaad.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The rate of growth of primary melanoma is a robust predictor of aggressiveness, but the mutational profile of fast-growing melanomas (FGMM) and the potential to stratify patients at high risk of death has not been comprehensively studied. OBJECTIVE To investigate the epidemiologic, clinical, and mutational profile of primary cutaneous melanomas with a thickness ≥ 1 mm, stratified by rate of growth. METHODS Observational prospective study. Deep-targeted sequencing of 40 melanoma driver genes on formalin fixed, paraffin-embedded primary melanoma samples. Comparison of FGMM (rate of growth > 0.5 mm/month) and nonFGMM (rate of growth ≤ 0.5 mm/month). RESULTS Two hundred patients were enrolled, among wom 70 had FGMM. The relapse-free survival was lower in the FGMM group (P = .014). FGMM had a higher number of predicted deleterious mutations within the 40 genes than nonFGMM (P = .033). Ulceration (P = .032), thickness (P = .006), lower sun exposure (P = .049), and fibroblast growth factor receptor 2 (FGFR2) mutations (P = .037) were significantly associated with fast growth. LIMITATIONS Single-center study, cohort size, potential memory bias, number of investigated genes. CONCLUSION Fast growth is linked to specific tumor biology and environmental factors. Ulceration, thickness, and FGFR2 mutations are associated with fast growth. Screening for FGFR2 mutations might provide an additional tool to better identify FGMM, which are probably good candidates for adjuvant therapies.
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Affiliation(s)
- Caroline Gaudy-Marqueste
- Aix Marseille University, Assistance Publique des Hopitaux de Marseille, Centre de Recherche en Cancérologie de Marseille Insitut National de la Santé Et de la Recherche Médicale U1068, Centre National de la Recherche Scientifique U7258, Centre Hospitalo-Universitaire Timone, Dermatology and Skin Cancer Department, Marseille, France.
| | - Nicolas Macagno
- Aix Marseille University, Assistance Publique des Hopitaux de Marseille, Insitut National de la Santé Et de la Recherche Médicale, Marseille Medical Genetics, Centre Hospitalo-Universitaire Timone, Department of Pathology, Marseille, France
| | - Anderson Loundou
- Aix Marseille University, Santé Publique et Maladie Chroniques EA3279, Clinical Research Unit, Department of Public Health, Marseille, France
| | - Eric Pellegrino
- Aix Marseille Univ, Assistance Publique des Hopitaux de Marseille, Centre National de la Recherche Scientifique, Institute of NeuroPhysiopathology, Faculté de Médecine Secteur Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - L'houcine Ouafik
- Aix Marseille Univ, Assistance Publique des Hopitaux de Marseille, Centre National de la Recherche Scientifique, Institute of NeuroPhysiopathology, Faculté de Médecine Secteur Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Timothy Budden
- Skin Cancer and Ageing Lab, Cancer Research United Kingdom Manchester Institute, The University of Manchester, Manchester, United Kingdom
| | - Piyushkumar Mundra
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Gabriela Gremel
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Victoria Akhras
- Department of Dermatology, St. George's National Health Service Foundation Trust, London, United Kingdom
| | - Lijing Lin
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Martin Cook
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Rajiv Kumar
- Division of Functional Genome Analysis, German Cancer Research Center, Heidelberg, Germany
| | - Jean-Jacques Grob
- Aix Marseille University, Assistance Publique des Hopitaux de Marseille, Centre de Recherche en Cancérologie de Marseille Insitut National de la Santé Et de la Recherche Médicale U1068, Centre National de la Recherche Scientifique U7258, Centre Hospitalo-Universitaire Timone, Dermatology and Skin Cancer Department, Marseille, France
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano Oncología, València, Spain
| | - Richard Marais
- Molecular Oncology, Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Amaya Virós
- Skin Cancer and Ageing Lab, Cancer Research United Kingdom Manchester Institute, The University of Manchester, Manchester, United Kingdom.
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Abstract
Hintergrund Das Pro und Kontra des 2008 bundesweit eingeführten Hautkrebsscreenings wird immer wieder diskutiert. Fragestellung Kommt es durch versäumte Hautkrebsscreeninguntersuchungen zur Änderung der Tumoreindringtiefe? Material und Methode Auswertung und Analyse von Praxisdaten aus den Vergleichsquartalen II/19, II/20 und II/21 mit der einfaktoriellen Varianzanalyse (Anova) mit Welch’s F‑Test. Ergebnisse Signifikante Zunahme der Eindringtiefe bei Plattenepithelkarzinomen und Basalzellkarzinomen, bei malignen Melanomen aufgrund geringer Daten nur Trend zu Dickenzunahme erkennbar. Schlussfolgerungen Die Ergebnisse der Untersuchung unterstreichen die große Bedeutung des Hautkrebsscreenings als Methode der Früherkennung und Reduktion von aufwendigen mutilierenden Operationen und belastenden teuren Immuntherapien durch raschere Erkennung der malignen Tumoren.
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Affiliation(s)
- Petra Ziegler
- Hautarztpraxis, Königsbergerstr. 2, 91550, Dinkelsbühl, Deutschland.
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Datzmann T, Schoffer O, Meier F, Seidler A, Schmitt J. Are patients benefiting from participation in the German skin cancer screening programme? A large cohort study based on administrative data. Br J Dermatol 2022; 186:69-77. [PMID: 34289097 DOI: 10.1111/bjd.20658] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The German programme for skin cancer screening was established in 2008 with the aim of reducing skin cancer mortality. However, the effectiveness and risk-benefit ratio of the programme remain unclear. OBJECTIVES To compare the mortality rates of patients with melanoma who participate in a screening programme to those who do not. METHODS A retrospective cohort study, based on pseudonymized health insurance data of 1 431 327 individuals from Saxony, Germany, was conducted for the period 2010-2016. Patients with prevalent and incident melanoma were defined based on diagnosis, medical procedures and prescriptions. Patients who underwent screening and had a first diagnosis of melanoma within 2 years of screening were assigned to the intervention group. Relative survival and Cox regression were used to assess potential differences in mortality. RESULTS We identified 4552 individuals with prevalent and 2475 individuals with incident melanoma. The percentage of screening participants (n = 1801) who had locoregional (4·2% vs. 13·5%) and/or distant metastases (4·3% vs. 8·0%), or who were treated with systemic anticancer therapies (11·6% vs. 21·8%) was lower vs. nonparticipants (n = 674). Screening participants had significantly better survival rates. The unadjusted Cox model gave a hazard ratio (HR) of 0·37 [95% confidence interval (CI) 0·30-0·46]. After adjusting for named confounders, the effect remained (HR 0·62, 95% CI 0·48-0·80). CONCLUSIONS Patients who participated in the screening programme had lower mortality than those who had not undergone screening. However, these findings may result from a healthy screen bias and/or overdiagnosis associated with screening, and not from the screening itself.
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Affiliation(s)
- T Datzmann
- National Center for Tumor Diseases, Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
| | - O Schoffer
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
| | - F Meier
- National Center for Tumor Diseases, Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Department of Dermatology, Skin Cancer Center at the University Cancer Centre, Dresden, Germany
| | - A Seidler
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Institute and Policlinic for Occupational and Social Medicine, Dresden, Germany
| | - J Schmitt
- National Center for Tumor Diseases, Dresden, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
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