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Tomás-Velázquez A, Moreno-Artero E, Romero J, Escalonilla P, Medina I, Petiti GH, Redondo P. What Have We Learned about the Prevention of NMSC from Albino Patients from Malawi? Secondary Prevention Maintained over Time. Cancers (Basel) 2024; 16:1522. [PMID: 38672604 PMCID: PMC11048476 DOI: 10.3390/cancers16081522] [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: 03/26/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND We have conducted cooperative campaigns focusing on albino patients in a rural area of Malawi. What have we learned? METHODS Three surgical campaigns were performed in Nkhotakota district (2019-2023). Albino clinical and tumor characteristics were collected. RESULTS Between 22 and 75 albinos were evaluated in each campaign (mean age < 28 years old). Most patients did not use sunscreen in a way that provided optimal photoprotection. Regarding tumors, the proportion of basal and squamous cell carcinomas ranged from 1:1 to almost 2:1. Of 156 albino patients, 34 attended more than once. However, of the 19 patients with 30 tumors operated on in 2021, only seven were assessed the following year (12 were lost to follow-up). At least 14 albinos with locally advanced tumors were evaluated. CONCLUSIONS Distributing photoprotective clothing could be more efficient or perhaps an earlier measure of sunscreen in rural Africa as it does not require permanent repositioning. Very-high-risk patients (previous interventions with positive margins or high-risk tumors, intense actinic damage, and new tumors constantly appearing, especially those presenting SCCs) require close follow-up and treatment and represent our main target. Secondary prevention with Malawian collaboration and the use of teledermatology is essential for patient tracking, as they are able to offer curative treatments.
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Affiliation(s)
| | - Ester Moreno-Artero
- Dermatology Department, Hospital Universitario Galdakao, 48960 Galdakao, Spain;
| | - Javier Romero
- Romero y Medina Dermatology Clinic, 29640 Fuengirola, Spain; (J.R.); (I.M.)
| | - Pilar Escalonilla
- Dermatology Department, Complejo Asistencial de Ávila, 05071 Ávila, Spain;
| | - Isabel Medina
- Romero y Medina Dermatology Clinic, 29640 Fuengirola, Spain; (J.R.); (I.M.)
| | - Gisela Hebe Petiti
- Dermatology Department, Consorci Sanitari Integral, Hospital Dos de Mayo, 08025 Barcelona, Spain;
| | - Pedro Redondo
- Dermatology Department, Clínica Universidad de Navarra, 28027 Madrid, Spain;
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Ravichandran S, Funchain P, Arbesman J. Characterizing melanoma in the setting of oculocutaneous albinism: an analysis of the literature. Arch Dermatol Res 2023; 315:2413-2417. [PMID: 35849167 DOI: 10.1007/s00403-022-02364-w] [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: 12/16/2021] [Revised: 05/18/2022] [Accepted: 06/10/2022] [Indexed: 11/02/2022]
Abstract
Although it is established that individuals with albinism have increased risks for nonmelanoma skin cancers, melanomas occurring in the setting of albinism are rare. PubMed and Google Scholar were searched for individual case reports describing melanoma in individuals with oculocutaneous albinism (OCA). All published cases characterizing individuals with albinism and melanoma in the medical literature were gathered to evaluate any epidemiologic or histologic differences from melanomas arising in the general population. Frequencies of melanoma characteristics between the OCA literature cohort and general population were compared using Clopper-Pearson confidence intervals. From 1952 to 2018, at least 64 cases of melanoma in 56 individuals with albinism were reported in the global medical literature. The median age of diagnosis for melanoma in individuals with albinism was 41 years, and the median Breslow depth at diagnosis was 2.0 mm. The subtypes of melanoma were nodular in 33% and superficial spreading in 46% of these cases, respectively. Amelanotic melanomas comprised 65% of the cases in our OCA cohort; however, histologic subtypes were only available for fourteen of the amelanotic cases. Finally, 17% of melanomas in patients with albinism arose from preexisting lesions. Despite their rarity, melanomas arising in oculocutaneous albinism have distinct characteristics from melanomas arising in the general population. Clinicians should consider a differential diagnosis of melanoma for any potential skin malignancies in individuals with albinism.
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Affiliation(s)
- S Ravichandran
- Department of Dermatology, Cleveland Clinic Dermatology and Plastic Surgery Institute, 2049 E 100th St., Cleveland, OH, 44195, USA.
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL, USA.
| | - P Funchain
- Cleveland Clinic Department of Hematology and Medical Oncology, Cleveland, OH, USA
| | - J Arbesman
- Department of Dermatology, Cleveland Clinic Dermatology and Plastic Surgery Institute, 2049 E 100th St., Cleveland, OH, 44195, USA
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Ma EZ, Zhou AE, Hoegler KM, Khachemoune A. Oculocutaneous albinism: epidemiology, genetics, skin manifestation, and psychosocial issues. Arch Dermatol Res 2023; 315:107-116. [PMID: 35217926 DOI: 10.1007/s00403-022-02335-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/06/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
Oculocutaneous albinism (OCA) is a group of rare, inherited disorders associated with reduced melanin biosynthesis. Clinical manifestations of the eight known subtypes of OCA include hypopigmented skin, eyes, and hair and ocular manifestations, such as decreased visual acuity and nystagmus. OCA affects people globally but is most prevalent in African countries. Individuals with oculocutaneous albinism lack UV protection and are prone to skin damage and skin cancers. For many African albino individuals, there are significant challenges in seeking treatment for skin cancer and preventing sun damage due to psychosocial factors and poor education. This review summarizes the current understanding of the epidemiology, genetics, and clinical manifestations of OCA. We also discuss the medical and psychosocial challenges that affect individuals with OCA and the current landscape of albinism treatment modalities. The extent of the psychosocial challenges needs to be better understood and additional educational interventions may improve quality of life for people with albinism.
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Affiliation(s)
- Emily Z Ma
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Albert E Zhou
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Karl M Hoegler
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amor Khachemoune
- Brooklyn Campus of the VA NY Harbor Healthcare System, FACMS, 800 Poly Place, Brooklyn, NY, USA. .,Department of Dermatology, SUNY Downstate, 450 Clarkson Ave, Brooklyn, NY, USA.
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Prevalence of Squamous and Basal Cell Carcinomas in African Albino Skin Cancer Lesions: A Systematic Review and Meta-Analysis of Proportion. J Skin Cancer 2022; 2022:5014610. [PMID: 36081682 PMCID: PMC9448621 DOI: 10.1155/2022/5014610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To estimate the prevalence of cutaneous SCC and BCC in all histologically confirmed skin cancer lesions in African albinos.The following five databases are as follows: African Journals Online (AJOL), PubMed, Europe PMC, and Google Scholar were searched for relevant articles. Study Selection: included studies were case series and cross-sectional studies of histologically confirmed skin cancers in African albinos. Data extraction and synthesis: data extraction and synthesis was informed by the meta-analysis of observational studies in epidemiology guideline. By random effect meta-analysis, we calculated the pooled prevalence of SCC and BCC in skin cancer lesions of the African albinos. Result We abstracted 695 skin cancer lesions from 540 African albinos (275 male and 241 female albinos with sex not stated in 24 subjects). There were 419 SCCs and 249 BCCs. By meta-analysis, the pooled prevalence of SCC is 64% (95% CI; 50–77%). The prevalence for BCC is 31% (95% CI; 19–45%). Conclusion Overall, squamous cell carcinoma is the predominant type of keratinocyte carcinoma reported in African albinos. SCC is preponderant in case series of surgical excision biopsies while BCC predominates in studies reporting on albino skin surveillance programmes.
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Hassan S, Louis SJ, Fethiere M, Dure D, Rosen J, Morrison BW. The prevalence of nonmelanoma skin cancer in a population of patients with oculocutaneous albinism in Haiti. Int J Dermatol 2022; 61:867-871. [PMID: 35393655 DOI: 10.1111/ijd.16199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/04/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple studies have examined the prevalence of nonmelanoma skin cancers (NMSC) in patients with oculocutaneous albinism (OCA). However, to date, no studies have examined this data in Caribbean populations. METHODS This study is a cross-sectional study of 106 patients with OCA who were seen at the Oculocutaneous Albinism Clinic in Port-au-Prince and Gros Morne, Haiti, between the dates of February 2017 and June 2018. RESULTS In our population, 31/106 (29%) patients were found to have NMSC, 10/31 (32%) had BCC, 12/31 (39%) had SCC, and 9/31 (29%) had both types of NMSC. The most common age groups were 31-40 years, with the overall range of ages being 18-63 years. Also, 60/106 (57%) of the patients had actinic keratoses (AK). CONCLUSIONS Our study provides new data examining the prevalence of NMSC within a population of patients with OCA in Haiti. Overall, it shows that patients with albinism develop NMSC at an earlier age compared with the rest of the population. Therefore, appropriate skin cancer screening and surveillance should be implemented within this high-risk population group.
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Affiliation(s)
- Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shesly J Louis
- Department of Dermatology and Sexually Transmitted Diseases, Hospital of the State University of Haiti, Port-Au-Prince, Haiti
| | | | - Danie Dure
- General Dermatology and Pediatric Dermatology, Hopital Universitaire de Mirebalais, Mirebalais, Haiti
| | - Jordan Rosen
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brian W Morrison
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Albinism: epidemiology, genetics, cutaneous characterization, psychosocial factors. An Bras Dermatol 2019; 94:503-520. [PMID: 31777350 PMCID: PMC6857599 DOI: 10.1016/j.abd.2019.09.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022] Open
Abstract
Oculocutaneous albinism is an autosomal recessive disease caused by the complete absence or decrease of melanin biosynthesis in melanocytes. Due to the reduction or absence of melanin, albinos are highly susceptible to the harmful effects of ultraviolet radiation and are at increased risk of actinic damage and skin cancer. In Brazil, as in other parts of the world, albinism remains a little known disorder, both in relation to epidemiological data and to phenotypic and genotypic variation. In several regions of the country, individuals with albinism have no access to resources or specialized medical care, and are often neglected and deprived of social inclusion. Brazil is a tropical country, with a high incidence of solar radiation during the year nationwide. Consequently, actinic damage and skin cancer occur early and have a high incidence in this population, often leading to premature death. Skin monitoring of these patients and immediate therapeutic interventions have a positive impact in reducing the morbidity and mortality associated with this condition. Health education is important to inform albinos and their families, the general population, educators, medical professionals, and public agencies about the particularities of this genetic condition. The aim of this article is to present a review of the epidemiological, clinical, genetic, and psychosocial characteristics of albinism, with a focus in skin changes caused by this rare pigmentation disorder.
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Lucas RM, Norval M, Wright CY. Solar ultraviolet radiation in Africa: a systematic review and critical evaluation of the health risks and use of photoprotection. Photochem Photobiol Sci 2016; 15:10-23. [DOI: 10.1039/c5pp00419e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The majority of the African continent experiences high solar UVB radiation throughout the year. The adverse consequences of this on the health of populations living in Africa are reviewed.
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Affiliation(s)
- Robyn M. Lucas
- National Centre for Epidemiology and Population Health
- The Australia National University
- Canberra
- Australia
| | - Mary Norval
- Biomedical Sciences
- University of Edinburgh
- Edinburgh
- UK
| | - Caradee Y. Wright
- South African Medical Research Council and University of Pretoria
- Pretoria
- South Africa
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Beltraminelli H, Kiprono S, Zuriel D, Swai B, Giabbani E, Grossmann H, Masenga J. Dermatopathology in sub-Saharan Africa: a systematic 5-year analysis of all histopathological diagnoses from the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. J Eur Acad Dermatol Venereol 2014; 29:1370-5. [DOI: 10.1111/jdv.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022]
Affiliation(s)
- H. Beltraminelli
- University Clinic for Dermatology; Inselspital - Bern University Hospital; Bern Switzerland
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - S. Kiprono
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
- Department of Dermatology; Provincial General Hospital; Kakamega Kenya
| | - D. Zuriel
- Pathology Department; University of Nairobi; Nairobi Kenya
| | - B. Swai
- Pathology Department at the Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - E. Giabbani
- University Clinic for Dermatology; Inselspital - Bern University Hospital; Bern Switzerland
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - H. Grossmann
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - J.E. Masenga
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
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Wright CY, Norval M, Hertle RW. Oculocutaneous albinism in sub-Saharan Africa: adverse sun-associated health effects and photoprotection. Photochem Photobiol 2014; 91:27-32. [PMID: 25298350 DOI: 10.1111/php.12359] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/01/2014] [Indexed: 01/15/2023]
Abstract
Oculocutaneous albinism (OCA) is a genetically inherited autosomal recessive condition. Individuals with OCA lack melanin and therefore are susceptible to the harmful effects of solar ultraviolet radiation, including extreme sun sensitivity, photophobia and skin cancer. OCA is a grave public health issue in sub-Saharan Africa with a prevalence as high as 1 in 1000 in some tribes. This article considers the characteristics and prevalence of OCA in sub-Saharan African countries. Sun-induced adverse health effects in the skin and eyes of OCA individuals are reviewed. Sun exposure behavior and the use of photoprotection for the skin and eyes are discussed to highlight the major challenges experienced by these at-risk individuals and how these might be best resolved.
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Affiliation(s)
- Caradee Y Wright
- Climate Studies, Modelling and Environmental Health Research Group, Council for Scientific and Industrial Research, Pretoria, South Africa; Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
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Sengupta M, Sarkar D, Mondal M, Samanta S, Sil A, Ray K. Analysis of MC1R variants in Indian oculocutaneous albinism patients: highlighting the risk of skin cancer among albinos. J Genet 2014; 92:305-8. [PMID: 23970088 DOI: 10.1007/s12041-013-0250-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mainak Sengupta
- Molecular and Human Genetics Division, Council of Scientific and Industrial Research - Indian Institute of Chemical Biology, Kolkata 700 032, India
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de Vijlder H, de Vijlder J, Neumann H. Oculocutaneous albinism and skin cancer risk. J Eur Acad Dermatol Venereol 2012; 27:e433-4. [DOI: 10.1111/j.1468-3083.2012.04633.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mabula JB, Chalya PL, Mchembe MD, Jaka H, Giiti G, Rambau P, Masalu N, Kamugisha E, Robert S, Gilyoma JM. Skin cancers among Albinos at a University teaching hospital in Northwestern Tanzania: a retrospective review of 64 cases. BMC DERMATOLOGY 2012; 12:5. [PMID: 22681652 PMCID: PMC3483204 DOI: 10.1186/1471-5945-12-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/21/2012] [Indexed: 11/28/2022]
Abstract
Background Skin cancers are a major risk associated with albinism and are thought to be a major cause of death in African albinos. The challenges associated with the care of these patients are numerous and need to be addressed. The aim of this study was to outline the pattern and treatment outcome of skin cancers among albinos treated at our centre and to highlight challenges associated with the care of these patients and proffer solutions for improved outcome. Methods This was a retrospective study of all albinos with a histopathological diagnosis of skin cancer seen at Bugando Medical Centre from March 2001 to February 2010. Data collected were analyzed using descriptive statistics. Results A total of 64 patients were studied. The male to female ratio was 1.5:1. The median age of patients was 30 years. The median duration of illness at presentation was 24 months. The commonest reason for late presentation was financial problem. Head and the neck was the most frequent site afflicted in 46(71.8%) patients. Squamous cell carcinoma was the most common histopathological type in 75% of cases. Surgical operation was the commonest modality of treatment in 60 (93.8%) patients. Radiotherapy was given in 24(37.5%) patients. Twenty-seven (42.2%) of the patients did not complete their treatment due to lack of funds. Local recurrence following surgical treatment was recorded in 6 (30.0%) patients. Only thirty-seven (61.7%) patients were available for follow-up at 6–12 months and the remaining patients were lost to follow-up. Conclusions Skin cancers are the most common cancers among albinos in our environment. Albinism and exposure to ultraviolet light appears to be the most important risk factor in the development of these cancers. Late presentation and failure to complete treatment due to financial difficulties and lack of radiotherapy services at our centre are major challenges in the care of these patients. Early institution of preventive measures, early presentation and treatment, and follow-up should be encouraged in this population for better outcome.
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Affiliation(s)
- Joseph B Mabula
- Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
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