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Emran AA, Nsengimana J, Punnia-Moorthy G, Schmitz U, Gallagher SJ, Newton-Bishop J, Tiffen JC, Hersey P. Study of the Female Sex Survival Advantage in Melanoma-A Focus on X-Linked Epigenetic Regulators and Immune Responses in Two Cohorts. Cancers (Basel) 2020; 12:E2082. [PMID: 32731355 PMCID: PMC7464825 DOI: 10.3390/cancers12082082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Survival from melanoma is strongly related to patient sex, with females having a survival rate almost twice that of males. Many explanations have been proposed but have not withstood critical scrutiny. Prior analysis of different cancers with a sex bias has identified six X-linked genes that escape X chromosome inactivation in females and are, therefore, potentially involved in sex differences in survival. Four of the genes are well-known epigenetic regulators that are known to influence the expression of hundreds of other genes and signaling pathways in cancer. METHODS Survival and interaction analysis were performed on the skin cutaneous melanoma (SKCM) cohort in The Cancer Genome Atlas (TCGA), comparing high vs. low expression of KDM6A, ATRX, KDM5C, and DDX3X. The Leeds melanoma cohort (LMC) on 678 patients with primary melanoma was used as a validation cohort. RESULTS Analysis of TCGA data revealed that two of these genes-KDM6A and ATRX-were associated with improved survival from melanoma. Tumoral KDM6A was expressed at higher levels in females and was associated with inferred lymphoid infiltration into melanoma. Gene set analysis of high KDM6A showed strong associations with immune responses and downregulation of genes associated with Myc and other oncogenic pathways. The LMC analysis confirmed the prognostic significance of KDM6A and its interaction with EZH2 but also revealed the expression of KDM5C and DDX3X to be prognostically significant. The analysis also confirmed a partial correlation of KDM6A with immune tumor infiltrates. CONCLUSION When considered together, the results from these two series are consistent with the involvement of X-linked epigenetic regulators in the improved survival of females from melanoma. The identification of gene signatures associated with their expression presents insights into the development of new treatment initiatives but provides a basis for exploration in future studies.
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Affiliation(s)
- Abdullah Al Emran
- Melanoma Oncology and Immunology Program, The Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia; (A.A.E.); (G.P.-M.); (S.J.G.); (J.C.T.)
- Melanoma Institute Australia, The University of Sydney, Sydney NSW 2006, Australia
| | - Jérémie Nsengimana
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds LS2 9JT, UK; (J.N.); (J.N.-B.)
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Gaya Punnia-Moorthy
- Melanoma Oncology and Immunology Program, The Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia; (A.A.E.); (G.P.-M.); (S.J.G.); (J.C.T.)
- Melanoma Institute Australia, The University of Sydney, Sydney NSW 2006, Australia
| | - Ulf Schmitz
- Computational Biomedicine Lab Centenary Institute, The University of Sydney, Camperdown NSW 2050, Australia;
- Gene & Stem Cell Therapy Program Centenary Institute, The University of Sydney, Camperdown NSW 2050, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown NSW 2050, Australia
| | - Stuart J. Gallagher
- Melanoma Oncology and Immunology Program, The Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia; (A.A.E.); (G.P.-M.); (S.J.G.); (J.C.T.)
- Melanoma Institute Australia, The University of Sydney, Sydney NSW 2006, Australia
| | - Julia Newton-Bishop
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds LS2 9JT, UK; (J.N.); (J.N.-B.)
| | - Jessamy C. Tiffen
- Melanoma Oncology and Immunology Program, The Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia; (A.A.E.); (G.P.-M.); (S.J.G.); (J.C.T.)
- Melanoma Institute Australia, The University of Sydney, Sydney NSW 2006, Australia
| | - Peter Hersey
- Melanoma Oncology and Immunology Program, The Centenary Institute, The University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia; (A.A.E.); (G.P.-M.); (S.J.G.); (J.C.T.)
- Melanoma Institute Australia, The University of Sydney, Sydney NSW 2006, Australia
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Ulmer MJ, Tonita JM, Hull PR. Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.
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Affiliation(s)
- Marcie J. Ulmer
- Division of Dermatology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jon M. Tonita
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Peter R. Hull
- Department of Dermatology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Melanoma early detection and awareness: how countries developing melanoma awareness programs could benefit from melanoma-proficient countries. Am J Ther 2015; 22:37-43. [PMID: 24914500 DOI: 10.1097/mjt.0000000000000038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Risk factors for melanoma are well known and have guided plans for primary and secondary prevention. The presentation of the disease, however, varies widely depending on the geographic area, ethnicity, and socioeconomic status. For this reason, many countries have developed specific strategies to increase public awareness and favor early diagnosis. Awareness campaigns, doctor education, and screening of high-risk subjects have all contributed to improve disease outcome in developed countries. The role of primary care physicians is particularly relevant in this regard. Developing countries are trying to implement similar measures. Future efforts to further improve the efficacy of preventive strategies should focus on populations that usually escape campaigns, such as elderly men and people with low socioeconomic status. Fast-growing tumors also require specific attention.
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Cadby G, Ward S, Cole J, Moses E, Millward M, Palmer L. The association of host and genetic melanoma risk factors with Breslow thickness in the Western Australian Melanoma Health Study. Br J Dermatol 2014; 170:851-7. [DOI: 10.1111/bjd.12829] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 01/03/2023]
Affiliation(s)
- G. Cadby
- Centre for Genetic Origins of Health and Disease; The University of Western Australia; M409, 35 Stirling Highway Crawley 6009 WA Australia
| | - S.V. Ward
- Centre for Genetic Origins of Health and Disease; The University of Western Australia; M409, 35 Stirling Highway Crawley 6009 WA Australia
| | - J.M. Cole
- St John of God Dermatology; St John of God Health Care Subiaco; Suite 301, 25 McCourt Street Subiaco 6008 WA Australia
| | - E.K. Moses
- Centre for Genetic Origins of Health and Disease; The University of Western Australia; M409, 35 Stirling Highway Crawley 6009 WA Australia
| | - M. Millward
- School of Medicine and Pharmacology; The University of Western Australia; M409, 35 Stirling Highway Crawley 6009 WA Australia
| | - L.J. Palmer
- Genetic Epidemiology and Biostatistics Platform; Ontario Institute for Cancer Research; MaRS Centre; South Tower, 101 College Street, Suite 800 Toronto M5G 0A3 ON Canada
- Samuel Lunenfeld Research Institute; 60 Murray St Toronto M5T 3L9 ON Canada
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Nikolaou V, del Marmol V, Stratigos AJ. The role of public education in the early detection of melanoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zalaudek I, Lallas A, Longo C, Moscarella E, Tiodorovic-Zivkovic D, Ricci C, Albertini G, Argenziano G. Problematic lesions in the elderly. Dermatol Clin 2013; 31:549-64, vii-viii. [PMID: 24075544 DOI: 10.1016/j.det.2013.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As the population continues to age, clinicians and dermatologists are increasingly faced with geriatric patients presenting with a range of dermatologic manifestations, including benign and malignant skin tumors. Knowledge of epidemiologic and morphologic features, including dermoscopy of common and benign melanocytic and nonmelanocytic skin tumors, provides the basis for a better understanding and management of problematic skin tumors in this age group. This article provides an overview of common and problematic skin lesions in elderly patients and addresses epidemiologic, clinical, and dermoscopic clues that aid the differential diagnosis and management of challenging skin lesions.
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Affiliation(s)
- Iris Zalaudek
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico-IRCCS, Viale Risorgimento 80, Reggio Emilia 42100, Italy; Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz 8036, Austria.
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Kruijff S, Bastiaannet E, Francken AB, Schaapveld M, van der Aa M, Hoekstra HJ. Breslow thickness in the Netherlands: a population-based study of 40 880 patients comparing young and elderly patients. Br J Cancer 2012; 107:570-4. [PMID: 22713665 PMCID: PMC3405205 DOI: 10.1038/bjc.2012.255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Melanoma incidence has increased rapidly in the last decades, and predictions show a continuing increase in the years to come. The aim of this study was to assess trends in melanoma incidence, Breslow thickness (BT), and melanoma survival among young and elderly patients in the Netherlands. METHODS Patients diagnosed with invasive melanoma between 1994 and 2008 were selected from the Netherlands Cancer Registry. Incidence (per 100 000) over time was calculated for young (<65 years) and elderly patients (≥65 years). Distribution of BT for young and elderly males and females was assessed. Regression analysis of the log-transformed BT was used to assess changes over time. Relative survival was calculated as the ratio of observed survival to expected survival. RESULTS Overall, 40 880 patients were included (42.3% male and 57.7% female). Melanoma incidence increased more rapidly among the elderly (5.4% estimated annual percentage change (EAPC), P<0.0001) than among younger patients (3.9% EAPC, P<0.0001). The overall BT declined significantly over time (P<0.001). Among younger patients, BT decreased for almost all locations. Among elderly males, BT decreased for melanomas in the head and neck region (P=0.001) and trunk (P<0.001), but did not decrease significantly for the other regions. Among elderly females, BT only decreased for melanomas at the trunk (P=0.01). The relative survival of elderly patients was worse compared with that of younger patients (P<0.001). CONCLUSION Melanoma incidence increases more rapidly for elderly than for younger patients and the decline in BT is less prominent among elderly patients than among young patients. Campaigns in the Netherlands should focus more on early melanoma detection in the elderly.
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Affiliation(s)
- S Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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Kruijff S, Vink R, Klaase J. Salvage surgery for a giant melanoma on the back. Rare Tumors 2011; 3:e28. [PMID: 22066035 PMCID: PMC3208415 DOI: 10.4081/rt.2011.e28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 06/23/2011] [Accepted: 07/01/2011] [Indexed: 11/23/2022] Open
Abstract
We report a case of a giant melanoma on the back with a very extreme Breslow thickness. On physical examination a large odorous and ulcerating tumour was seen adjacent to two large crusted lesions, probably in transit metastases. In the right and left axilla enlarged lymph nodes were palpated. The patient underwent salvage surgery consisting of a complete wide excision of the tumors on the back as well as axillary lymph node dissection on both sides. Histopathology showed a malignant melanoma with a Breslow thickness of 48 mm. Four of fifteen nodes in the right axilla and one of nine nodes in the left axilla, were positive for metastatic disease. Also various in transit and subcutaneous metastases were found in the wide excision specimen. The interest of our observation relies in the rarity of a melanoma with such an extreme Breslow thickness and the difficulty in performing adequate palliative therapy that offers quality of life by means of tumor control.
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McLaughlin JM, Fisher JL, Paskett ED. Marital status and stage at diagnosis of cutaneous melanoma: results from the Surveillance Epidemiology and End Results (SEER) program, 1973-2006. Cancer 2010; 117:1984-93. [PMID: 21509776 DOI: 10.1002/cncr.25726] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/27/2010] [Accepted: 09/20/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND We evaluated the effect of marital status on risk of late-stage cutaneous melanoma diagnosis. METHODS Information about melanoma patients was obtained from Surveillance Epidemiology and End Results (SEER), 1973-2006. A multivariable logistic regression model was used to estimate relative risks of late-stage disease at diagnosis. RESULTS After exclusion criteria, 192,014 adult melanoma patients remained for analyses. After adjustment for age, race, year of diagnosis, tumor histology, anatomic site, socioeconomic status, and SEER site, the relationship between estimated risk of late-stage melanoma diagnosis and marital status was dependent on sex (P < .0001 for interaction). Although unmarried patients had a higher risk of being diagnosed at a late stage among men and women, the magnitude of the effect varied by sex. Moreover, among married, single, and divorced or separated patients, men had more than a 50% increase in risk of late-stage diagnosis when compared with women. Widowed men and widowed women, however, were not statistically different in their stage at diagnosis. CONCLUSIONS Results from this study are important and may be used by clinicians and public health practitioners interested in increasing the proportion of melanoma patients diagnosed at an early stage through screening, perhaps by specifically targeting unmarried individuals in addition to having broad-based skin cancer prevention programs.
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Affiliation(s)
- John M McLaughlin
- Ohio State University, College of Public Health, Division of Epidemiology, Ohio State University, Columbus, Ohio 43201, USA.
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Abstract
The incidence of melanoma is continuing to increase worldwide. UV exposure is a known risk factor for melanoma. Geographic location is known to influence UV exposure and the distribution of the incidence of melanoma. Furthermore, epidemiologic data suggest that gender and genetics may influence the distribution of melanoma on the body surface and histopathologic characteristics of the lesion. This article describes what is known about the impact of gender, ethnicity and geography on the progression of melanoma. Advanced-stage cutaneous melanoma has a median survival time of less than 1 year. Surgical removal, radiotherapy, chemotherapy, targeted therapies and a variety of immunotherapies have been utilized in the treatment of melanoma. Current treatment strategies and the results of recent clinical trials are also discussed in this article.
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Affiliation(s)
- Esther Erdei
- University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Nagore E, Hueso L, Botella-Estrada R, Alfaro-Rubio A, Serna I, Guallar JP, González I, Ribes I, Guillen C. Smoking, sun exposure, number of nevi and previous neoplasias are risk factors for melanoma in older patients (60 years and over). J Eur Acad Dermatol Venereol 2010; 24:50-7. [DOI: 10.1111/j.1468-3083.2009.03353.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Goldberg MS, Doucette JT, Lim HW, Spencer J, Carucci JA, Rigel DS. Risk factors for presumptive melanoma in skin cancer screening: American Academy of Dermatology National Melanoma/Skin Cancer Screening Program experience 2001-2005. J Am Acad Dermatol 2007; 57:60-6. [PMID: 17490783 DOI: 10.1016/j.jaad.2007.02.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Revised: 02/27/2007] [Accepted: 02/27/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Since its inception in 1985, the American Academy of Dermatology (AAD) National Melanoma/Skin Cancer Screening Program has strived to enhance early detection of cutaneous malignant melanoma (MM) by providing nationwide skin cancer education campaigns in combination with free skin cancer screenings. OBJECTIVE To analyze the AAD screening data from 2001 to 2005 in order to identify factors associated with MM detection, and thereby derive a model of increased likelihood for MM detection through visual skin examinations at screenings. MATERIALS AND METHODS Patients completed a standardized AAD pre-screening form with historical and phenotypic information. Clinicians then recorded suspected clinical findings noted at visual skin examination. Statistical analyses were conducted using SPSS 14 (SPSS Inc., Chicago, Ill). RESULTS Five factors, which can be remembered with the acronym HARMM, independently increased the likelihood of suspected MM being found in the 362,804 persons screened: History of previous melanoma (odds ratio [OR] = 3.3; 95% confidence interval [CI], 2.9-3.8); Age over 50 (OR = 1.2; 95% CI, 1.1-1.3); Regular dermatologist absent (OR = 1.4; 95% CI, 1.3-1.5); Mole changing (OR = 2.0; 95% CI, 1.9-2.2); and Male gender (OR = 1.4; 95% CI, 1.3-1.5). Individuals at highest risk (4 or 5 factors) comprised only 5.8% of the total population, yet accounted for 13.6% of presumptive MM findings, and were 4.4 times (95% CI, 3.8-5.1) more likely to be diagnosed with suspected MM than individuals at lowest risk (0 or 1 factor). Receipt of a total skin examination at screening independently increased the likelihood for identifying suspected MM (OR = 1.4; 95% CI, 1.3-1.6). However, significantly fewer screenees in the highest risk group versus those in the lowest risk group underwent total skin examinations (53.7% vs 62.5%). LIMITATIONS Risk factors studied limited to variables collected in screenee enrollment form. CONCLUSIONS A higher-risk subgroup of the skin cancer screening population can be identified through assessment of MM risk factors using the HARMM criteria. Refocusing efforts to provide a total skin examination to those individuals with multiple risk factors has the potential to both reduce costs and increase yields for suspected MM in future mass screening initiatives.
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Askari SK, Schram SE, Wenner RA, Bowers S, Liu A, Bangerter AK, Warshaw EM. Evaluation of prospectively collected presenting signs/symptoms of biopsy-proven melanoma, basal cell carcinoma, squamous cell carcinoma, and seborrheic keratosis in an elderly male population. J Am Acad Dermatol 2007; 56:739-47. [PMID: 17258839 DOI: 10.1016/j.jaad.2006.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 11/09/2006] [Accepted: 11/29/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Presenting signs/symptoms of skin cancer may aid in earlier detection and diagnosis. OBJECTIVE We sought to compare prospectively collected, presenting signs/symptoms of malignant melanoma (MM), basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and seborrheic keratosis (SK). METHODS This analysis was part of a larger study on teledermatology involving 3039 skin neoplasms in 2152 patients at a Department of Veterans Affairs medical center. At presentation, participants were asked about signs/symptoms of specific skin lesions. In all, 912 biopsy-proven MM (39), BCC (411), SCC (238), and SK (224) were included in this analysis. Pearson chi(2) analyses were used to test associations of lesion type and specific signs/symptoms in pairwise comparisons. RESULTS "No symptoms" was reported more often with MM (82%) as compared with BCC (relative risk [RR] 2.26, confidence interval [CI] 1.86, 2.75), SCC (RR 3.31, CI 2.54, 4.32), or SK (RR 2.0, CI 1.61, 2.48; all P < .0001). Tenderness was more commonly reported with SCC (40%) as compared with MM (RR 15.9, CI 2.28, 110.69), SK (RR 3.0, CI 2.11, 4.39), or BCC (RR 2.6, CI 1.97, 3.38; all P < .0001). Bleeding was more commonly reported with BCC (37%) as compared with SK (RR 2.3, CI 1.67, 3.20), SCC (RR 1.6, CI 1.22, 2.05), or MM (RR 29.8, CI 1.89, 469.65; all P <or= .007). LIMITATIONS The small number of MM and study population characteristics (elderly, Caucasian, male) limit generalizability. CONCLUSION This study describes common signs/symptoms of BCC, SCC, and SK. Our findings suggest that MM may be asymptomatic more often than previously recognized.
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Affiliation(s)
- Sharone K Askari
- Department of Dermatology at Minneapolis Veterans Affairs Medical Center, MN 55417, USA
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MacDonald A, Berty C, Holmes S. An audit of the management of melanoma patients at Glasgow Royal Infirmary 1998-2003. Scott Med J 2006; 51:30-3. [PMID: 16562423 DOI: 10.1258/rsmsmj.51.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Melanoma is an important cause of morbidity and mortality. Recently published Scottish Intercollegiate Guideline Network (SIGN) guidelines outline standard management for melanoma patients in Scotland. METHODS We audited the management of consecutive patients diagnosed with melanoma in Glasgow Royal Infirmary (1998-2003), using the SIGN guidelines as a gold standard. RESULTS Of 102 patients, 41% were male and 59% were female. The mean ages of men and women were 58 and 50 years respectively. Fifty five per cent of all patients had a superficial spreading melanoma, and the median Breslow thickness was 0.64 mm. The most commonly affected site was the head and neck (29%). Most patients (87%) were referred by their general practitioner, but only 30% were marked as urgent by the referrer, and accordingly the median time to first appointment varied between 20 days (1998) and 52 days (2001). The most frequently noted suspicious feature was irregular pigmentation. The median time to biopsy was 6 days. Seventy-one per cent of patients had an excision biopsy, and of those who did not, most (71%) had lesions on the head and neck. There was poor recording of surgical margins (13%) and histological margins were used to determine the need for re-excision. The SIGN guidelines for re-excision and sentinel lymph node biopsy were closely followed. CONCLUSION The SIGN guidelines for melanoma have been adhered to in our department, although time to first appointment exceeded national recommendations.
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Affiliation(s)
- A MacDonald
- Department of Dermatology, Glasgow Royal Infirmary.
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Janda M, Youl PH, Lowe JB, Baade PD, Elwood M, Ring IT, Aitken JF. What motivates men age ≥ 50 years to participate in a screening program for melanoma? Cancer 2006; 107:815-23. [PMID: 16832794 DOI: 10.1002/cncr.22051] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The screening behavior and screening outcomes of men age > or =50 years was investigated within a randomized controlled trial of a community-based intervention of screening for melanoma, consisting of a community education program, an education program for medical practitioners, and the provision of dedicated skin-screening clinics. METHODS Data from cross-sectional telephone surveys before (559 completed interviews), at the end (591 completed interview), and at 2 years after the intervention (445 completed interviews) were analyzed. In addition, the authors analyzed data from skin-screening clinics within the intervention program (3355 men age > or =50 years participated). RESULTS During the intervention period men age > or =50 years increased both their screening behavior and intention to screen. Those men age > or =50 years who reported a past history of removal of a mole as well as other risk factors for skin cancer and positive attitudes toward screening were more likely to participate in skin screening across time. Men age > or =50 years accounted for 20.5% of all skin-screening clinic attendees, 31.3% of those referred for a suspicious lesion, 48.5% of melanomas, and 45% of all keratinocyte carcinomas diagnosed within the screening program, respectively. CONCLUSIONS The intervention program successfully motivated men age > or =50 years to attend screening for skin cancer, resulting in the highest yield of skin cancer within this subgroup of the population. Messages addressing skin cancer risk factors and attitudes toward skin cancer and screening could be used to target a screening program for melanoma toward men age > or =50 years.
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Affiliation(s)
- Monika Janda
- Viertel Centre for Research in Cancer Control, Queensland Cancer Fund, Brisbane, Queensland, Australia.
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Dai DL, Martinka M, Li G. Prognostic significance of activated Akt expression in melanoma: a clinicopathologic study of 292 cases. J Clin Oncol 2005; 23:1473-82. [PMID: 15735123 DOI: 10.1200/jco.2005.07.168] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Akt is a serine/threonine kinase that leads to stimulation of cell cycle progression, cell proliferation, and inhibition of apoptosis. To investigate the role of Akt in melanoma pathogenesis, we examined the expression of phospho-Akt (p-Akt; Ser-473) in melanocytic lesions at different stages and analyzed the correlations between the p-Akt expression level and clinicopathologic factors and patient survival. PATIENTS AND METHODS We evaluated the p-Akt expression in 12 cases of normal nevi, 58 cases of dysplastic nevi, 170 cases of primary melanomas, and 52 cases of melanoma metastases using tissue microarray and immunohistochemistry. RESULTS Strong p-Akt expression was observed in 17%, 43%, 49%, and 77% of the biopsies in normal nevi, dysplastic nevi, primary melanoma, and melanoma metastases, respectively. Significant differences for p-Akt staining pattern were observed between normal nevi and primary melanomas (P < .05), and between primary melanomas and melanoma metastases (P < .001). Furthermore, our Kaplan-Meier survival curves showed that strong p-Akt expression is inversely correlated with both overall and disease-specific 5-year survival of patients with primary melanoma (P < .05 for both). Strikingly, our multivariate Cox regression analysis revealed that p-Akt is an independent prognostic factor in low-risk melanomas (thickness < or = 1.5 mm; relative risk, 6.44; 95% CI, 1.28 to 32.55; P = .018). CONCLUSION The expression of p-Akt increases dramatically with melanoma invasion and progression and is inversely correlated with patient survival. In addition, p-Akt may serve as an independent prognostic marker and help to identify those patients with low-risk melanomas who are at increased risk of death.
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Affiliation(s)
- Derek L Dai
- Department of Medicine, Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
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Dancey A, Rayatt S, Courthold J, Roberts J. Views of UK melanoma patients on routine follow-up care. ACTA ACUST UNITED AC 2005; 58:245-50. [PMID: 15710122 DOI: 10.1016/j.bjps.2004.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 10/15/2004] [Indexed: 11/28/2022]
Abstract
Although the need for melanoma follow-up is universally accepted, there is still much debate on the duration and frequency of appointments. The UK guidelines were revised in June 2002 to streamline melanoma follow-up. Following the change in protocol, some of our patients expressed concern at the shorter duration of follow-up. We therefore polled all our active melanoma patients to obtain their views on the outpatient clinics. In particular we asked whether they would be happy to have routine follow-up in a primary care setting. In conjunction with the department of psychology, a short questionnaire was devised assessing patient satisfaction and concerns about follow-up. This was sent to all active melanoma patients in our trust. Out of 304 eligible patients currently attending outpatients, 231 (76%) completed replies were received. Ninety-eight percent of respondents found the clinics to be useful. Twenty two and a half percent felt it was difficult to attend the clinic and this was mainly due to logistical problems, i.e. hospital car parking. The majority were reassured by the clinic visits and felt it was a chance to ask questions and check for new disease. Of the 12% of respondents who had a recurrence, 52% indicated that they had detected it themselves. Sixty percent of patients would be happy to consider routine follow-up with their GP, provided they were suitably experienced and trained. A survey of 50 local GP's found that 70% would be unhappy to monitor their patients. Patients want and benefit from follow-up. However, they are an increasing burden on outpatient clinics, given the increasing incidence of melanoma. GP follow-up may be appropriate for a small subgroup of patients. This combined with shared care and practice based clinical nurse specialists may be the way forward in melanoma follow-up.
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Affiliation(s)
- A Dancey
- Department of Plastic and Reconstructive Surgery, North Staffordshire University Hospital, Stoke-on-Trent ST4 6QG, UK.
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Hershock D. Genetics, prevention and screening for melanoma. CANCER CHEMOTHERAPY AND BIOLOGICAL RESPONSE MODIFIERS 2005; 22:707-28. [PMID: 16110635 DOI: 10.1016/s0921-4410(04)22031-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Diane Hershock
- Department of Hematology/Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Van Durme DJ, Ullman R, Campbell RJ, Roetzheim R. Effects of physician supply on melanoma incidence and mortality in Florida. South Med J 2003; 96:656-60. [PMID: 12940314 DOI: 10.1097/01.smj.0000053569.81565.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing supplies of dermatologists and family physicians have been associated with earlier detection of malignant melanoma. We investigated whether physician supply was similarly related to incidence and mortality rates of malignant melanoma. METHODS Using the state tumor registry, we determined melanoma incidence and mortality rates for the years 1993 to 1995 for each Florida county. We measured physician supply for each Florida county using data from the 1994 American Medical Association Physician Masterfile. Multiple linear regression analysis was used to determine relationships between physician supply and melanoma incidence and mortality rates, controlling for other county-level characteristics. RESULTS Among male patients, an increasing supply of family physicians was associated with higher melanoma incidence and lower melanoma mortality. Increasing supplies of dermatologists were associated with lower overall melanoma mortality rates, and increasing supplies of general internists were associated with higher overall melanoma mortality. CONCLUSION We found that melanoma incidence and mortality rates varied substantially among Florida's 67 counties, and that differences in physician supply explained some of this variability. Further study is needed to confirm these findings and to elucidate possible mechanisms that would account for these associations.
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Affiliation(s)
- Daniel J Van Durme
- Department of Family Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 13, Tampa, FL 33612, USA.
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Abstract
OBJECTIVES To describe the epidemiology of melanoma and nonmelanoma skin cancers. DATA SOURCES Review and research articles, book chapters, and Surveillance, Epidemiology, and End Results (SEER) data. CONCLUSIONS In 2002, an estimated 1.3 million Americans were diagnosed with skin cancer. Of these, 53,000 individuals were diagnosed with melanoma, the most common fatal form of skin cancer, and more than 7,000 Americans died of melanoma. Nonmelanoma skin cancer has the highest incidence of all cancers and the rise in the rate of cutaneous melanoma exceeds all other preventable cancers. IMPLICATIONS FOR NURSING PRACTICE Nurses can act as case-finders and as advocates and educators for prevention of overexposure to ultraviolet radiation. Nurses should ascertain possible inherited risk and monitor patients for additional primary skin cancers.
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Affiliation(s)
- Alan C Geller
- School of Medicine, and Epidemiology, School of Public Health, Boston University, MA, USA
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Geller AC, Sober AJ, Zhang Z, Brooks DR, Miller DR, Halpern A, Gilchrest BA. Strategies for improving melanoma education and screening for men age >or= 50 years: findings from the American Academy of Dermatological National Skin Cancer Sreening Program. Cancer 2002; 95:1554-61. [PMID: 12237925 DOI: 10.1002/cncr.10855] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recently, the Institute of Medicine (2000) and the Third United States Preventive Services Task Force (2001) called for studies to help clinicians identify patients, especially elderly patients, who are at high risk for melanoma. In the current study, the authors sought to identify factors associated with a high yield in skin cancer screening and to explore strategies for improving mass screenings for melanoma. METHODS The authors analyzed the data base of the 242,374 skin cancer screenings conducted on more than 206,000 Americans who attended the American Academy of Dermatology National Skin Cancer Screening Programs during the period 1992-1994. RESULTS Ninety-six percent of 3476 screenees with a presumptive diagnosis of melanoma or possible melanoma were contacted, and follow-up records were obtained for 73% of screenees. Of these, 363 screenees had histologically proven melanoma. Middle-aged and older men (age >or= 50 years) comprised only 25% of screenees but comprised 44% of those with a confirmed diagnosis of melanoma. The overall yield of melanoma (the number of confirmed diagnoses per the number of screenees) was 1.5 per 1000 screenings (363 diagnoses of 242,374 screenees) compared with a yield of 2.6 per 1000 screenings among men age >or= 50 years. The yield was improved further for men age >or= 50 years who reported either a changing mole (4.6 per 1000 screenings) or skin types I and II (3.8 per 1000 screenings). The predictive value of a screening diagnosis of melanoma was more than twice as high for men age >or= 50 years with either a changing mole or skin types I and II compared with all other participants. CONCLUSIONS The yield of mass screening for melanoma would be improved by outreach to middle-aged and older men, with particular focus on men with changing moles or with skin types I and II. Primary care physicians should be attuned to the risk factors among all of their patients but should be alerted in particular to the heightened risk of melanoma for men age >or= 50 years. Formal assessment of the impact of targeted screening on mortality warrants further study.
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Affiliation(s)
- Alan C Geller
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Abstract
This article describes major screening studies of the past two decades, discusses the evidence-based screening recommendations, highlights the need to screen high-risk and previously unscreened populations, and concludes with suggestions for risk assessment and physician-nurse training in the skin cancer examination.
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Affiliation(s)
- Alan C Geller
- Department of Dermatology, School of Medicine, Department of Epidemiology and Biostatistics, School of Public Health, Boston University, Boston, MA, USA.
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Abstract
CONTEXT Malignant melanoma is often lethal, and its incidence in the United States has increased rapidly over the past 2 decades. Nonmelanoma skin cancer is seldom lethal, but, if advanced, can cause severe disfigurement and morbidity. Early detection and treatment of melanoma might reduce mortality, while early detection and treatment of nonmelanoma skin cancer might prevent major disfigurement and to a lesser extent prevent mortality. Current recommendations from professional societies regarding screening for skin cancer vary. OBJECTIVE To examine published data on the effectiveness of routine screening for skin cancer by a primary care provider, as part of an assessment for the U.S. Preventive Services Task Force. DATA SOURCES We searched the MEDLINE database for papers published between 1994 and June 1999, using search terms for screening, physical examination, morbidity, and skin neoplasms. For information on accuracy of screening tests, we used the search terms sensitivity and specificity. We identified the most important studies from before 1994 from the Guide to Clinical Preventive Services, second edition, and from high-quality reviews. We used reference lists and expert recommendations to locate additional articles. STUDY SELECTION Two reviewers independently reviewed a subset of 500 abstracts. Once consistency was established, the remainder were reviewed by one reviewer. We included studies if they contained data on yield of screening, screening tests, risk factors, risk assessment, effectiveness of early detection, or cost effectiveness. DATA EXTRACTION We abstracted the following descriptive information from full-text published studies of screening and recorded it in an electronic database: type of screening study, study design, setting, population, patient recruitment, screening test description, examiner, advertising targeted at high-risk groups or not targeted, reported risk factors of participants, and procedure for referrals. We also abstracted the yield of screening data including probabilities and numbers of referrals, types of suspected skin cancers, biopsies, confirmed skin cancers, and stages and thickness of skin cancers. For studies that reported test performance, we recorded the definition of a suspicious lesion, the "gold-standard" determination of disease, and the number of true positive, false positive, true negative, and false negative test results. When possible, positive predictive values, likelihood ratios, sensitivity, and specificity were recorded. DATA SYNTHESIS No randomized or case-control studies have been done that demonstrate that routine screening for melanoma by primary care providers reduces morbidity or mortality. Basal cell carcinoma and squamous cell carcinoma are very common, but detection and treatment in the absence of formal screening are almost always curative. No controlled studies have shown that formal screening programs will improve this already high cure rate. While the efficacy of screening has not been established, the screening procedures themselves are noninvasive, and the follow-up test, skin biopsy, has low morbidity. Five studies from mass screening programs reported the accuracy of skin examination as a screening test. One of these, a prospective study, tracked patients with negative results to determine the number of patients with false-negative results. In this study, the sensitivity of screening for skin cancer was 94% and specificity was 98%. Several recent case-control studies confirm earlier evidence that risk of melanoma rises with the presence of atypical moles and/or many common moles. One well-done prospective study demonstrated that risk assessment by limited physical exam identified a relatively small (<10%) group of primary care patients for more thorough evaluation. CONCLUSIONS The quality of the evidence addressing the accuracy of routine screening by primary care providers for early detection of melanoma or nonmelanoma skin cancer ranged from poor to fair. We found no studies that assessed the effectiveness of periodic skin examination by a clinician in reducing melanoma mortality. Both self-assessment of risk factors or clinician examination can classify a small proportion of patients as at highest risk for melanoma. Skin cancer screening, perhaps using a risk-assessment technique to identify high-risk patients who are seeing a physician for other reasons, merits additional study as a strategy to address the excess burden of disease in older adults.
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Affiliation(s)
- M Helfand
- Division of Medical Informatics and Outcomes Research, Evidence-based Practice Center, Oregon Health Sciences University, Portland, Oregon 97201-3098, USA.
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Abstract
BACKGROUND Breslow thickness is a major predictor of prognosis in cutaneous malignant melanoma (MM) and patients continue to present with thick lesions, which have a poorer prognosis. OBJECTIVES To investigate correlations of Breslow thickness with demographic variables, tumour site, clinical features, false negative diagnostic rate and clinic of primary referral. METHODS Data were obtained from the records of 738 patients with histologically diagnosed cutaneous MM. Tumours included were in situ and invasive MM and lentigo maligna melanoma. In view of the skewed distribution of MM thickness, categories of MM thickness were used for analysis, using the commonly applied cut-offs of 0.75, 1.5 and 3.5 mm. The variables investigated were particularly associated with changes in the proportion of the thickest group, 'thick' MMs. The proportion of this thickness category is proposed as an appropriate and sensitive variable for the investigation of correlations with MM thickness. Thickness >/= 1.5 mm has also been considered in view of its prognostic significance. RESULTS Results were similar for the two thickness groups, but more significant for the thick group. The previously described correlations of tumour thickness and increasing age (P < 0.00001) and location on head and neck (P = 0.0002), together with the independence of these variables, have been confirmed. The correlation with male gender was also confirmed but this was weak (P = 0.05). Novel findings were correlations of Breslow thickness with all features of the seven-point checklist (P varying from P = 0.01 to P < 0.00001) and tumour elevation (P < 0.00001). In general in the seven-point checklist, the absence of the major features (except variation in size) (P < 0.00001) and presence of minor features (except altered sensation) (P varying from P = 0.004 to P < 0.00001) were strongly associated with thick MMs. These results for tumour thickness are a further argument for retention of the minor features of the seven-point checklist. False negative diagnosis was found to be correlated with tumour thickness (P < 0.02) but this relationship was lost on multivariate analysis with inclusion of the clinical features. MM thickness was highly correlated with primary referral clinic (P < 0.00001). Only approximately 8% of MMs presenting to the Pigmented Lesion Clinic (PLC) were thick, while the proportion presenting to general dermatology was about three times greater and to plastic surgery about five times greater. This was maintained on multivariate analysis, including all other variables and, therefore, there must be other determining factors of referral not examined in the study. Conclusion MM thickness is associated with increasing age, male gender, location on the head and neck, all features of the seven-point checklist, tumour elevation and referral to the PLC. It is important to investigate further the reasons for general practitioner referral of different thickness MM to different types of clinic, as referral to clinics other than the PLC results in delay in the first hospital appointment, and it is now apparent that thicker lesions are disproportionately affected.
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Affiliation(s)
- J E Osborne
- Department of Dermatology, Leicester Royal Infirmary, Leicester, LE1 5WW U.K
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Hanrahan PF, Menzies SW, D'Este CA, Plummer T, Hersey P. Participation of older males in a study on photography as an aid to early detection of melanoma. Aust N Z J Public Health 2000; 24:615-8. [PMID: 11215011 DOI: 10.1111/j.1467-842x.2000.tb00527.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the acceptability of photography as an aid to skin examinations in men over 50 years of age. METHODS A randomised trial of men selected from the electoral roll. All participants were photographed, but only half received their photographs. Skin examinations by GPs at years one and two. RESULTS 55% of men consented to have photographs taken and 51% did so. 86% of respondents had risk factors for melanoma (compared to 68% of non-responders) and 47% had two or more risk factors (compared to 23% of non-responders). At year one, 91% of participants remaining in study regions had been examined. Photographs were lost by only six participants. CONCLUSIONS Men over 50 years of age respond to personalised health messages about melanoma and respondents include a high proportion of males with risk factors for melanoma. IMPLICATIONS These initial results suggest that photography may be a logistically acceptable approach for assisting in the early detection of melanoma.
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Affiliation(s)
- P F Hanrahan
- Oncology & Immunology Unit, Newcastle Mater Misericordiae Hospital, New South Wales
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27
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Christos PJ, Oliveria SA, Berwick M, Elder DE, Synnestvedt M, Fine JA, Barnhill RL, Halpern AC. Signs and symptoms of melanoma in older populations. J Clin Epidemiol 2000; 53:1044-53. [PMID: 11027938 DOI: 10.1016/s0895-4356(00)00224-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We conducted a descriptive study to assess the relationship between increasing age and the reporting of melanoma signs/symptoms in 634 hospital-based and 624 population-based incident cases of melanoma. Multivariate logistic regression was used to evaluate the relationship between older age (> or = 50 years) and the reporting of melanoma signs/symptoms. Older patients were less likely to report itching and change in elevation of their lesions (P < 0.05). Change in color was also less likely to be reported by older patients, although not statistically significant. Ulceration of the lesion was reported significantly more by older patients (P < 0.05). Older individuals may be less likely to report itching and change in elevation/color of their lesions, but more likely to report ulceration, a symptom associated with advanced disease and poor prognosis. Further research is necessary to provide a better understanding of the development of melanoma in older populations so that new strategies can be explored to improve early detection in this age group.
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Affiliation(s)
- P J Christos
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Abstract
BACKGROUND The objective of this study was to describe recent developments in cutaneous melanoma from the German speaking countries in Europe (Germany, Austria, and Switzerland) and from Queensland, Australia. METHODS All incident invasive cutaneous melanoma cases recorded between 1986 and 1996 by the Queensland Melanoma Register and by the Central Malignant Melanoma Registry of the German Dermatological Society were included in the analysis. Weighted linear trend analyses were performed to assess significant changes over the years using yearly sample sizes as weights. RESULTS In Central Europe, the median tumor thickness decreased from 1.2 mm in 1986 to 0.8 mm in 1996 (P < 0.001), whereas it varied insignificantly between 0.5 mm and 0.6 mm in Queensland. The percentage of patients with Clark Level II invasion increased significantly in Queensland (P < 0.001; 1996, 61.1%) and in Central Europe (P = 0.041; 1996, 24.5%). The percentage of superficial spreading melanomas rose in Central Europe (P = 0.043; 1996, 64.4%), whereas it decreased slightly in Queensland (P = 0.032; 1996, 75%). In Queensland and in Central Europe, younger people and women presented more frequently with thinner melanomas (</= 0.75 mm). CONCLUSIONS In both Central Europe and Queensland, trends toward thinner and less invasive melanomas were observed between 1986 and 1996, although the median tumor thickness decreased significantly only for Central European data. Men and elderly individuals should be the focus of health-promotion activities, because they tended to present on average with thicker and prognostically poorer melanomas.
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Affiliation(s)
- C Garbe
- Section of Dermatological Oncology, Department of Dermatology, Central Malignant Melanoma Registry of the German Dermatological Society, Eberhard-Karls-University, Tuebingen, Germany
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29
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Abstract
BACKGROUND Despite the importance of early detection in preventing mortality from melanoma, little is known regarding how patients with the disease come to diagnosis. METHODS The authors prospectively evaluated 471 newly diagnosed melanoma patients between 1995 and 1998. Patients completed a questionnaire that included 1) identification of the person who detected the lesion, 2) the anatomic location of the lesion, and 3) family history of melanoma. Logistic regression analysis was performed to examine the relation between detection patterns and lesion thickness, adjusting for age, gender, anatomic site of the primary lesion, and family history of melanoma. RESULTS The majority of patients detected their own melanoma (n = 270; 57%). Females were more likely to self-detect than males (69% vs. 47%; P < 0.0001). Physicians detected the melanoma in 16% of patients (n = 74), followed by "spouse" in 11% of patients (n = 51). Within this group, detection by wives was 7.5 times more common than detection by husbands (P < 0.0001). Logistic regression analysis revealed that physicians were 3.6 times more likely to detect thin lesions (</=0.75 mm) compared with nonphysician detectors (95% confidence interval [95% CI], 2.1, 6.5; P = 0.0001). In addition, patients who reported a family history of melanoma had a 2.7-fold increased likelihood of presenting with a thin lesion (95% CI, 1.6, 4.7; P = 0.0003). CONCLUSIONS Physician detection and a report of a family history of melanoma are associated with the presentation of patients with early melanoma, suggesting that awareness of the disease among physicians and the public is critical for preventing mortality from melanoma. Increasing melanoma awareness in males may be a particularly effective means of secondary prevention.
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Affiliation(s)
- M S Brady
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Abstract
The incidence of skin cancer has been rising at an alarming rate for the past several years. This poses a significant public health problem in the United States. Detection and treatment of melanoma early in its course is critical for improved outcome. Of the approaches to cancer control that can reduce mortality from melanoma and nonmelanoma skin cancer, screening holds the greatest promise for a rapid and major impact. Prevention and early detection are crucial in reducing morbidity and mortality from skin cancer. For a number of reasons, however, the full effect of screening for both melanoma and nonmelanoma skin cancers has not been achieved. Controversy exists regarding who should perform screening, who should be screened, and whether screening should be performed at all. It is clear that melanoma and nonmelanoma skin cancer control programs combining primary prevention, education, and screening are in developmental stages. This review will discuss the advantages and disadvantages of screening for skin cancer.
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Affiliation(s)
- J T Wolfe
- Department of Dermatology, University of Pennsylvania Hospital, Philadelphia 19104-4283, USA
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Marks R. Two decades of the public health approach to skin cancer control in Australia: why, how and where are we now? Australas J Dermatol 1999; 40:1-5. [PMID: 10098281 DOI: 10.1046/j.1440-0960.1999.00307.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Incidence and mortality rates due to skin cancer are rising in most Western countries. Early detection of these tumours at a stage when they can be easily cured is the primary approach taken by many people wishing to deal with the problem. A primary prevention approach, that is, reduction in sunlight exposure, is being considered by an increasing number of organizations. The public health approach to primary prevention of skin cancer, including melanoma, requires an understanding of the role of sunlight in the production of these tumours. Despite a clear understanding of exactly how sunlight does this, there is enough epidemiological and laboratory evidence to suggest a broad approach to the problem. This includes reduction of sunlight exposure, particularly in childhood and adolescence. It also suggests the need to recommend avoidance of suntanning and particularly the excessive exposures that lead to sunburn. Widespread primary prevention public health programmes have been running in Australia for almost 20 years. The data measuring the effect of these programmes indicate a very large shift in knowledge attitudes and beliefs about sunlight exposure and suntans, and major shifts in behaviour. Suntans are no longer as popular as they were and people are reducing their sunlight exposure by a variety of methods encapsulated in Slip! Slop! Slap! Cohort analysis of the incidence rates for melanoma and non-melanoma skin cancer show that the incidence of these tumours is levelling out in young people and is dropping in some instances. These are the people who were able to be influenced by the public health programmes in recent decades. Finally, following initial dramatic changes in all the behavioural variables related to the programme, a period of consolidation with continuing effort and more specific targeting will be required in the coming decades to maintain the improvement.
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Affiliation(s)
- R Marks
- University of Melbourne, Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Australia
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Abstract
OBJECTIVE To examine whether presentation of older people with thick melanoma is a result of the site and histological type or of their reduced ability to identify melanoma. DESIGN AND SETTING Retrospective analysis of the Newcastle Melanoma Unit patient database. PATIENTS 2154 patients with melanoma for whom complete data (histological type, thickness and site of melanoma) were available and who presented from February 1981 to April 1997. MAIN OUTCOME MEASURES Histological type and site of melanoma in older (> or = 50 years) versus younger men and women; frequency with which these groups identified melanoma and the first changes of melanoma that were noticed. RESULTS Patients aged > or = 50 years, particularly men, were more likely to present with thicker lesions. Older men and, to a lesser extent, older women were more likely to present with nodular melanoma, which were more frequent on the scalp and face in older, compared with younger, men, and scalp and back in older men compared with older women. Failure to identify melanoma was associated with older age, sites on the scalp and back and histological type of the lesion, but was independent of sex once histological type, age, site and thickness were taken into account. Multivariate analysis indicated that the association of older age of patients with failure to identify melanoma applied irrespective of the site, type and thickness of their melanoma. CONCLUSION The higher frequency of thick melanoma in older people is accounted for by an increased proportion of nodular melanoma and decreased ability to recognise the changes of melanoma. These findings have important implications for examination of older patients by doctors and for design of strategies for early detection of melanoma in this age group.
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Affiliation(s)
- John W Kelly
- Department of MedicineAlfred HospitalMelbourneVIC
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35
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Koh HK, Geller AC. Public health interventions for melanoma. Prevention, early detection, and education. Hematol Oncol Clin North Am 1998; 12:903-28. [PMID: 9759586 DOI: 10.1016/s0889-8588(05)70030-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Worldwide melanoma control programs that include some combination of primary prevention, education, and screening activities have only recently begun to undergo an evaluation process. More studies with rigorous design and evaluation are needed. Until then, the proper public health policy guidelines for melanoma control, especially screening, are open to debate. Future studies must determine how screening, early detection, case finding, and education can best be used to reduce mortality and achieve optimal melanoma control.
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Affiliation(s)
- H K Koh
- Department of Dermatology, Boston University School of Medicine, Massachusetts, USA
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Atlan G, Verrault JM, Franchebois P. Has There Been Progress in the Early Diagnosis of Malignant Melanoma? THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 1998. [DOI: 10.1177/229255039800600102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lesion thickness is still the best predictor of prognosis of cutaneous malignant melanoma. In order to evaluate whether some benefit resulted from early diagnosis, cases of melanoma referred to St Luke Hospital, Montreal, Quebec from 1983 to 1993 were studied. The series was homogenous in that the recruitment staff, surgeon and dermatopathologist were the same for all cases. It was observed that, from 1983 to 1991 the thickness of malignant melanoma cases was about the same. In 1992 and 1993, relatively more thin cases versus very thick cases were detected. Further study is indicated.
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Affiliation(s)
| | - Jean-Marc Verrault
- Chirurgien des Hôpitaux, Centre Hospitalier Universitaire de Montpellier, France
| | - Pierre Franchebois
- Service de Pathologie et Service de Chirurgie Oncologique, Hôpital Saint-Luc, Université de Montréal, Québec
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Sylaidis P, Gordon D, Rigby H, Kenealy J. Follow-up requirements for thick cutaneous melanoma. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:349-53. [PMID: 9245869 DOI: 10.1016/s0007-1226(97)90544-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The primary aim of postoperative melanoma follow-up is the early detection and treatment of treatable recurrences which gives a survival advantage to these patients. The need for follow-up is universally accepted. However, there is ongoing controversy about the duration of follow-up and frequency of reviews. We present a retrospective review of 244 patients with localised thick (> or = 4.0 mm) cutaneous melanoma, who had completed a 10-year follow-up or had died form their melanoma within 10 years. For these criteria, this is the largest series of this type which has been reported to date. The incidence of treatable recurrences peaked in the first postoperative year at 40% and then rapidly decreased, levelling off after year 5 at 2.5% per annum. We believe that this high incidence of treatable recurrences reinforces the need for 10-year follow-up of these patients. We also recommend that the annual frequency of follow-up reviews in each year be based on that year's risk for getting a treatable recurrence. Following this principle, we provide an example of such a follow-up programme.
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Affiliation(s)
- P Sylaidis
- Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol, UK
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Cox NH, Aitchison TC, Sirel JM, MacKie RM. Comparison between lentigo maligna melanoma and other histogenetic types of malignant melanoma of the head and neck. Scottish Melanoma Group. Br J Cancer 1996; 73:940-4. [PMID: 8611411 PMCID: PMC2074252 DOI: 10.1038/bjc.1996.168] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A study of 953 invasive cutaneous malignant melanomas of the head and neck was performed to determine differences between lentigo maligna melanoma and other histogenetic types with regard to patients and sites affected; prognosis was analysed in 595 of these cases. The cases studied comprised all head and neck melanomas registered with the Scottish Melanoma Group between 1979 and 1992, apart from the 3% of cases that were unclassifiable or rare histogenetic types. The histogenetic types of melanoma were 498 (52%) lentigo maligna melanoma (LMM), 237 (25%) superficial spreading melanoma (SSM) and 218 (23%) nodular melanoma (NM). All types increased in incidence throughout the study period. Patients with LMM (mean age 73 years) and NM (mean 68 years) were significantly older than those with SSM (mean 57 years). There were significant anatomical subsite differences related to sex of patients and histogenetic type of melanoma; melanomas on the face were more frequent in females and 90% of LMM occurred at this site, whereas melanomas on the scalp, neck and ears were more frequent in men. Kaplan-Meier estimates of the probability of survival were produced for the 595 of these 953 patients with 5 year follow-up details. In this group of patients the prognostic significance of tumour thickness, Clark level of invasion, ulceration, histogenetic type of melanoma and number of mitoses were studied using stepwise variable selection of procedures. Each of these possible prognostic factors attained individual significance but the tumour thickness was the dominant risk factor in the proportional hazards analysis. When patients were divided into four sex/ulceration subgroups (male/ulcerated, female/ulcerated, male/non-ulcerated, female/non-ulcerated) and analysed by proportional hazards analysis, no variable other than the tumour thickness had any further prognostic effect. Histogenetic type did not remain an independent prognostic variable at this stage. Despite sex and subsite differences, the prognosis for invasive lentigo maligna melanoma does not differ from that for other histogenetic types after controlling for tumour thickness.
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Affiliation(s)
- N H Cox
- Department of Dermatology, Cumberland Infirmary, Carlisle, UK
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Girgis A, Clarke P, Burton RC, Sanson-Fisher RW. Screening for melanoma by primary health care physicians: a cost-effectiveness analysis. J Med Screen 1996; 3:47-53. [PMID: 8861052 DOI: 10.1177/096914139600300112] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND DESIGN - Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost-effectiveness estimates of melanoma screening were calculated. RESULTS - Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12 137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. CONCLUSION - The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.
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Affiliation(s)
- A Girgis
- NSW Cancer Council, Cancer Education Research Program (CERP), Newcastle, Australia
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Katris P, Crock JG, Gray BN. Research note: the Lions Cancer Institute and the Western Australian Society of Plastic Surgeons skin cancer screening programme. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1996; 66:101-4. [PMID: 8602803 DOI: 10.1111/j.1445-2197.1996.tb01122.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Lions Cancer Institute, Perth, and the Western Australian Society of Plastic Surgeons have been investigating the feasibility of community based skin cancer screening. Members of the community responded to newspaper advertisements to attend free skin cancer screening events. This report presents preliminary results obtained from the methods development programme. METHODS Seventeen screening clinics were conducted in Perth (4) and country towns (14) in Western Australia between January 1991 and October 1993. The participants were interviewed and given promotional literature and their personal profiles were determined. A total body skin examination was performed by a specialist plastic surgeon and any suspicious lesions were recorded and, if necessary, recommendations for further treatment was documented. RESULTS The number of individuals screened was 3397. Of these, 572 patients were referred to general practitioners for further medical attention of suspicious lesions, 79 patients were clinically diagnosed as having suspicious pigmented skin lesions (13.8% of total lesions and 2.3% of total sample screened). Of these, 53 individual patient pathology reports were obtained. Four invasive malignant melanomas and two in situ melanomas arising in Hutchinson's melanotic freckles were detected. CONCLUSIONS Debates concerning the efficacy of screening for skin cancer have recently received great attention from many medical disciplines. However, as yet the effectiveness of population based skin cancer screening programmes have not been adequately evaluated with randomized controlled studies. The study reported here provides some findings that may be used to enhance future screening studies.
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Affiliation(s)
- P Katris
- Lions Cancer Institute, Perth, Western Australia, Australia
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Rosenblatt L, Marks R. Deaths due to squamous cell carcinoma in Australia: is there a case for a public health intervention? Australas J Dermatol 1996; 37:26-9. [PMID: 8936067 DOI: 10.1111/j.1440-0960.1996.tb00990.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The death certificates of all people who died from cancer in Victoria for the years 1988-1990 were examined looking for deaths due primarily to squamous cell carcinoma (SCC) of the skin. The findings were compared with the Australian Bureau of Statistics (ABS) published data on the number of deaths due to non melanoma skin cancer (NMSC) for the same period. One hundred and fifteen deaths due to SCC were identified. The mean age of death for the 74 males (64%) was 74.2 (s.d. 11.7) years and the 41 females (36%) was 81.3 (s.d. 10.3) years. Seventy (80%) of the 91 people where satisfactory information was able to be extracted had one or more major illnesses which were likely to have contributed substantially to the death. Only 3.5% of the total tumours were on the trunk in the covered areas, the remainder were on exposed areas of the body easily seen during a consultation. Seventeen cases of AIDS (Kaposi's Sarcoma) were incorrectly classified by the ABS as primary NMSC deaths. Seventeen other misclassifications included seven deaths from melanoma, eight deaths from cancers which were not skin tumours and two non-cancer deaths. Thirty-one deaths due to SCC were identified from death certificates and careful medical follow up which were not recorded in ABS data. The results suggest that there is likely to be little, if any, reduction in the number of deaths due to SCC as a result of an early detection programme directed at those people currently developing lethal tumours. A professional education programme directed at doctors who are seeing these elderly people with tumours on easily examined sites is more likely to be fruitful. The results also suggest the need for further education about the correct filling out of death certificates by medical practitioners and the careful supervision of those who extract data from these records at the ABS.
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Affiliation(s)
- L Rosenblatt
- Department of Medicine (Dermatology), University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Koh HK, Geller AC, Miller DR, Lew RA. The Current Status of Melanoma Early Detection and Screening. Dermatol Clin 1995. [DOI: 10.1016/s0733-8635(18)30068-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hanrahan PF, Hersey P, Watson AB, Callaghan TM. The effect of an educational brochure on knowledge and early detection of melanoma. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995; 19:270-4. [PMID: 7542928 DOI: 10.1111/j.1753-6405.1995.tb00442.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Men over the age of 45 present with thicker, more advanced melanomas than younger people. A randomised trial was conducted in this group to evaluate whether an educational brochure would increase knowledge about melanoma and the ability to recognise and discriminate between pigmented skin lesions. Men in an industrial complex were allocated to an intervention group (n = 110) and two control groups (n = 96 and n = 108). The intervention group was given two educational brochures about melanoma. Their effect on knowledge and ability to detect pigmented lesions was assessed by a questionnaire and a self-examination body chart given before the brochure, and at four weeks and three months after return of the brochure. The control groups did not receive any educational material, but control group 2 received the questionnaire and chart. At the end of the study all participants were examined for pigmented lesions by doctors, whose counts were compared with those of the participants. There was a significant (19.8 per cent) increase in knowledge about melanoma in the intervention group (but not in the control groups), except for discrimination of photos of benign and malignant lesions. The educational material did not improve the ability of those in the intervention group to recognise and count their pigmented lesions nor to discriminate between benign and malignant pigmented lesions. The increased knowledge about melanoma was retained for at least three months.
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Affiliation(s)
- P F Hanrahan
- Newcastle Melanoma Unit, Wallsend District Hospital
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MacNeill IB, Elwood JM, Miller D, Mao Y. Trends in mortality from melanoma in Canada and prediction of future rates. Stat Med 1995; 14:821-39. [PMID: 7644862 DOI: 10.1002/sim.4780140811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A long term increase in incidence of and mortality due to malignant melanoma has been observed in all well documented white populations. The major identified cause of melanoma is sun exposure. One would expect predictions of future atmospheric ozone depletion to lead to an increase in ultraviolet radiation (UVR) and in the effects of sun exposure. We consider age-period data for Canadian malignant malanoma mortality. We fit a multiplicative exponential/logistic (MEL) model to the data and extrapolate to AD 2010 hence yielding point estimates of future rates. We obtain total mortality forecasts by multiplying rates by population estimates. We present standard errors for forecasts. We forecast that melanoma will be a much larger burden on the health care system in the early years of the next century than it is at present. We obtain an age-cohort model by a simple transformation of the age-period model. Also, we obtain unconditional probabilities of death due to melanoma both for age-period and age-cohort models. We discuss the assumptions underlying the MEL model that suggest possible relationships between UVR and melanoma.
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Affiliation(s)
- I B MacNeill
- Department of Statistical and Actuarial Sciences, University of Western Ontario, London, Canada
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Kelly B, Raphael B, Smithers M, Swanson C, Reid C, McLeod R, Thomson D, Walpole E. Psychological responses to malignant melanoma. An investigation of traumatic stress reactions to life-threatening illness. Gen Hosp Psychiatry 1995; 17:126-34. [PMID: 7789783 DOI: 10.1016/0163-8343(94)00098-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A cross-sectional study of 95 individuals with malignant melanoma was conducted to investigate posttraumatic stress responses to a diagnosis of melanoma and to validate the use of the Impact of Event Scale (IES) as a measure of the response to the trauma of life-threatening disease. The diagnosis and progression of malignant disease are likely to present a range of acute and chronic trauma to the individual and the individual's family. The findings suggest that the IES is a reliable and valid measure of this distress, with scores varying according to disease progression and prognostic status of nonmetastatic disease patients. This indicates the importance of clinical attention to the specific symptoms that may best reflect the traumatic impact of life-threatening illness and its progression, and the applicability of posttraumatic stress syndromes in understanding the psychological distress of this clinical population.
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Affiliation(s)
- B Kelly
- Department of Psychiatry, University of Queensland, Brisbane Australia
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Abstract
Cutaneous melanoma is an increasingly common public health problem in industrialized nations. In theory, education and early detection should decrease melanoma morbidity and mortality, because the lesion is external and visible, risk factors are known, and thin tumors are associated with a high 5-year survival rate. The efficacy of early detection and screening programs, however, remains untested by randomized trials. Some early data are available from melanoma prevention and control efforts that have begun in many nations over the past decade. Textbook definitions of cancer screening are particularly challenging when applied to skin cancer control. Although some propose that there are rigid differences among screening, education, and early detection of skin cancer, the visible nature of this cancer makes early detection through education and screening inextricably intertwined. This article discusses the intermediate measures of education and screening within the context of the American Academy of Dermatology programs. Over the next few decades, screening and education for melanoma and other skin cancer will receive increasing worldwide attention. Multiple strategies will be required to combat increasing incidence and mortality rates. Screening and educational programs have been implemented worldwide, but data on their effects are only just being collected. Future collaborative work in melanoma/skin cancer prevention, education, and early detection holds promise as a way to decrease mortality and save lives.
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Affiliation(s)
- H K Koh
- Department of Dermatology, Boston University School of Medicine, MA 02118
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Abstract
The mandate of the Canadian Dermatology Association's Sun Awareness Program is to increase awareness of the dangers of the sun's ultraviolet (UV) rays and to provide information on prevention and early detection of skin cancer. Major projects include an annual national press campaign, which reaches an increasing number of Canadians each year, and the production and distribution of educational materials. Each year during Sun Awareness Week, screening stations have been established across the country, staffed by volunteer dermatologists and members of the Canadian Cancer Society. In Vancouver between 1991 and 1993, 1767 people were screened for skin cancer. Results indicate that these events can attract people at risk for skin cancer, even though people older than age 65 are probably underrepresented as a group. Although popular with the public, these screenings are difficult to organize and are limited by human resources. These events continue in limited numbers, because they provide an excellent venue for the dissemination of educational material. Cooperation with federal agencies has been a major focus of the program. For the past 2 years, educational material on protecting newborns and children from the sun has been made available free to every new mother in Canada, while Environment Canada's Ultraviolet index program provides daily information on UV intensity along with public health messages. With the realization that health promotion requires a sustained change in behavior of an individual, we are now embarking on a national program to evaluate the knowledge, attitudes, and behavior of Canadians concerning UV radiation. With this information, we hope to adapt our educational materials so that people will adopt and maintain healthy behavior choices while out in the sun.
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Affiliation(s)
- J K Rivers
- Division of Dermatology, University of British Columbia, Vancouver, Canada
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Abstract
The incidence and mortality rates of skin cancer are rising in the United States and in many other countries. Concerns about stratospheric ozone depletion adding to the problem have made many organizations look at public and professional health programs as a possible solution. Early detection can reduce the problem in the short term, because mortality due to melanoma is clearly related to the depth of invasion of the tumor when it is removed. This is the factor which is amenable to change in an education program on early detection. Exposure to sunlight is clearly related to risk of development of skin cancer, including both melanoma and nonmelanoma skin cancers. This is the component of the equation of constitutional predisposition plus exposure to environmental risk factors leading to skin cancer that is amenable to change as a result of educational programs. On the basis of available data, there is a case for further development, provision, and evaluation of public and professional education programs designed to control what is becoming a major public health problem in the community.
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Affiliation(s)
- R Marks
- University of Melbourne, Department of Medicine, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Marks R. Skin cancer control in Australia: have we made any difference? AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1994; 18:127-8. [PMID: 7948326 DOI: 10.1111/j.1753-6405.1994.tb00212.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Burton RC, Coates MS, Hersey P, Roberts G, Chetty MP, Chen S, Hayes MH, Howe CG, Armstrong BK. An analysis of a melanoma epidemic. Int J Cancer 1993; 55:765-70. [PMID: 8244573 DOI: 10.1002/ijc.2910550512] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Between 1986 and 1988 the annual incidence of invasive melanoma in the Hunter area of New South Wales, Australia, almost doubled to 52.5 per 100,000 in men and 42.9 per 100,000 in women. These rates have been maintained and are similar to those reported for 1987 in Queensland, Australia, which are the highest in the world. Most of the increase in incidence was in melanomas less than 1.50 mm in thickness, and adults of both sexes and all ages were affected. Thicker melanomas also increased in incidence but only in adults 45 years and older, and mainly in men. An analysis of health insurance data on treatment of skin lesions and data from a histopathology laboratory suggested that diagnosis and treatment of skin lesions generally in the Hunter area had increased almost 2-fold over this period. Advancement of the time of diagnosis and a real increase in incidence were likely explanations for some of the observed trends. Increasing diagnosis of a non-metastasising form of thin melanoma, consequent upon increasing removal of pigmented skin lesions by medical practitioners, may also explain some of the observed increase in the incidence of the disease. This possibility has important implications for proposed population screening programs, and methods are needed to distinguish such lesions, if they exist, from potentially fatal melanoma.
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Affiliation(s)
- R C Burton
- Newcastle Melanoma Unit, Wallsend District Hospital, Wallsend, NSW
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