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Pham JP, Allen N, Star P, Cust AE, Stewart C, Guitera P, Marghoob AA, Smith A. Full-body skin examination in screening for cutaneous malignancy: a focus on concealed sites and the practices of Australian dermatologists. Int J Dermatol 2024; 63:467-473. [PMID: 38036942 DOI: 10.1111/ijd.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/01/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Full-body skin examination (FSE) is a vital practice in the diagnosis of cutaneous malignancy. Precisely how FSE should be conducted with respect to concealed site inclusion remains poorly elucidated. OBJECTIVE To establish the approach of Australian dermatologists to concealed site examination (CSE). METHODS A cross-sectional study was performed consisting of an online self-administered 11-question survey delivered to fellows of the Australasian College of Dermatologists. RESULTS There were 237 respondents. Anogenitalia was the least often examined concealed site (4.6%), and 59.9, 32.9, and 14.3% reported always examining the scalp, breasts, and oral mucosa, respectively. Patient concern was the most frequently cited factor prompting examination, while many cited low incidence of pathology and limited chaperone availability as the main barriers to routine examination of these sites. CONCLUSION Most Australian dermatologists do not routinely examine breasts, oral mucosal, or anogenital sites as part of an FSE. Emphasis should be made on identifying individual patient risk factors and education regarding self-examination of sensitive sites. A consensus approach to the conduct of the FSE, including concealed sites, is needed to better delineate clinician responsibilities and address medicolegal implications.
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Affiliation(s)
- James P Pham
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Darlinghurst, NSW, Australia
| | - Nicholas Allen
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Phoebe Star
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute of Australia, North Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Cameron Stewart
- Sydney Health Law, Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - Pascale Guitera
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute of Australia, North Sydney, NSW, Australia
| | - Ashfaq A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Annika Smith
- St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute of Australia, North Sydney, NSW, Australia
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Dunlop KLA, Singh N, Robbins HA, Zahed H, Johansson M, Rankin NM, Cust AE. Implementation considerations for risk-tailored cancer screening in the population: A scoping review. Prev Med 2024; 181:107897. [PMID: 38378124 DOI: 10.1016/j.ypmed.2024.107897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Risk-tailored screening has emerged as a promising approach to optimise the balance of benefits and harms of existing population cancer screening programs. It tailors screening (e.g., eligibility, frequency, interval, test type) to individual risk rather than the current one-size-fits-all approach of most organised population screening programs. However, the implementation of risk-tailored cancer screening in the population is challenging as it requires a change of practice at multiple levels i.e., individual, provider, health system levels. This scoping review aims to synthesise current implementation considerations for risk-tailored cancer screening in the population, identifying barriers, facilitators, and associated implementation outcomes. METHODS Relevant studies were identified via database searches up to February 2023. Results were synthesised using Tierney et al. (2020) guidance for evidence synthesis of implementation outcomes and a multilevel framework. RESULTS Of 4138 titles identified, 74 studies met the inclusion criteria. Most studies in this review focused on the implementation outcomes of acceptability, feasibility, and appropriateness, reflecting the pre-implementation stage of most research to date. Only six studies included an implementation framework. The review identified consistent evidence that risk-tailored screening is largely acceptable across population groups, however reluctance to accept a reduction in screening frequency for low-risk informed by cultural norms, presents a major barrier. Limited studies were identified for cancer types other than breast cancer. CONCLUSIONS Implementation strategies will need to address alternate models of delivery, education of health professionals, communication with the public, screening options for people at low risk of cancer, and inequity in outcomes across cancer types.
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Affiliation(s)
- Kate L A Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
| | - Nehal Singh
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Hilary A Robbins
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Hana Zahed
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Milley K, Druce P, McNamara M, Bergin RJ, Chan RJ, Cust AE, Davis N, Fishman G, Jefford M, Rankin N, Yates P, Emery J. Cancer in general practice research priorities in Australia. Aust J Gen Pract 2024; 53:227-234. [PMID: 38575544 DOI: 10.31128/ajgp-02-23-6699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVES The Primary Care Collaborative Cancer Clinical Trials Group (PC4) is funded by Cancer Australia to support the development of new cancer in primary care research. We undertook a research prioritisation exercise to identify cancer research priorities in Australian general practice. METHOD We adapted the nominal group technique, including a literature search and stakeholder survey. An expert group from the Primary Care Collaborative Cancer Clinical Trials Group consolidated and ranked priorities. A second stakeholder survey reviewing the top 50 priorities informed a final prioritisation workshop. RESULTS Overall, 311 priorities were identified across the cancer continuum. Nearly one-third of priorities were related to cancer survivorship and included strategies to detect recurrence, behavioural interventions and tools to assess physical and psychosocial aspects of survivorship. Prevention/early detection comprised 43.4% of priorities. Palliative care produced the least priorities (9.6%). Cross cutting research priorities (15.1%) included quality and models of care. DISCUSSION This is the first study to identify cancer research priorities for general practice in Australia. It could be used to inform the development of targeted research and funding to improve the care and outcomes for Australians affected by cancer.
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Affiliation(s)
- Kristi Milley
- BAppSci, PhD, National Manager, Primary Care Collaborative Cancer Clinical Trials Group (PC4), Department of General Practice, and Centre for Cancer Research, University of Melbourne, Vic
| | - Paige Druce
- BSc (Hons), MSc (Epi), Clinical Trial Network Coordinator, Monash University, Melbourne, Vic
| | - Mairead McNamara
- BAppSc, MDietPrac, Project Manager, Peter MacCallum Cancer Centre, Melbourne, Vic
| | - Rebecca J Bergin
- BA@Sc (Hons), PhD, Research Fellow, Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Vic; Department of General Practice/Centre for Cancer Research, University of Melbourne, Melbourne, Vic
| | - Raymond J Chan
- RN, BNurs, MAppSci, PhD, FACN, Director and Professor in Cancer Nursing, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA
| | - Anne E Cust
- MPH (Hons), PhD, Head of Cancer Epidemiology and Prevention Research Group, Sydney School of Public Health and Melanoma Institute Australia, University of Sydney, NSW; Professor of Cancer Epidemiology, Sydney Medical School, University of Sydney, NSW
| | - Nikki Davis
- PC4 Community Advisory Group, Primary Care Collaborative Cancer Clinical Trials Group, Melbourne, Vic
| | - George Fishman
- PC4 Community Advisory Group, Primary Care Collaborative Cancer Clinical Trials Group, Melbourne, Vic
| | - Michael Jefford
- MBBS, MPH, MHlthServMt, PhD, FRACP, Consultant Medical Oncologist, Department of Medical Oncology, Peter MacCallum Cancer Centre, Vic; Director, Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Vic; Lead, Survivorship and Living Well After Cancer Research, Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Vic; Professor, Sir Peter MacCallum Department of Oncology, University of Melbourne
| | - Nicole Rankin
- PhD, Head, Evaluation and Implementation Science Unit, The University of Sydney, Sydney, NSW
| | - Patsy Yates
- AM, PhD, RN, FACN, FAAN, Executive Dean of the Faculty of Health, Centre for Health Policy, The University of Melbourne, Melbourne, Vic
| | - Jon Emery
- MA, MBBCh, FRACGP, MRCGP, DPhil, Herman Professor of Primary Care Cancer Research, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Vic
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LA Dunlop K, Smit AK, Keogh LA, Newson AJ, Rankin NM, Cust AE. Acceptability of risk-tailored cancer screening among Australian GPs: a qualitative study. Br J Gen Pract 2024; 74:BJGP.2023.0117. [PMID: 38373853 PMCID: PMC10904141 DOI: 10.3399/bjgp.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/22/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Cancer screening that is tailored to individual risk has the potential to improve health outcomes and reduce screening-related harms, if implemented well. However, successful implementation depends on acceptability, particularly as this approach will require GPs to change their practice. AIM To explore Australian GPs' views about the acceptability of risk-tailored screening across cancer types and to identify barriers to and facilitators of implementation. DESIGN AND SETTING A qualitative study using semi-structured interviews with Australian GPs. METHOD Interviews were carried out with GPs and audio-recorded and transcribed. Data were first analysed inductively then deductively using an implementation framework. RESULTS Participants (n = 20) found risk-tailored screening to be acceptable in principle, recognising potential benefits in offering enhanced screening to those at highest risk. However, they had significant concerns that changes in screening advice could potentially cause confusion. They also reported that a reduced screening frequency or exclusion from a screening programme for those deemed low risk may not initially be acceptable, especially for common cancers with minimally invasive screening. Other reservations about implementing risk-tailored screening in general practice included a lack of high-quality evidence of benefit, fear of missing the signs or symptoms of a patient's cancer, and inadequate time with patients. While no single preferred approach to professional education was identified, education around communicating screening results and risk stratification was considered important. CONCLUSION GPs may not currently be convinced of the net benefits of risk-tailored screening. Development of accessible evidence-based guidelines, professional education, risk calculators, and targeted public messages will increase its feasibility in general practice.
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Affiliation(s)
- Kate LA Dunlop
- The Daffodil Centre, a joint venture with Cancer Council NSW and Melanoma Institute Australia, University of Sydney, Sydney
| | - Amelia K Smit
- The Daffodil Centre, a joint venture with Cancer Council NSW and Melanoma Institute Australia, University of Sydney, Sydney
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, University of Sydney, Sydney
| | - Nicole M Rankin
- Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Anne E Cust
- The Daffodil Centre, a joint venture with Cancer Council NSW and Melanoma Institute Australia, University of Sydney, Sydney
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Singh N, Dunlop KLA, Woolley N, Wills Vashishtha T, Damian DL, Vuong K, Cust AE, Smit AK. A review of skin cancer primary prevention activities in primary care settings. Public Health Res Pract 2024:34012401. [PMID: 38316050 DOI: 10.17061/phrp34012401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES Skin cancer is highly preventable through primary prevention activities such as avoiding ultraviolet radiation exposure during peak times and regular use of sun protection. General practitioners (GPs) and primary care nurses have key responsibilities in promoting sustained primary prevention behaviour. We aimed to review the evidence on skin cancer primary prevention activities in primary care settings, including evidence on feasibility, effectiveness, barriers and enablers. STUDY TYPE Rapid review and narrative synthesis. METHODS We searched published literature from January 2011 to October 2022 in Embase, Medline, PsychInfo, Scopus, Cochrane Central and CINAHL. The search was limited to skin cancer primary prevention activities within primary care settings, for studies or programs conducted in Australia or countries with comparable health systems. Analysis of barriers and enablers was informed by an implementation science framework. RESULTS A total of 31 peer-reviewed journal articles were included in the review. We identified four main primary prevention activities: education and training programs for GPs; behavioural counselling on prevention; the use of novel risk assessment tools and provision of risk-tailored prevention strategies; and new technologies to support early detection that have accompanying primary prevention advice. Enablers to delivering skin cancer primary prevention in primary care included pairing preventive activities with early detection activities, and access to patient resources and programs that fit with existing workflows and systems. Barriers included unclear requirements for skin cancer prevention counselling, competing demands within the consultation and limited access to primary care services, especially in regional and remote areas. CONCLUSIONS These findings highlight potential opportunities for improving skin cancer prevention activities in primary care. Ensuring ease of program delivery, integration with early detection and availability of resources such as risk assessment tools are enablers to encourage and increase uptake of primary prevention behaviours in primary care, for both practitioners and patients.
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Affiliation(s)
- Nehal Singh
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Australia
| | - Kate LA Dunlop
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Australia; Melanoma Institute Australia, University of Sydney, NSW, Australia
| | | | | | - Diona L Damian
- Melanoma Institute Australia, University of Sydney, NSW, Australia ; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Dermatology, Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Kylie Vuong
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia ; School of Population Health, UNSW Sydney, Australia
| | - Anne E Cust
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Australia; Melanoma Institute Australia, University of Sydney, NSW, Australia ; Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Amelia K Smit
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Australia; Melanoma Institute Australia, University of Sydney, NSW, Australia ; Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, NSW, Australia;
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Smith J, Cust AE, Lo SN. Risk factors for subsequent primary melanoma in patients with previous melanoma: a systematic review and meta-analysis. Br J Dermatol 2024; 190:174-183. [PMID: 37562043 DOI: 10.1093/bjd/ljad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Compared with the general population, people with a previous melanoma are at increased risk of developing another primary melanoma. Understanding the risk factors associated with multiple primary melanomas can inform patient education and tailored surveillance. OBJECTIVES To examine the risk factors for subsequent primary melanoma in people with a previous melanoma, by conducting a systematic review and meta-analysis of the available data. METHODS A systematic literature search was conducted in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase and MEDLINE. Studies that reported a risk estimate or raw frequencies and conducted between 1982 and August 2022 were included. Adjusted risk estimates were prioritized over univariable risk estimates. PRISMA reporting guidelines were followed. Random effects meta-analysis was conducted to derive pooled estimates. Quality assessment was conducted by two researchers using the Newcastle-Ottawa scale. GRADE was used to rate the certainty and quality of the evidence. RESULTS Data from 27 studies involving 413 181 participants were pooled and analysed. Risk factors assessed included age and sex, environmental, lifestyle, phenotypic, genetic and histopathological factors, and there was wide variation in how they were categorized and analysed. Independent risk factors identified from pooled analyses included male sex [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.40-1.53], increasing age per 10 years (HR 1.19, 95% CI 1.14-1.24), light skin colour (HR 1.44, 95% CI 1.23-1.70), family history [odds ratio (OR) 1.79, 95% CI 1.25-2.56], CDKN2A mutation (OR 5.29, 95% CI 2.70-10.37), a high or moderate naevus count [OR 2.63 (95% CI 1.61-4.30) and OR 1.64 (95% CI 1.07-2.51), respectively], one or more atypical naevi (OR 3.01, 95% CI 1.52-5.97), first lesions occurring on the head or neck, lentigo maligna subtype (HR 1.16, 95% CI 1.15-1.17), other subtype (HR 1.14, 95% CI 1.03-1.27) and inadequate sun protection (HR 1.85, 95% CI 0.98-3.50). Based on the GRADE criteria, there was high to very low confidence in the pooled effect estimates. CONCLUSIONS This meta-analysis identified several consistent, independent risk factors for the development of subsequent primary melanoma. These findings will help stratify the risk of subsequent melanoma, tailor skin-check schedules and inform patient education.
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Affiliation(s)
- Juliet Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia
- Sydney School of Public Health
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia
- Sydney School of Public Health
| | - Serigne N Lo
- Melanoma Institute Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ni Y, Watts CG, Scolyer RA, Madronio C, Armstrong BK, Morton RL, Menzies SW, Mann GJ, Thompson JF, Cust AE, Lo SN. Prognosis for people with multiple primary melanomas compared with a single primary melanoma. J Am Acad Dermatol 2024; 90:170-174. [PMID: 37714220 DOI: 10.1016/j.jaad.2023.08.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Yuan Ni
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Caroline G Watts
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia; The Kirby Institute UNSW, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Christine Madronio
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bruce K Armstrong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; School of Population and Global Health, The University of WA, Perth, WA, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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8
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Smit AK, Cust AE. Unpacking factors contributing to melanoma overdiagnosis: does polygenic risk play a role? Br J Dermatol 2023; 190:4-5. [PMID: 37942844 DOI: 10.1093/bjd/ljad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 10/25/2023] [Accepted: 09/21/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Dunlop KLA, Keogh LA, Smith AL, Aranda S, Aitken J, Watts CG, Smit AK, Janda M, Mann GJ, Cust AE, Rankin NM. Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants. PLoS One 2023; 18:e0287591. [PMID: 38091281 PMCID: PMC10718433 DOI: 10.1371/journal.pone.0287591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers. METHODS This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist. RESULTS Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging. CONCLUSION Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.
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Affiliation(s)
- Kate L. A. Dunlop
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A. Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea L. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sanchia Aranda
- School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Caroline G. Watts
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Surveillance, Evaluation & Research Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amelia K. Smit
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Graham J. Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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10
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Law CK, Cust AE, Smit AK, Trevena L, Fernandez-Penas P, Nieweg OE, Menzies AM, Wordsworth S, Morton RL. Long-term cost-effectiveness of a melanoma prevention program using genomic risk information compared with standard prevention advice in Australia. Genet Med 2023; 25:100970. [PMID: 37658729 DOI: 10.1016/j.gim.2023.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE Evidence indicates that a melanoma prevention program using personalized genomic risk provision and genetic counseling can affect prevention behaviors, including reducing sunburns in adults with no melanoma history. This analysis evaluated its longer-term cost-effectiveness from an Australian health system perspective. METHODS The primary outcome was incremental cost effectiveness ratio (ICER) of genomic risk provision (intervention) compared with standard prevention advice. A decision-analytic Markov model was developed using randomized trial data to simulate lifetime cost-effectiveness. All costs were presented in 2018/19 Australian dollars (AUD). The intervention effect on reduced sunburns was stratified by sex and traditional risk, which was calculated through a validated prediction model. Deterministic and probabilistic sensitivity analyses were undertaken for robustness checks. RESULTS The per participant cost of intervention was AUD$189. Genomic risk provision targeting high-traditional risk individuals produced an ICER of AUD$35,254 (per quality-adjusted life year gained); sensitivity analyses indicated the intervention would be cost-effective in more than 50% of scenarios. When the intervention was extended to low-traditional risk groups, the ICER was AUD$43,746 with a 45% probability of being cost-effective. CONCLUSION Genomic risk provision targeted to high-traditional melanoma risk individuals is likely a cost-effective strategy for reducing sunburns and will likely prevent future melanomas and keratinocyte carcinomas.
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Affiliation(s)
- Chi Kin Law
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia; School of Public Health, The University of Sydney, Sydney, Australia
| | - Amelia K Smit
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia; School of Public Health, The University of Sydney, Sydney, Australia
| | - Lyndal Trevena
- School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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11
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Koh U, Cust AE, Fernández-Peñas P, Mann G, Morton R, Wolfe R, Payne E, Horsham C, Kwaan G, Mahumud RA, Sashindranath M, Soyer HP, Mar V, Janda M. ACEMID cohort study: protocol of a prospective cohort study using 3D total body photography for melanoma imaging and diagnosis. BMJ Open 2023; 13:e072788. [PMID: 37770274 PMCID: PMC10546123 DOI: 10.1136/bmjopen-2023-072788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/20/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Three-dimensional (3D) total body photography may improve early detection of melanoma and facilitate surveillance, leading to better prognosis and lower healthcare costs. The Australian Centre of Excellence in Melanoma Imaging and Diagnosis (ACEMID) cohort study will assess long-term outcomes from delivery of a precision strategy of monitoring skin lesions using skin surface imaging technology embedded into health services across Australia. METHODS AND ANALYSIS A prospective cohort study will enrol 15 000 participants aged 18 years and above, across 15 Australian sites. Participants will attend study visits according to their melanoma risk category: very high risk, high risk or low/average risk, every 6, 12 and 24 months, respectively, over 3 years. Participants will undergo 3D total body photography and dermoscopy imaging at study visits. A baseline questionnaire will be administered to collect sociodemographic, phenotypic, quality of life and sun behaviour data. A follow-up questionnaire will be administered every 12 months to obtain changes in sun behaviour and quality of life. A saliva sample will be collected at the baseline visit from a subsample. ETHICS AND DISSEMINATION The ACEMID cohort study was approved by the Metro South Health Human Research Ethics Committee (approval number: HREC/2019/QMS/57206) and the University of Queensland Human Research Ethics Committee (approval number: 2019003077). The findings will be reported through peer-reviewed and lay publications and presentations at conferences. TRIAL REGISTRATION NUMBER ACTRN12619001706167.
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Affiliation(s)
- Uyen Koh
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne E Cust
- The Daffodil Centre (A Joint Venture with Cancer Council NSW), The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Fernández-Peñas
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Graham Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rachael Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Payne
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Grace Kwaan
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maithili Sashindranath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Hans Peter Soyer
- Frazer Institute, Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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12
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Gibbs DC, Thomas NE, Kanetsky PA, Luo L, Busam KJ, Cust AE, Anton-Culver H, Gallagher RP, Zanetti R, Rosso S, Sacchetto L, Edmiston SN, Conway K, Ollila DW, Begg CB, Berwick M, Ward SV, Orlow I. Association of functional, inherited vitamin D-binding protein variants with melanoma-specific death. JNCI Cancer Spectr 2023; 7:pkad051. [PMID: 37494457 PMCID: PMC10496570 DOI: 10.1093/jncics/pkad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND It is unclear whether genetic variants affecting vitamin D metabolism are associated with melanoma prognosis. Two functional missense variants in the vitamin D-binding protein gene (GC), rs7041 and rs4588, determine 3 common haplotypes, Gc1s, Gc1f, and Gc2, of which Gc1f may be associated with decreased all-cause death among melanoma patients based on results of a prior study, but the association of Gc1f with melanoma-specific death is unclear. METHODS We investigated the association of the Gc1s, Gc1f, and Gc2 haplotypes with melanoma-specific and all-cause death among 4490 individuals with incident, invasive primary melanoma in 2 population-based studies using multivariable Cox-proportional hazards regression. RESULTS In the pooled analysis of both datasets, the patients with the Gc1f haplotype had a 37% lower risk of melanoma-specific death than the patients without Gc1f (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.47 to 0.83, P = .001), with adjustments for age, sex, study center, first- or higher-order primary melanoma, tumor site, pigmentary phenotypes, and Breslow thickness. Associations were similar in both studies. In pooled analyses stratified by Breslow thickness, the corresponding melanoma-specific death HRs for those patients with the Gc1f haplotype compared with those without Gc1f were 0.89 (95% CI = 0.63 to 1.27) among participants with tumor Breslow thickness equal to or less than 2.0 mm and 0.40 (95% CI = 0.25 to 0.63) among participants with tumor Breslow thickness greater than 2.0 mm (Pinteraction = .003). CONCLUSIONS Our findings suggest that individuals with the GC haplotype Gc1f may have a lower risk of dying from melanoma-specifically from thicker, higher-risk melanoma-than individuals without this Gc1f haplotype.
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Affiliation(s)
| | - Nancy E Thomas
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Klaus J Busam
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anne E Cust
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, CA, USA
| | - Richard P Gallagher
- Cancer Control Research, British Columbia Cancer and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Roberto Zanetti
- Center for Cancer Prevention, Piedmont Cancer Registry, Torino, Italy
- Fondo Elena Moroni for Oncology, Torino, Italy
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Stefano Rosso
- Center for Cancer Prevention, Piedmont Cancer Registry, Torino, Italy
- Fondo Elena Moroni for Oncology, Torino, Italy
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Lidia Sacchetto
- Center for Cancer Prevention, Piedmont Cancer Registry, Torino, Italy
- Fondo Elena Moroni for Oncology, Torino, Italy
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon N Edmiston
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen Conway
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings Global School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - David W Ollila
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Sarah V Ward
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Blake SC, Guitera P, Cust AE, Galea C, Lo SN, Scolyer RA, Armstrong BK, Thompson JF, Menzies SW, Madronio C, Morton RL, Mann GJ, Watts CG. The association of dermatologist demographic density with melanoma survival in New South Wales, Australia. Australas J Dermatol 2023; 64:425-429. [PMID: 37353974 PMCID: PMC10953459 DOI: 10.1111/ajd.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Stephanie C. Blake
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Pascale Guitera
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Sydney Melanoma Diagnostic CentreRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Anne E. Cust
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- The Daffodil CentreThe University of Sydney, A Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Claire Galea
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Serigne N. Lo
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Richard A. Scolyer
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
- Tissue Pathology and Diagnostic OncologyRoyal Prince Alfred Hospital and NSW Health PathologySydneyNew South WalesAustralia
- Charles Perkins CentreThe University of SydneySydneyNew South WalesAustralia
| | - Bruce K. Armstrong
- Sydney School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- School of Population and Global Health, Population and Public HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - John F. Thompson
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Scott W. Menzies
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Christine Madronio
- Faculty of Medicine and Health, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Rachael L. Morton
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- NHMRC Clinical Trials CentreThe University of SydneySydneyNew South WalesAustralia
| | - Graham J. Mann
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- The John Curtin School of Medical ResearchAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Caroline G. Watts
- The Daffodil CentreThe University of Sydney, A Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
- Surveillance and Evaluation Research Program, Kirby InstituteUniversity of New South WalesSydneyNew South WalesAustralia
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14
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Adler NR, Cust AE, Mar VJ, Martin LK, Guitera P. Reply to: 'Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance'. Australas J Dermatol 2023; 64:e307-e308. [PMID: 37228230 PMCID: PMC10952183 DOI: 10.1111/ajd.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Nikki R. Adler
- Victorian Melanoma ServiceAlfred HospitalMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Anne E. Cust
- The Daffodil CentreThe University of Sydney, a Joint Venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Victoria J. Mar
- Victorian Melanoma ServiceAlfred HospitalMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Linda K. Martin
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine & HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Pascale Guitera
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Sydney Melanoma Diagnostic CentreRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
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15
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Cust AE, Scolyer RA. Melanoma In Situ-Getting the Diagnosis and Prognosis Right. JAMA Dermatol 2023:2805526. [PMID: 37285137 DOI: 10.1001/jamadermatol.2023.1485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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16
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Goldstein AM, Qin R, Chu EY, Elder DE, Massi D, Adams DJ, Harms PW, Robles-Espinoza CD, Newton-Bishop JA, Bishop DT, Harland M, Holland EA, Cust AE, Schmid H, Mann GJ, Puig S, Potrony M, Alos L, Nagore E, Millán-Esteban D, Hayward NK, Broit N, Palmer JM, Nathan V, Berry EG, Astiazaran-Symonds E, Yang XR, Tucker MA, Landi MT, Pfeiffer RM, Sargen MR. Association of germline variants in telomere maintenance genes ( POT1, TERF2IP, ACD, and TERT) with spitzoid morphology in familial melanoma: A multi-center case series. JAAD Int 2023; 11:43-51. [PMID: 36876055 PMCID: PMC9978843 DOI: 10.1016/j.jdin.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Background Spitzoid morphology in familial melanoma has been associated with germline variants in POT1, a telomere maintenance gene (TMG), suggesting a link between telomere biology and spitzoid differentiation. Objective To assess if familial melanoma cases associated with germline variants in TMG (POT1, ACD, TERF2IP, and TERT) commonly exhibit spitzoid morphology. Methods In this case series, melanomas were classified as having spitzoid morphology if at least 3 of 4 dermatopathologists reported this finding in ≥25% of tumor cells. Logistic regression was used to calculate odds ratios (OR) of spitzoid morphology compared to familial melanomas from unmatched noncarriers that were previously reviewed by a National Cancer Institute dermatopathologist. Results Spitzoid morphology was observed in 77% (23 of 30), 75% (3 of 4), 50% (2 of 4), and 50% (1 of 2) of melanomas from individuals with germline variants in POT1, TERF2IP, ACD, and TERT, respectively. Compared to noncarriers (n = 139 melanomas), POT1 carriers (OR = 225.1, 95% confidence interval: 51.7-980.5; P < .001) and individuals with TERF2IP, ACD, and TERT variants (OR = 82.4, 95% confidence interval: 21.3-494.6; P < .001) had increased odds of spitzoid morphology. Limitations Findings may not be generalizable to nonfamilial melanoma cases. Conclusion Spitzoid morphology in familial melanoma could suggest germline alteration of TMG.
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Affiliation(s)
- Alisa M. Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Richard Qin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Emily Y. Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E. Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniela Massi
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - David J. Adams
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, England
| | - Paul W. Harms
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Carla Daniela Robles-Espinoza
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, England
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Campus Juriquilla, Santiago de Querétaro, Qro, Mexico
| | - Julia A. Newton-Bishop
- Division of Haematology and Immunology, Institute of Medical Research at St James’s, University of Leeds, Leeds, England
| | - D. Timothy Bishop
- Division of Haematology and Immunology, Institute of Medical Research at St James’s, University of Leeds, Leeds, England
| | - Mark Harland
- Division of Haematology and Immunology, Institute of Medical Research at St James’s, University of Leeds, Leeds, England
| | - Elizabeth A. Holland
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Sydney, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Helen Schmid
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Sydney, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Graham J. Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona University, Barcelona, Spain
- Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Miriam Potrony
- Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
- Melanoma Unit, Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, IDIBAPS, Barcelona University, Barcelona, Spain
| | - Llucia Alos
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eduardo Nagore
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain
- School of Medicine, Universidad Católica de València San Vicente Mártir, València, Spain
| | - David Millán-Esteban
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain
- School of Medicine, Universidad Católica de València San Vicente Mártir, València, Spain
| | | | - Natasa Broit
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Jane M. Palmer
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Vaishnavi Nathan
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Elizabeth G. Berry
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Xiaohong R. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Margaret A. Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Michael R. Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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17
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Wallingford CK, Demeshko A, Krishnakripa AK, Smit D, Duffy DL, Betz-Stablein B, Pflugfelder A, Jagirdar K, Holland E, Mann GJ, Primiero CA, Yanes T, Malvehy J, Badenas C, Carrera C, Aguilera P, Olsen C, Ward SV, Haass NK, Sturm RA, Puig S, Whiteman D, Law MH, Cust AE, Potrony M, Soyer H P, McInerney-Leo AM. The MC1R r allele does not increase melanoma risk in MITF E318K carriers. Br J Dermatol 2023; 188:770-776. [PMID: 36879448 PMCID: PMC10230961 DOI: 10.1093/bjd/ljad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/18/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Population-wide screening for melanoma is not cost-effective, but genetic characterization could facilitate risk stratification and targeted screening. Common Melanocortin-1 receptor (MC1R) red hair colour (RHC) variants and Microphthalmia-associated transcription factor (MITF) E318K separately confer moderate melanoma susceptibility, but their interactive effects are relatively unexplored. OBJECTIVES To evaluate whether MC1R genotypes differentially affect melanoma risk in MITF E318K+ vs. E318K- individuals. MATERIALS AND METHODS Melanoma status (affected or unaffected) and genotype data (MC1R and MITF E318K) were collated from research cohorts (five Australian and two European). In addition, RHC genotypes from E318K+ individuals with and without melanoma were extracted from databases (The Cancer Genome Atlas and Medical Genome Research Bank, respectively). χ2 and logistic regression were used to evaluate RHC allele and genotype frequencies within E318K+/- cohorts depending on melanoma status. Replication analysis was conducted on 200 000 general-population exomes (UK Biobank). RESULTS The cohort comprised 1165 MITF E318K- and 322 E318K+ individuals. In E318K- cases MC1R R and r alleles increased melanoma risk relative to wild type (wt), P < 0.001 for both. Similarly, each MC1R RHC genotype (R/R, R/r, R/wt, r/r and r/wt) increased melanoma risk relative to wt/wt (P < 0.001 for all). In E318K+ cases, R alleles increased melanoma risk relative to the wt allele [odds ratio (OR) 2.04 (95% confidence interval 1.67-2.49); P = 0.01], while the r allele risk was comparable with the wt allele [OR 0.78 (0.54-1.14) vs. 1.00, respectively]. E318K+ cases with the r/r genotype had a lower but not significant melanoma risk relative to wt/wt [OR 0.52 (0.20-1.38)]. Within the E318K+ cohort, R genotypes (R/R, R/r and R/wt) conferred a significantly higher risk compared with non-R genotypes (r/r, r/wt and wt/wt) (P < 0.001). UK Biobank data supported our findings that r did not increase melanoma risk in E318K+ individuals. CONCLUSIONS RHC alleles/genotypes modify melanoma risk differently in MITF E318K- and E318K+ individuals. Specifically, although all RHC alleles increase risk relative to wt in E318K- individuals, only MC1R R increases melanoma risk in E318K+ individuals. Importantly, in the E318K+ cohort the MC1R r allele risk is comparable with wt. These findings could inform counselling and management for MITF E318K+ individuals.
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Affiliation(s)
- Courtney K Wallingford
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Anastassia Demeshko
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | | | - Darren J Smit
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - David L Duffy
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Brigid Betz-Stablein
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Annette Pflugfelder
- Center of Dermato-Oncology, Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Kasturee Jagirdar
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- Biochemistry and Molecular Biology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Holland
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Graham J Mann
- The Melanoma Institute Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Clare A Primiero
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Tatiane Yanes
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Josep Malvehy
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Cèlia Badenas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Paula Aguilera
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Catherine M Olsen
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Sarah V Ward
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Nikolas K Haass
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Richard A Sturm
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
| | - Susana Puig
- Dermatology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - David C Whiteman
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD, 4006, Australia
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- The Melanoma Institute Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Miriam Potrony
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - H Peter Soyer
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Aideen M McInerney-Leo
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
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Ward SV, Autuori I, Luo L, LaPilla E, Yoo S, Sharma A, Busam KJ, Olilla DW, Dwyer T, Anton-Culver H, Zanetti R, Sacchetto L, Cust AE, Gallagher RP, Kanetsky PA, Rosso S, Begg CB, Berwick M, Thomas NE, Orlow I. Sex-Specific Associations of MDM2 and MDM4 Variants with Risk of Multiple Primary Melanomas and Melanoma Survival in Non-Hispanic Whites. Cancers (Basel) 2023; 15:2707. [PMID: 37345045 PMCID: PMC10216616 DOI: 10.3390/cancers15102707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
MDM2-SNP309 (rs2279744), a common genetic modifier of cancer incidence in Li-Fraumeni syndrome, modifies risk, age of onset, or prognosis in a variety of cancers. Melanoma incidence and outcomes vary by sex, and although SNP309 exerts an effect on the estrogen receptor, no consensus exists on its effect on melanoma. MDM2 and MDM4 restrain p53-mediated tumor suppression, independently or together. We investigated SNP309, an a priori MDM4-rs4245739, and two coinherited variants, in a population-based cohort of 3663 primary incident melanomas. Per-allele and per-haplotype (MDM2_SNP309-SNP285; MDM4_rs4245739-rs1563828) odds ratios (OR) for multiple-melanoma were estimated with logistic regression models. Hazard ratios (HR) for melanoma death were estimated with Cox proportional hazards models. In analyses adjusted for covariates, females carrying MDM4-rs4245739*C were more likely to develop multiple melanomas (ORper-allele = 1.25, 95% CI 1.03-1.51, and Ptrend = 0.03), while MDM2-rs2279744*G was inversely associated with melanoma-death (HRper-allele = 0.63, 95% CI 0.42-0.95, and Ptrend = 0.03). We identified 16 coinherited expression quantitative loci that control the expression of MDM2, MDM4, and other genes in the skin, brain, and lungs. Our results suggest that MDM4/MDM2 variants are associated with the development of subsequent primaries and with the death of melanoma in a sex-dependent manner. Further investigations of the complex MDM2/MDM4 motif, and its contribution to the tumor microenvironment and observed associations, are warranted.
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Affiliation(s)
- Sarah V. Ward
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Isidora Autuori
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Li Luo
- Department of Internal Medicine, The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87106, USA
| | - Emily LaPilla
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sarah Yoo
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ajay Sharma
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Klaus J. Busam
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - David W. Olilla
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Terence Dwyer
- Clinical Sciences Theme, Heart Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, VIC 3010, Australia
- Oxford Martin School, University of Oxford, Oxford OX1 3BD, UK
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Hoda Anton-Culver
- Department of Medicine, University of California, Irvine, CA 92617, USA
| | - Roberto Zanetti
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, 10126 Turin, Italy
| | - Lidia Sacchetto
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, 10126 Turin, Italy
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW 2006, Australia
- Melanoma Institute Australia, The University of Sydney, Wollstonecraft, NSW 2065, Australia
| | - Richard P. Gallagher
- BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC V5Z 4E8, Canada
| | - Peter A. Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Stefano Rosso
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, 10126 Turin, Italy
| | - Colin B. Begg
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Marianne Berwick
- Department of Internal Medicine, The University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87106, USA
| | - Nancy E. Thomas
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27514, USA
- Department of Dermatology, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Irene Orlow
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Reyes-Marcelino G, McLoughlin K, Harrison C, Watts CG, Kang YJ, Aranda S, Aitken JF, Guitera P, Cust AE. Skin cancer-related conditions managed in general practice in Australia, 2000-2016: a nationally representative, cross-sectional survey. BMJ Open 2023; 13:e067744. [PMID: 37142316 DOI: 10.1136/bmjopen-2022-067744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE Skin cancer is Australia's most common and costly cancer. We examined the frequency of Australian general practice consultations for skin cancer-related conditions, by patient and general practitioner (GP) characteristics and by time period. DESIGN Nationally representative, cross-sectional survey of general practice clinical activity. SETTING, PARTICIPANTS Patients aged 15 years or older having a skin cancer-related condition managed by GPs in the Bettering the Evaluation And Care of Health study between April 2000 and March 2016. PRIMARY OUTCOME MEASURES Proportions and rates per 1000 encounters. RESULTS In this period, 15 678 GPs recorded 1 370 826 patient encounters, of which skin cancer-related conditions were managed 65 411 times (rate of 47.72 per 1000 encounters, 95% CI 46.41 to 49.02). Across the whole period, 'skin conditions' managed were solar keratosis (29.87%), keratinocyte cancer (24.85%), other skin lesion (12.93%), nevi (10.98%), skin check (10.37%), benign skin neoplasm (8.76%) and melanoma (2.42%). Over time, management rates increased for keratinocyte cancers, skin checks, skin lesions, benign skin neoplasms and melanoma; but remained stable for solar keratoses and nevi. Skin cancer-related encounter rates were higher for patients aged 65-89 years, male, living in Queensland or in regional or remote areas, with lower area-based socioeconomic status, of English-speaking background, Veteran card holders and non-healthcare card holders; and for GPs who were aged 35-44 years or male. CONCLUSION These findings show the spectrum and burden of skin cancer-related conditions managed in general practice in Australia, which can guide GP education, policy and interventions to optimise skin cancer prevention and management.
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Affiliation(s)
- Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Kirstie McLoughlin
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Caroline G Watts
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Yoon-Jung Kang
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sanchia Aranda
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
- Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Spanos S, Singh N, Laginha BI, Arnolda G, Wilkinson D, Smith AL, Cust AE, Braithwaite J, Rapport F. Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol 2023; 64:177-193. [PMID: 36960976 PMCID: PMC10952799 DOI: 10.1111/ajd.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Bela I. Laginha
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - David Wilkinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- National Skin Cancer CentresSouth BrisbaneQueenslandAustralia
| | - Andrea L. Smith
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Anne E. Cust
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
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21
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Bhave P, Wong J, McInerney-Leo A, Cust AE, Lawn C, Janda M, Mar VJ. Management of cutaneous melanoma in Australia: a narrative review. Med J Aust 2023; 218:426-431. [PMID: 37120760 DOI: 10.5694/mja2.51910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/05/2023] [Accepted: 02/28/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Prachi Bhave
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC
- Alfred Hospital, Melbourne, VIC
| | | | - Aideen McInerney-Leo
- Dermatology Research Centre, University of Queensland Diamantina Institute for Cancer Immunology and Metabolic Medicine, Brisbane, QLD
- Australian Centre of Excellence in Melanoma Imaging, Brisbane, QLD
| | - Anne E Cust
- Australian Centre of Excellence in Melanoma Imaging, Brisbane, QLD
- Melanoma Institute Australia, Sydney, NSW
| | - Craig Lawn
- Melanoma Institute Australia, Sydney, NSW
- Centre of Excellence in Melanoma Imaging, Brisbane, QLD
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Victoria J Mar
- Alfred Hospital, Melbourne, VIC
- Monash University, Melbourne, VIC
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Karki S, Bell KJL, Hayen A, Liu B, Cust AE, Olynyk JK, Irving DO. Regular high-frequency whole blood donation and risk of cardiovascular disease in middle-aged and older blood donors in Australia. Transfusion 2023; 63:1012-1022. [PMID: 37057641 DOI: 10.1111/trf.17358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Previous mixed findings on the associations between whole blood (WB) donation and risk of cardiovascular diseases (CVD) may in part reflect inadequate adjustment for the "healthy donor effect" (HDE). METHODS We used the Sax Institute's 45 and Up Study linked with blood donation history and other health-related databases to examine the association between regular, high-frequency WB donation and the risk of CVD. To mitigate the impact of HDE, we used a "5-years qualification period," in which donors must donate at least 1 WB donation in the 1st and 5th year of "qualification period." We then compared the risk of CVD in the years following the "qualification period" between the regular high-frequency WB donors (≥2 WB donation in each qualification year) and others using Cox proportional-hazards models. Analyses were adjusted for potential confounders, such as sociodemographic, lifestyle, and health-related variables, and results are reported separately for male and female donors. RESULTS A total of 2736 male and 2917 female donors were included in the analyses. The median years of follow-up per donor was 5.84 years (Q1-Q3, 5.47-6.23). The rate of CVD hospitalization was 11.20 and 4.50 per 1000 person-years for males and females, respectively. In fully adjusted models, the risk (hazard ratio) of CVD in regular high-frequency donors compared to other donors was 0.93 (95% Confidence Interval (CI), 0.68-1.29) for males and 0.79 (95% CI, 0.49-1.28) for females. CONCLUSIONS We did not observe a statistically significant reduction of CVD risk in regular, high-frequency WB donors when adjusted for potential confounders.
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Affiliation(s)
- Surendra Karki
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
- School of Population Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology, Sydney, New South Wales, Australia
| | - Bette Liu
- School of Population Health, UNSW Australia, Sydney, New South Wales, Australia
| | - Anne E Cust
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - John K Olynyk
- School of Health and Medical Sciences, Edith Cowan University, Bull Creek, Western Australia, Australia
| | - David O Irving
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
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23
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Yan MK, Cust AE, Soyer HP, Janda M, Loewe K, Byars G, Fishburn P, White P, Mahumud RA, Saw RPM, Herschtal A, Fernandez-Penas P, Guitera P, Morton RL, Kelly J, Wolfe R, Mar VJ. Study protocol for a randomised controlled trial to evaluate the use of melanoma surveillance photography to the Improve early detection of MelanomA in ultra-hiGh and high-risk patiEnts (the IMAGE trial). Trials 2023; 24:236. [PMID: 36991460 DOI: 10.1186/s13063-023-07203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Melanoma surveillance photography (MSP) is a comprehensive surveillance method that comprises two- or three-dimensional total body photography with tagged digital dermoscopy, performed at prescribed intervals. It has the potential to reduce unnecessary biopsies and enhance early detection of melanoma, but it is not yet standard care for all high-risk patients in Australia. This protocol describes a randomised controlled trial (RCT) designed to evaluate the clinical impact and cost-effectiveness of using MSP for the surveillance of individuals at ultra-high or high risk of melanoma from a health system perspective. METHODS AND DESIGN This is a registry-based, unblinded, multi-site, parallel-arm RCT that will be conducted over 3 years. We aim to recruit 580 participants from three Australian states: Victoria, New South Wales and Queensland, via state cancer registries or direct referral from clinicians. Eligible participants within 24 months of a primary cutaneous melanoma diagnosis will be randomised 1:1 to receive either MSP in addition to their routine clinical surveillance (intervention group) or routine clinical surveillance without MSP (control group). Most participants will continue surveillance with their usual care provider, and the frequency of follow-up visits in both groups will depend on the stage of their primary melanoma and risk factors. The primary outcome measure of the study is the number of unnecessary biopsies (i.e. false positives, being cases where a lesion is biopsied due to suspected melanoma on clinical examination, either with or without MSP, but the resulting histopathology finding is negative for melanoma). Secondary outcomes include the evaluation of health economic outcomes, quality of life and patient acceptability. Two sub-studies will explore the benefit of MSP in high-risk patients prior to a melanoma diagnosis and the diagnostic performance of MSP in the teledermatology setting compared to the en face clinical setting. DISCUSSION This trial will determine the clinical efficacy, cost-effectiveness and affordability of MSP to facilitate policy decision-making at the national and local levels, across primary and specialist care. TRIAL REGISTRATION ClinicalTrials.gov NCT04385732 . Registered on May 13, 2020.
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Affiliation(s)
- Mabel K Yan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, Australia.
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
- Dermatology Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Katja Loewe
- Melanoma and Skin Cancer Research Centre, Monash University, Melbourne, VIC, Australia
| | - Gabrielle Byars
- Melanoma and Skin Cancer Research Centre, Monash University, Melbourne, VIC, Australia
| | - Paul Fishburn
- Norwest Skin Cancer Centre, Bella Vista, New South Wales, Australia
| | - Paul White
- Melanoma and Skin Cancer Research Centre, Monash University, Melbourne, VIC, Australia
| | | | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alan Herschtal
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - John Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Victoria J Mar
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC, Australia
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24
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Ni Y, Watts CG, Scolyer RA, Madronio C, Armstrong BK, Morton RL, Menzies SW, Mann GJ, Thompson JF, Lo SN, Cust AE. Risk of developing a second primary melanoma after a first primary melanoma in a population-based Australian cohort. Br J Dermatol 2023; 188:814-816. [PMID: 36946230 DOI: 10.1093/bjd/ljad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
The cross-sectional survey identified risk factors for developing a second primary melanoma. Melanoma patients with characteristics such as male sex, older age, high nevus count, or melanoma on the trunk or upper limbs have a substantially higher risk of subsequent melanoma and therefore should be monitored with priority accordingly.
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Affiliation(s)
- Yuan Ni
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Caroline G Watts
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- The Kirby Institute UNSW, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Christine Madronio
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Bruce K Armstrong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- School of Population and Global Health, The University of WA, Perth, WA, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Anne E Cust
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Zhang R, Smit AK, Espinoza D, Allen M, Reyes-Marcelino G, Kimlin MG, Lo SN, Sharman AR, Law MH, Kanetsky PA, Mann GJ, Cust AE. Validation of self-reported sun exposure against electronic ultraviolet radiation dosimeters. Int J Epidemiol 2023; 52:324-328. [PMID: 36153755 DOI: 10.1093/ije/dyac179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/14/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ran Zhang
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Amelia K Smit
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Allen
- MacDiarmid Institute for Advanced Materials and Nanotechnology, Electrical and Computer Engineering, University of Canterbury, Christchurch, New Zealand
| | - Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Michael G Kimlin
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Ashleigh R Sharman
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matthew H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland University of Technology (QUT), Brisbane, Australia
| | | | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, ANU, Canberra, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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Young MA, Yanes T, Cust AE, Dunlop K, Limb S, Newson AJ, Purvis R, Thiyagarajan L, Scott RJ, Verma K, James PA, Steinberg J. Human Genetics Society of Australasia Position Statement: Use of Polygenic Scores in Clinical Practice and Population Health. Twin Res Hum Genet 2023; 26:40-48. [PMID: 36950972 DOI: 10.1017/thg.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Considerable progress continues to be made with regards to the value and use of disease associated polygenic scores (PGS). PGS aim to capture a person's genetic liability to a condition, disease, or a trait, combining information across many risk variants and incorporating their effect sizes. They are already available for clinicians and consumers to order in Australasia. However, debate is ongoing over the readiness of this information for integration into clinical practice and population health. This position statement provides the viewpoint of the Human Genetics Society of Australasia (HGSA) regarding the clinical application of disease-associated PGS in both individual patients and population health. The statement details how PGS are calculated, highlights their breadth of possible application, and examines their current challenges and limitations. We consider fundamental lessons from Mendelian genetics and their continuing relevance to PGS, while also acknowledging the distinct elements of PGS. Use of PGS in practice should be evidence based, and the evidence for the associated benefit, while rapidly emerging, remains limited. Given that clinicians and consumers can already order PGS, their current limitations and key issues warrant consideration. PGS can be developed for most complex conditions and traits and can be used across multiple clinical settings and for population health. The HGSA's view is that further evaluation, including regulatory, implementation and health system evaluation are required before PGS can be routinely implemented in the Australasian healthcare system.
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Affiliation(s)
- Mary-Anne Young
- Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne E Cust
- The Melanoma Institute Australia, The University of Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kate Dunlop
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Sharne Limb
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Ainsley J Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics. Sydney, New South Wales, Australia
| | - Rebecca Purvis
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Lavvina Thiyagarajan
- The University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Rodney J Scott
- School of Biomedical Sciences and Pharmacy, College of Health and Wellbeing, University of Newcastle, New South Wales, Australia
- Division of Molecular Medicine, NSW Health Pathology North, New Lambton, Newcastle, New South Wales, Australia
| | - Kunal Verma
- Monash Genetics, Monash Health, Melbourn, Victoria, Australia
- Monash Heart, Monash Health, Victoria, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
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Ho G, Smith A, Cust AE, Melhoranse-Gouveia B, Collgros H, Martin L, Guitera P. Reflectance confocal microscopy in Australia: Perspectives on barriers to implementation and uptake. Australas J Dermatol 2023; 64:e109-e111. [PMID: 36412240 DOI: 10.1111/ajd.13954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Genevieve Ho
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia
| | - Andrea Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia.,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Bruna Melhoranse-Gouveia
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Australia
| | - Helena Collgros
- Faculty of Medicine and Health, University of Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia
| | - Linda Martin
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, North Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, New South Wales, Sydney, Australia
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28
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Orlow I, Sadeghi KD, Edmiston SN, Kenney JM, Lezcano C, Wilmott JS, Cust AE, Scolyer RA, Mann GJ, Lee TK, Burke H, Jakrot V, Shang P, Ferguson PM, Boyce TW, Ko JS, Ngo P, Funchain P, Rees JR, O'Connell K, Hao H, Parrish E, Conway K, Googe PB, Ollila DW, Moschos SJ, Hernando E, Hanniford D, Argibay D, Amos CI, Lee JE, Osman I, Luo L, Kuan PF, Aurora A, Gould Rothberg BE, Bosenberg MW, Gerstenblith MR, Thompson C, Bogner PN, Gorlov IP, Holmen SL, Brunsgaard EK, Saenger YM, Shen R, Seshan V, Nagore E, Ernstoff MS, Busam KJ, Begg CB, Thomas NE, Berwick M. InterMEL: An international biorepository and clinical database to uncover predictors of survival in early-stage melanoma. PLoS One 2023; 18:e0269324. [PMID: 37011054 PMCID: PMC10069769 DOI: 10.1371/journal.pone.0269324] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION We are conducting a multicenter study to identify classifiers predictive of disease-specific survival in patients with primary melanomas. Here we delineate the unique aspects, challenges, and best practices for optimizing a study of generally small-sized pigmented tumor samples including primary melanomas of at least 1.05mm from AJTCC TNM stage IIA-IIID patients. We also evaluated tissue-derived predictors of extracted nucleic acids' quality and success in downstream testing. This ongoing study will target 1,000 melanomas within the international InterMEL consortium. METHODS Following a pre-established protocol, participating centers ship formalin-fixed paraffin embedded (FFPE) tissue sections to Memorial Sloan Kettering Cancer Center for the centralized handling, dermatopathology review and histology-guided coextraction of RNA and DNA. Samples are distributed for evaluation of somatic mutations using next gen sequencing (NGS) with the MSK-IMPACTTM assay, methylation-profiling (Infinium MethylationEPIC arrays), and miRNA expression (Nanostring nCounter Human v3 miRNA Expression Assay). RESULTS Sufficient material was obtained for screening of miRNA expression in 683/685 (99%) eligible melanomas, methylation in 467 (68%), and somatic mutations in 560 (82%). In 446/685 (65%) cases, aliquots of RNA/DNA were sufficient for testing with all three platforms. Among samples evaluated by the time of this analysis, the mean NGS coverage was 249x, 59 (18.6%) samples had coverage below 100x, and 41/414 (10%) failed methylation QC due to low intensity probes or insufficient Meta-Mixed Interquartile (BMIQ)- and single sample (ss)- Noob normalizations. Six of 683 RNAs (1%) failed Nanostring QC due to the low proportion of probes above the minimum threshold. Age of the FFPE tissue blocks (p<0.001) and time elapsed from sectioning to co-extraction (p = 0.002) were associated with methylation screening failures. Melanin reduced the ability to amplify fragments of 200bp or greater (absent/lightly pigmented vs heavily pigmented, p<0.003). Conversely, heavily pigmented tumors rendered greater amounts of RNA (p<0.001), and of RNA above 200 nucleotides (p<0.001). CONCLUSION Our experience with many archival tissues demonstrates that with careful management of tissue processing and quality control it is possible to conduct multi-omic studies in a complex multi-institutional setting for investigations involving minute quantities of FFPE tumors, as in studies of early-stage melanoma. The study describes, for the first time, the optimal strategy for obtaining archival and limited tumor tissue, the characteristics of the nucleic acids co-extracted from a unique cell lysate, and success rate in downstream applications. In addition, our findings provide an estimate of the anticipated attrition that will guide other large multicenter research and consortia.
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Affiliation(s)
- Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Keimya D Sadeghi
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Sharon N Edmiston
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jessica M Kenney
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Tim K Lee
- British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Hazel Burke
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Valerie Jakrot
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Ping Shang
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter M Ferguson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - Tawny W Boyce
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Peter Ngo
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Pauline Funchain
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States of America
| | - Kelli O'Connell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Honglin Hao
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Eloise Parrish
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen Conway
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Paul B Googe
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - David W Ollila
- Department of Surgery, Division of Surgical Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stergios J Moschos
- Department of Medicine, Division of Medical Oncology, The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, United States of America
| | - Eva Hernando
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Douglas Hanniford
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Diana Argibay
- Department of Pathology, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Christopher I Amos
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jeffrey E Lee
- Department of Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Iman Osman
- Department of Urology, New York University Grossman School of Medicine, New York, NY, United States of America
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
- Department of Dermatology, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Pei-Fen Kuan
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, United States of America
| | - Arshi Aurora
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Bonnie E Gould Rothberg
- Smilow Cancer Hospital, Yale-New Haven Health System, New Haven, Connecticut, United States of America
| | - Marcus W Bosenberg
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Meg R Gerstenblith
- Department of Dermatology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Cheryl Thompson
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Paul N Bogner
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Ivan P Gorlov
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Sheri L Holmen
- Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Elise K Brunsgaard
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Yvonne M Saenger
- Department of Medicine, Division of Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, United States of America
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Ronglai Shen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Venkatraman Seshan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Marc S Ernstoff
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, ImmunoOncology Branch, Developmental Therapeutics Program, Rockville, Maryland, United States of America
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Nancy E Thomas
- Department of Dermatology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
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So C, McCarthy D, Watts CG, Kearney C, Reyes-Marcelino G, Goldsbury DE, McLoughlin K, Emery J, Cust AE. Diagnostic biopsies of suspected skin cancer in general practice from 2010 to 2017 in Victoria, Australia. Br J Dermatol 2022; 188:560-561. [PMID: 36689340 DOI: 10.1093/bjd/ljac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Chi So
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Caroline G Watts
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.,Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | | | - Gillian Reyes-Marcelino
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.,The Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - David E Goldsbury
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Kirstie McLoughlin
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Jon Emery
- Department of General Practice.,Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Cust
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia.,The Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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30
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Drabarek D, Habgood E, Ackermann D, Hersch J, Janda M, Morton RL, Guitera P, Soyer HP, Collgros H, Cust AE, Saw RP, Emery J, Mar V, Dieng M, Azzi A, Lilleyman A, Bell KJ. Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study. JMIR Dermatol 2022; 5:e40623. [PMID: 37632906 PMCID: PMC10334935 DOI: 10.2196/40623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/24/2022] [Accepted: 11/19/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The growing number of melanoma patients who need long-term surveillance increasingly exceeds the capacity of the dermatology workforce, particularly outside of metropolitan areas. Digital technologies that enable patients to perform skin self-examination and send dermoscopic images of lesions of concern to a dermatologist (mobile teledermoscopy) are a potential solution. If these technologies and the remote delivery of melanoma surveillance are to be incorporated into routine clinical practice, they need to be accepted by clinicians providing melanoma care, such as dermatologists and general practitioners (GPs). OBJECTIVE This study aimed to explore perceptions of potential benefits and harms of mobile teledermoscopy, as well as experiences with this technology, among clinicians participating in a pilot randomized controlled trial (RCT) of patient-led melanoma surveillance. METHODS This qualitative study was nested within a pilot RCT conducted at dermatologist and skin specialist GP-led melanoma clinics in New South Wales, Australia. We conducted semistructured interviews with 8 of the total 11 clinicians who were involved in the trial, including 4 dermatologists (3 provided teledermatology, 2 were treating clinicians), 1 surgical oncologist, and 3 GPs with qualifications in skin cancer screening (the remaining 3 GPs declined an interview). Thematic analysis was used to analyze the data with reference to the concepts of "medical overuse" and "high-value care." RESULTS Clinicians identified several potential benefits, including increased access to dermatology services, earlier detection of melanomas, reassurance for patients between scheduled visits, and a reduction in unnecessary clinic visits. However, they also identified some potential concerns regarding the use of the technology and remote monitoring that could result in diagnostic uncertainty. These included poor image quality, difficulty making assessments from a 2D digital image (even if good quality), insufficient clinical history provided, and concern that suspicious lesions may have been missed by the patient. Clinicians thought that uncertainty arising from these concerns, together with perceived potential medicolegal consequences from missing a diagnosis, might lead to increases in unnecessary clinic visits and procedures. Strategies suggested for achieving high-value care included managing clinical uncertainty to decrease the potential for medical overuse and ensuring optimal placement of patient-led teledermoscopy within existing clinical care pathways to increase the potential for benefits. CONCLUSIONS Clinicians were enthusiastic about the potential and experienced benefits of mobile teledermoscopy; however, managing clinical uncertainty will be necessary to achieve these benefits in clinical care outside of trial contexts and minimize potential harms from medical overuse. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12616001716459; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865.
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Affiliation(s)
- Dorothy Drabarek
- School of Public Health, University of Sydney, Sydney, Australia
| | - Emily Habgood
- Centre for Cancer Research, Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Deonna Ackermann
- School of Public Health, University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- School of Public Health, University of Sydney, Sydney, Australia
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Rachael L Morton
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - H Peter Soyer
- Frazer Institute, University of Queensland, Dermatology Research Centre, Brisbane, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Helena Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Anne E Cust
- School of Public Health, University of Sydney, Sydney, Australia
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- The Daffodil Centre, University of Sydney, Sydney, Australia
| | - Robyn Pm Saw
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Melanoma Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mbathio Dieng
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | | | - Katy Jl Bell
- School of Public Health, University of Sydney, Sydney, Australia
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Luo L, Shen R, Arora A, Orlow I, Busam KJ, Lezcano C, Lee TK, Hernando E, Gorlov I, Amos C, Ernstoff MS, Seshan VE, Cust AE, Wilmott J, Scolyer R, Mann G, Nagore E, Funchain P, Ko J, Ngo P, Edmiston SN, Conway K, Googe PB, Ollila D, Lee JE, Fang S, Rees JR, Thompson CL, Gerstenblith M, Bosenberg M, Gould Rothberg B, Osman I, Saenger Y, Reynolds AZ, Schwartz M, Boyce T, Holmen S, Brunsgaard E, Bogner P, Kuan PF, Wiggins C, Thomas N, Begg CB, Berwick M. Landscape of mutations in early stage primary cutaneous melanoma: An InterMEL study. Pigment Cell Melanoma Res 2022; 35:605-612. [PMID: 35876628 PMCID: PMC9640183 DOI: 10.1111/pcmr.13058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
It is unclear why some melanomas aggressively metastasize while others remain indolent. Available studies employing multi-omic profiling of melanomas are based on large primary or metastatic tumors. We examine the genomic landscape of early-stage melanomas diagnosed prior to the modern era of immunological treatments. Untreated cases with Stage II/III cutaneous melanoma were identified from institutions throughout the United States, Australia and Spain. FFPE tumor sections were profiled for mutation, methylation and microRNAs. Preliminary results from mutation profiling and clinical pathologic correlates show the distribution of four driver mutation sub-types: 31% BRAF; 18% NRAS; 21% NF1; 26% Triple Wild Type. BRAF mutant tumors had younger age at diagnosis, more associated nevi, more tumor infiltrating lymphocytes, and fewer thick tumors although at generally more advanced stage. NF1 mutant tumors were frequent on the head/neck in older patients with severe solar elastosis, thicker tumors but in earlier stages. Triple Wild Type tumors were predominantly male, frequently on the leg, with more perineural invasion. Mutations in TERT, TP53, CDKN2A and ARID2 were observed often, with TP53 mutations occurring particularly frequently in the NF1 sub-type. The InterMEL study will provide the most extensive multi-omic profiling of early-stage melanoma to date. Initial results demonstrate a nuanced understanding of the mutational and clinicopathological landscape of these early-stage tumors.
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Smith AL, Watts CG, Henderson M, Long GV, Rapport F, Saw RPM, Scolyer RA, Spillane AJ, Thompson JF, Cust AE. Factors influencing acceptance, adoption and adherence to sentinel node biopsy recommendations in the Australian Melanoma Management Guidelines: a qualitative study using an implementation science framework. Implement Sci Commun 2022; 3:103. [PMID: 36183121 PMCID: PMC9526940 DOI: 10.1186/s43058-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sentinel node biopsy (SN biopsy) is a surgical procedure used to accurately stage patients with primary melanoma at high risk of recurrence. Although Australian Melanoma Management Guidelines recommend SN biopsy be considered in patients with melanomas > 1 mm thick, SN biopsy rates in Australia are reportedly low. Our objective was to identify factors impacting the acceptance, adoption and adherence to the Australian SN biopsy guideline recommendations. METHODS Opinions of Australian key informants including clinicians, representatives from melanoma education and training providers, professional associations and colleges, and melanoma advocacy organisations were collected through semi-structured interviews (n = 29) and from publicly released statements (n = 14 news articles). Data analysis involved inductive and deductive thematic analysis using Flottorp's determinants framework. RESULTS A complex interplay of contemporary and historical factors was identified as influencing acceptance, adoption and adherence to the SN biopsy guideline recommendations at the individual, guideline, patient, organisational and social levels. Expert and peer opinion leaders have played an important role in facilitating or inhibiting adoption of guideline recommendations, as have financial incentives driven by healthcare-funding policies and non-financial incentives including professional identity and standing. Of critical importance have been the social and knowledge boundaries that exist between different professional groups to whom the guidelines apply (surgeons, dermatologists and primary care practitioners) with adherence to the guideline recommendations having the potential to shift work across professional boundaries, altering a clinician's workflow and revenue. More recently, the emergence of effective immunotherapies and targeted therapies for patients at high risk of recurrence, the emergence of new opinion leaders on the topic (in medical oncology), and patient demands for accurate staging are playing crucial roles in overcoming the resistance to change created by these social and knowledge boundaries. CONCLUSIONS Acceptance and adherence to SN biopsy guideline recommendations in Australia over the past 20 years has involved a process of renegotiation and reframing of the evidence for SN biopsy in melanoma by clinicians from different professional groups and networks. This process has helped to refine the evidence for SN biopsy and our understanding of appropriate adoption. New effective systemic therapies have changed the balance towards accepting guideline recommendations.
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Affiliation(s)
- Andrea L. Smith
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia ,grid.1004.50000 0001 2158 5405Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia
| | - Caroline G. Watts
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Surveillance, Epidemiology and Research Program, Kirby Institute, University of New South Wales, Sydney, NSW Australia
| | - Michael Henderson
- grid.1055.10000000403978434Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Georgina V. Long
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW Australia ,grid.513227.0Mater Hospital, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia
| | - Frances Rapport
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia
| | - Robyn P. M. Saw
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.513227.0Mater Hospital, Sydney, NSW Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Richard A. Scolyer
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XCharles Perkins Centre, The University of Sydney, Sydney, NSW Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Sydney, NSW Australia ,grid.416088.30000 0001 0753 1056NSW Health Pathology, Sydney, NSW Australia
| | - Andrew J. Spillane
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW Australia ,grid.513227.0Mater Hospital, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, NSW Australia
| | - John F. Thompson
- grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia ,grid.413249.90000 0004 0385 0051Royal Prince Alfred Hospital, Sydney, NSW Australia
| | - Anne E. Cust
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XMelanoma Institute Australia, The University of Sydney, Sydney, NSW Australia
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Dunlop KLA, Rankin NM, Smit AK, Newson AJ, Keogh LA, Cust AE. Views of the Australian public on the delivery of risk-stratified cancer screening in the population: a qualitative study. Public Health Res Pract 2022:32232213. [PMID: 36065020 DOI: 10.17061/phrp32232213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective and importance of study: Risk-stratified approaches to cancer screening aim to provide tailored risk advice to individuals, rather than the mostly one-size-fits-all approach designed for the average person that is currently used in Australia. Stratified cancer screening has the potential to increase the benefits and reduce the harms of screening. Initial risk assessment is a crucial first step for screening programs that use risk stratification. We report findings from a qualitative study exploring the views of the Australian public on how to best deliver risk-stratified cancer screening in the population to help inform future implementation. STUDY TYPE Qualitative interview study. METHODS We conducted semistructured interviews with participants from a previous study, half of whom had received personal genomic risk information and half of whom had not. We asked how and where they would like to see risk-stratified screening delivered and how they felt about different health professionals assessing their cancer risk. Data were analysed thematically. RESULTS Forty interviews were conducted. The age range of participants was 21-68 years; 58% were female. Themes included: 1) Convenience is a priority; 2) General practice is a good fit for some; 3) Web-based technology is part of the process; and 4) "I would want to know why [I was being stratified]". Similar views were expressed by both groups. Our findings suggest that although health professionals were identified as having an important role, there were mixed preferences for delivery by general practitioners, medical specialists or nurses. Participants were less concerned about who undertook the risk assessment than whether the health professional had the appropriate skill set and availability. Clear communication and evidence of the need for change in screening eligibility and frequency were key factors in the successful delivery of risk-stratified screening. CONCLUSION We identified that convenience and good communication, including clear explanations to the public with convincing evidence for change, will enable the successful delivery of risk-stratified cancer screening in the population, including organised and opportunistic screening approaches. Health professional education and upskilling across disciplines will be key facilitators. Engagement and further consultation with primary care and other key stakeholders will be central.
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Affiliation(s)
- Kate LA Dunlop
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, University of Sydney, NSW;
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Amelia K Smit
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, University of Sydney, NSW
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Anne E Cust
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, University of Sydney, NSW
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Drabarek D, Habgood E, Janda M, Hersch J, Ackermann D, Low D, Low C, Morton RL, Dieng M, Cust AE, Morgan A, Smith E, Bell KLJ. Experiences of Patient-Led Surveillance, Including Patient-Performed Teledermoscopy, in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study. JMIR Dermatol 2022; 5:e35916. [PMID: 37632893 PMCID: PMC10334928 DOI: 10.2196/35916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Current clinician-led melanoma surveillance models require frequent routinely scheduled clinic visits, with associated travel, cost, and time burden for patients. Patient-led surveillance is a new model of follow-up care that could reduce health care use such as clinic visits and medical procedures and their associated costs, increase access to care, and promote early diagnosis of a subsequent new melanoma after treatment of a primary melanoma. Understanding patient experiences may allow improvements in implementation. OBJECTIVE This study aims to explore patients' experiences and perceptions of patient-led surveillance during the 6 months of participation in the MEL-SELF pilot randomized controlled trial. Patient-led surveillance comprised regular skin self-examination, use of a mobile dermatoscope to image lesions of concern, and a smartphone app to track and send images to a teledermatologist for review, in addition to usual care. METHODS Semistructured interviews were conducted with patients previously treated for melanoma localized to the skin in New South Wales, Australia, who were randomized to the patient-led surveillance (intervention group) in the trial. Thematic analysis was used to analyze the data with reference to the technology acceptance model. RESULTS We interviewed 20 patients (n=8, 40% women and n=12, 60% men; median age 62 years). Patients who were more adherent experienced benefits such as increased awareness of their skin and improved skin self-examination practice, early detection of melanomas, and opportunities to be proactive in managing their clinical follow-up. Most participants experienced difficulty in obtaining clear images and technical problems with the app. These barriers were overcome or persevered by participants with previous experience with digital technology and with effective help from a skin check partner (such as a spouse, sibling, or friend). Having too many or too few moles decreased perceived usefulness. CONCLUSIONS Patients with melanoma are receptive to and experience benefits from patient-led surveillance using teledermoscopy. Increased provision of training and technical support to patients and their skin check partners may help to realize the full potential benefits of this new model of melanoma surveillance.
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Affiliation(s)
- Dorothy Drabarek
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Emily Habgood
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Jolyn Hersch
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Deonna Ackermann
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Don Low
- Cancer Voices NSW, Sydney, Australia
| | | | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Adelaide Morgan
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Elloise Smith
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Katy L J Bell
- Sydney School of Public Health, University of Sydney, Sydney, Australia
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Laginha BI, Rapport F, Smith A, Wilkinson D, Cust AE, Braithwaite J. Systematic development of quality indicators for skin cancer management in primary care: a mixed-methods study protocol. BMJ Open 2022; 12:e059829. [PMID: 35725249 PMCID: PMC9214379 DOI: 10.1136/bmjopen-2021-059829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Australia has the highest incidence of skin cancer in the world, with two out of three Australians expected to be diagnosed with skin cancer in their lifetime. Such incidence necessitates large-scale, effective skin cancer management practices. General practitioners (in mainstream practice and in skin cancer clinics) play an important role in skin cancer care provision, making decisions based on relevant evidence-based guidelines, protocols, experience and training. Diversity in these decision-making practices can result in unwarranted variation. Quality indicators are frequently implemented in healthcare contexts to measure performance quality at the level of the clinician and healthcare practice and mitigate unwarranted variation. Such measurements can facilitate performance comparisons between peers and a standard benchmark, often resulting in improved processes and outcomes. A standardised set of quality indicators is yet to be developed in the context of primary care skin cancer management. AIMS This research aims to identify, develop and generate expert consensus on a core set of quality indicators for skin cancer management in primary care. METHODS This mixed-methods study involves (1) a scoping review of the available evidence on quality indicators in skin cancer management in primary care, (2) identification and development of a core set of quality indicators through interviews/qualitative proforma surveys with participants, and (3) a focus group involving discussion of quality indicators according to Nominal Group Technique. Qualitative and quantitative data will be collected and analysed using thematic and descriptive statistical analytical methods. ETHICS AND DISSEMINATION Approval was granted by the university's Research Ethics Committee (HREC no. 520211051532420). Results from this study will be widely disseminated in publications, study presentations, educational events and reports.
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Affiliation(s)
- Bela Ines Laginha
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrea Smith
- University of Sydney, a joint venture with Cancer Council NSW, The Daffodil Centre, Sydney, New South Wales, Australia
| | - David Wilkinson
- National Skin Cancer Centres, South Brisbane, Queensland, Australia
| | - Anne E Cust
- University of Sydney, a joint venture with Cancer Council NSW, The Daffodil Centre, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Law CK, Smit AK, Cust AE, Trevena L, Penas PF, Nieweg OE, Menzies AM, Wordsworth S, Morton RL. Cost-effectiveness of targeted genomic risk provision to prevent skin cancer: Results of a randomized trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10536 Background: Many melanomas and keratinocyte cancers (KC) are preventable by reducing sun exposure and improving sun protection behaviors. Recent evidence indicates a melanoma prevention program involving personalized genomic risk information provision can reduce self-reported sunburns at 12 months in Australian adults with no history of melanoma. This was alongside genetic counselling and educational materials on skin cancer prevention and early detection. However, the economic impact of this approach was unclear. This study aimed to determine the cost-effectiveness of the program to prevent melanoma and KC. Methods: A decision-analytic Markov model was developed to simulate the lifetime cost-effectiveness of personalized genomic risk provision compared with standard prevention advice alone, from a health system perspective. We used data from the Melanoma Genomics Managing Your Risk Study Randomized Control Trial. Traditional risk was measured by a validated melanoma risk prediction model involving hair color, nevus density, history of non-melanoma skin cancer, family history of melanoma, level of sunbed sessions. Quality-adjusted life years (QALY) gained was the primary outcome measure used to estimate an incremental cost-effectiveness ratio (ICER). Both deterministic and probabilistic sensitivity analyses (PSA) were undertaken. Results: The cost of the genomic testing and risk counselling program was AUD$189 (USD$132) per participant. Genomic risk provision targeting high-traditional risk individuals was the most cost-effective lifetime strategy with an ICER of AUD$23,033 (USD$16,059) per QALY gained and an 80% probability of being cost-effective at a willingness-to-pay threshold of AUD$50,000, compared with standard preventive advice (Table). When genomic risk provision was extended to low-traditional risk groups the ICER was $43,746 (USD30,500) per QALY gained with a 45% probability of being cost-effective. Conclusions: Genomic risk provision targeted to individuals at high-traditional risk of melanoma is a cost-effective strategy for the prevention of melanoma and KCs. Long-term sustainability of the program’s effect should be examined in future research. Clinical trial information: ACTRN12617000691347. [Table: see text]
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Affiliation(s)
- Chi Kin Law
- NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, NSW, Australia
| | - Amelia K Smit
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne E. Cust
- Sydney School of Public Health, and Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Lyndal Trevena
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Pablo Fernandez Penas
- Department of Dermatology, Westmead Hospital/Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Omgo E. Nieweg
- Melanoma Institute Australia, Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia
| | - Alexander M. Menzies
- Melanoma Institute Australia, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of population health, Oxford, United Kingdom
| | - Rachael L. Morton
- Melanoma Institute Australia, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
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Tan K, Lo SN, Cust AE, Wolfe R, Mar V. Sensitivity of two Australian melanoma risk tools to identify high-risk individuals among people presenting with their first primary melanoma. Australas J Dermatol 2022; 63:352-358. [PMID: 35522684 DOI: 10.1111/ajd.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/08/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022]
Abstract
AIMS Regular skin examinations for early detection of melanoma are recommended for high-risk individuals, but there is minimal consensus regarding what constitutes 'high-risk'. Melanoma risk prediction models may guide this. We compared two online melanoma risk prediction tools: Victorian Melanoma Service (VMS) and Melanoma Institute Australia (MIA) risk tools; to assess classification differences of patients at high-risk of a first primary melanoma. METHODS Risk factor data for 357 patients presenting with their first primary melanoma were entered into both risk tools. Predicted risks were recorded: 5-year absolute risk (VMS tool and MIA tool); 10-year, lifetime, and relative risk estimates (MIA tool). Sensitivities for each tool were calculated using the same high-risk thresholds. The MIA risk tool showed greater sensitivity on comparison of 5-year absolute risks (90% MIA vs 78% VMS). Patients had significantly higher odds of being classified as high or very-high risk using the MIA risk tool overall, and for each patient subgroup. Using either tool, patients of male gender or with synchronous multiple first primary melanomas were more likely to be correctly classified as high- or very-high risk using 5-year absolute risk thresholds; but tumour invasiveness was unrelated to risk. Classification differed when using the MIA risk categories based on relative risk. CONCLUSIONS Both melanoma risk prediction tools had high sensitivity for identifying individuals at high-risk and could be used for optimising prevention campaigns. The choice of which risk tool, measure, and threshold for risk stratification depends on the intended purpose of risk prediction, and ideally requires information on specificity.
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Affiliation(s)
- Katrina Tan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
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Arnold M, Singh D, Laversanne M, Vignat J, Vaccarella S, Meheus F, Cust AE, de Vries E, Whiteman DC, Bray F. Global Burden of Cutaneous Melanoma in 2020 and Projections to 2040. JAMA Dermatol 2022; 158:495-503. [PMID: 35353115 PMCID: PMC8968696 DOI: 10.1001/jamadermatol.2022.0160] [Citation(s) in RCA: 215] [Impact Index Per Article: 107.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
Importance Despite many cases being preventable, cutaneous melanoma remains the most serious skin cancer worldwide. Understanding the scale and profile of the disease is vital to concentrate and reinforce global prevention efforts. Objective To examine global patterns of cutaneous melanoma in 2020 and to provide projected estimates of cases and deaths by 2040. Design, Setting, and Participants This population-based study used the GLOBOCAN 2020 database for global epidemiological assessment of new cases and deaths due to invasive melanoma. Main Outcomes and Measures Age-standardized incidence and mortality rates were calculated per 100 000 person-years by country, world region, and 4-tier level of human development. Estimated numbers of cases and deaths were calculated for the year 2040. Results A worldwide total of 325 000 new melanoma cases (174 000 males, 151 000 females) and 57 000 deaths (32 000 males, 25 000 females) was estimated for 2020. Large geographic variations existed across countries and world regions, with the highest incidence rates among males (42 per 100 000 person-years) and females (31 per 100 000 person-years) observed in Australia/New Zealand, followed by Western Europe (19 per 100 000 person-years for males and females), North America (18 per 100 000 person-years for males, 14 per 100 000 person-years for females), and Northern Europe (17 per 100 000 person-years for males, 18 per 100 000 person-years for females). Melanoma continued to be rare in most African and Asian countries, with incidence rates commonly less than 1 per 100 000 person-years. Mortality rates peaked at 5 per 100 000 person-years in New Zealand, and geographic variations were less pronounced than for incidence. Melanoma was more frequent among males than females in most world regions. If 2020 rates continue, the burden from melanoma is estimated to increase to 510 000 new cases (a roughly 50% increase) and to 96 000 deaths (a 68% increase) by 2040. Conclusions and Relevance This epidemiological assessment suggests that melanoma remains an important challenge to cancer control and public health globally, especially in fair-skinned populations of European descent.
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Affiliation(s)
- Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney with Cancer Council New South Wales, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - David C. Whiteman
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Steinberg J, Iles MM, Lee JY, Wang X, Law MH, Smit AK, Nguyen‐Dumont T, Giles GG, Southey MC, Milne RL, Mann GJ, Bishop DT, MacInnis RJ, Cust AE. Independent evaluation of melanoma polygenic risk scores in UK and Australian prospective cohorts. Br J Dermatol 2022; 186:823-834. [PMID: 34921685 PMCID: PMC9545863 DOI: 10.1111/bjd.20956] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/11/2021] [Accepted: 12/11/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND Previous studies suggest that polygenic risk scores (PRSs) may improve melanoma risk stratification. However, there has been limited independent validation of PRS-based risk prediction, particularly assessment of calibration (comparing predicted to observed risks). OBJECTIVES To evaluate PRS-based melanoma risk prediction in prospective UK and Australian cohorts with European ancestry. METHODS We analysed invasive melanoma incidence in the UK Biobank (UKB; n = 395 647, 1651 cases) and a case-cohort nested within the Melbourne Collaborative Cohort Study (MCCS, Australia; n = 4765, 303 cases). Three PRSs were evaluated: 68 single-nucleotide polymorphisms (SNPs) at 54 loci from a 2020 meta-analysis (PRS68), 50 SNPs significant in the 2020 meta-analysis excluding UKB (PRS50) and 45 SNPs at 21 loci known in 2018 (PRS45). Ten-year melanoma risks were calculated from population-level cancer registry data by age group and sex, with and without PRS adjustment. RESULTS Predicted absolute melanoma risks based on age and sex alone underestimated melanoma incidence in the UKB [ratio of expected/observed cases: E/O = 0·65, 95% confidence interval (CI) 0·62-0·68] and MCCS (E/O = 0·63, 95% CI 0·56-0·72). For UKB, calibration was improved by PRS adjustment, with PRS50-adjusted risks E/O = 0·91, 95% CI 0·87-0·95. The discriminative ability for PRS68- and PRS50-adjusted absolute risks was higher than for risks based on age and sex alone (Δ area under the curve 0·07-0·10, P < 0·0001), and higher than for PRS45-adjusted risks (Δ area under the curve 0·02-0·04, P < 0·001). CONCLUSIONS A PRS derived from a larger, more diverse meta-analysis improves risk prediction compared with an earlier PRS, and might help tailor melanoma prevention and early detection strategies to different risk levels. Recalibration of absolute risks may be necessary for application to specific populations.
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Affiliation(s)
- Julia Steinberg
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
| | - Mark M. Iles
- Leeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Jin Yee Lee
- School of Public HealthThe University of SydneySydneyNSWAustralia
| | - Xiaochuan Wang
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVICAustralia
| | - Matthew H. Law
- Statistical Genetics LaboratoryQIMR Berghofer Medical Research InstituteBrisbaneQLDAustralia
- School of Biomedical Sciences, Faculty of Health, and Institute of Health and Biomedical InnovationQueensland University of TechnologyKelvin GroveQLDAustralia
| | - Amelia K. Smit
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
| | - Tu Nguyen‐Dumont
- Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVICAustralia
- Department of Clinical PathologyThe University of MelbourneMelbourneVICAustralia
| | - Graham G. Giles
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVICAustralia
- Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVICAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVICAustralia
| | - Melissa C. Southey
- Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVICAustralia
| | - Roger L. Milne
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVICAustralia
- Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVICAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVICAustralia
| | - Graham J. Mann
- John Curtin School of Medical ResearchAustralian National UniversityCanberraACTAustralia
| | | | - Robert J. MacInnis
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVICAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVICAustralia
| | - Anne E. Cust
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
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Preston P, Sinclair C, Cust AE, Olsen CM. Skin cancer - time for national leadership to meet critical challenges ahead. Public Health Res Pract 2022; 32:3212201. [PMID: 35290992 DOI: 10.17061/phrp3212201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Paige Preston
- Cancer Council Queensland, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia
| | - Craig Sinclair
- Cancer Council Victoria, Melbourne, Australia; University of Queensland, Brisbane, Australia; Queensland University of Technology, Brisbane, Australia;
| | - Anne E Cust
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Australia; Melanoma Institute Australia, University of Sydney, NSW, Australia
| | - Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
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Janda M, Olsen CM, Mar V, Cust AE. Early detection of skin cancer in Australia - current approaches and new opportunities. Public Health Res Pract 2022; 32:3212204. [PMID: 35290997 DOI: 10.17061/phrp3212204] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives and importance of study: Melanoma and keratinocyte carcinomas impose a significant health and financial burden on the Australian population and healthcare system. The impacts of skin cancer can be minimised through early detection, as morbidity, mortality and costs of treatment are strongly associated with stage of disease at diagnosis. STUDY TYPE Narrative review. METHODS Building on the discussions from the Melanoma Screening Summit held in Brisbane, Australia, in 2019, we reviewed evidence related to current approaches and new opportunities for early detection of melanoma and other skin cancers. RESULTS Population-based melanoma screening is not currently recommended due to insufficient evidence that screening reduces melanoma mortality. Instead, in most countries including Australia, early detection of melanoma and keratinocyte carcinomas is undertaken opportunistically, by either the patient presenting for a routine skin check or with a lesion of concern, or by the doctor detecting a lesion incidentally. Several concerns about the current unstructured approach to skin cancer early detection have been identified, including variable quality of care, sociodemographic inequalities in medical access and health outcomes, excision of many benign lesions, overdiagnosis, gaps in workforce training, and health system inefficiencies. There has also been renewed interest in melanoma screening in Australia, driven by a changing landscape of skin cancer early detection. These changes include increasing health system costs for adjuvant therapies, advances in diagnostic technologies and artificial intelligence, the availability of validated risk-stratification tools, and consumer-driven digital technologies. CONCLUSIONS The future of skin cancer early detection in Australia and internationally may incorporate features such as a more structured approach to skin cancer risk assessment using online risk calculators and invitations to screen, consumer-driven melanoma surveillance, and new technologies for diagnosis and monitoring of lesions. High-quality research evidence is being generated across multiple research programs, and is essential to underpin any changes to policy and practice in skin cancer early detection.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Catherine M Olsen
- Cancer Control Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Skin and Cancer Foundation Inc., Melbourne, VIC, Australia
| | - Anne E Cust
- Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, University of Sydney, NSW;
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Thompson JR, Smith AL, Lo SN, Kasparian NA, Saw RP, Dieng M, Seaman L, Martin LK, Guitera P, Milne D, Schmid H, Cust AE, Bartula I. Protocol for the implementation of a stepped-care model to address fear of cancer recurrence in patients previously diagnosed with early-stage (0-II) melanoma. BMJ Open 2022; 12:e054337. [PMID: 35241467 PMCID: PMC8896053 DOI: 10.1136/bmjopen-2021-054337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/04/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Fear of cancer recurrence (FCR) is commonly reported by patients diagnosed with early-stage (0-II) melanoma and can have a significant impact on daily functioning. This study will pilot the implementation of the Melanoma Care Program, an evidence-based, psychological intervention to reduce FCR, into routine practice, using a stepped-care model. METHODS AND ANALYSIS Intervention effectiveness and level of implementation will be investigated using a hybrid type I design. Between 4 weeks before and 1 week after their next dermatological appointment, patients with melanoma will be invited to complete the Fear of Cancer Recurrence Inventory Short-Form, measuring self-reported FCR severity. Using a stepped-care model, clinical cut-off points will guide the level of support offered to patients. This includes: (1) usual care, (2) Melanoma: Questions and Answers psychoeducational booklet, and (3) three or five psychotherapeutic telehealth sessions. This longitudinal, mixed-methods pilot implementation study aims to recruit 108 patients previously diagnosed with stage 0-II melanoma. The primary effectiveness outcome is change in FCR severity over time. Secondary effectiveness outcomes include change in anxiety, depression, stress, health-related quality of life and melanoma-related knowledge over time. All outcomes are measured at baseline, within 1 week of the final telehealth session, and 6 and 12 months post-intervention. Implementation stakeholders at each study site and interested patients will provide feedback on intervention acceptability and appropriateness. Implementation stakeholders will also provide feedback on intervention cost, feasibility, fidelity and sustainability. These outcomes will be measured throughout implementation, using questionnaires and semistructured interviews/expert group discussions. Descriptive statistics, linear mixed-effects regression and thematic analysis will be used to analyse study data. ETHICS AND DISSEMINATION Ethics approval was granted by the Sydney Local Health District-Royal Prince Alfred Zone (2020/ETH02518), protocol number: X20-0495. Results will be disseminated through peer-reviewed journals, conference presentations, social media and result summaries distributed to interested participants. TRIAL REGISTRATION DETAILS: (ACTRN12621000145808).
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Affiliation(s)
- Jake R Thompson
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
| | - Andrea L Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robyn Pm Saw
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Linda Seaman
- Consumer Representative, Sydney, New South Wales, Australia
| | - Linda K Martin
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Donna Milne
- Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Helen Schmid
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne E Cust
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Iris Bartula
- Melanoma Institute Australia, University of Sydney, North Sydney, New South Wales, Australia
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Lee Solano M, Robinson S, Allen MW, Reyes-Marcelino G, Espinoza D, Beswick B, Tse DH, Ding L, Humphreys L, Van Kemenade C, Dobbinson S, Smit AK, Cust AE. Effect of an interactive educational activity using handheld ultraviolet radiation dosimeters on sun protection knowledge among Australian primary school students. Prev Med Rep 2022; 25:101690. [PMID: 35127364 PMCID: PMC8800069 DOI: 10.1016/j.pmedr.2021.101690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/17/2021] [Accepted: 12/26/2021] [Indexed: 11/24/2022] Open
Abstract
This interactive educational activity incorporated handheld UV dosimeters. The intervention improved UV-related knowledge among primary school students. Knowledge about the UV Index improved the most. Knowledge about UV harms, sun protective clothing and behaviours also improved.
Ultraviolet radiation (UV) is the main cause of skin cancer, and children are a priority group for reducing UV exposure. We evaluated whether an interactive educational activity using handheld dosimeters improved UV-related knowledge among primary (elementary) school students. We conducted an uncontrolled before-after study among 427 students in grades 3–6 (ages 8–12 years) at five schools in the Greater Sydney region, Australia. Students used UV dosimeters to measure UV exposure, using the UV index scale, at different locations on their school grounds with and without different forms of sun protection, followed by an indoor classroom presentation and discussion. A 10-point anonymous questionnaire was completed by each student before and after the entire session (60–90 min). Before-after responses were compared using a generalised linear mixed model, adjusted for school, grade and gender. Overall, the mean raw scores increased from 6.3 (out of 10) before the intervention to 8.9 after the intervention, and the adjusted difference in scores was 2.6 points (95% confidence interval 2.4–2.8; p < 0.0001). Knowledge improved for all questions, with the greatest improvement for questions related to the UV Index (p < 0.05). The effect of the intervention was similar across different school, grade and gender groups. School and grade had no significant effect on mean survey scores, but girls scored an average 0.2 points higher than boys (95% confidence interval 0.1–0.4; p = 0.01). In conclusion, Australian primary school students had moderate knowledge about UV and sun protection, and knowledge improved significantly after a short interactive educational activity using handheld UV dosimeters.
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Ackermann DM, Dieng M, Medcalf E, Jenkins MC, van Kemenade CH, Janda M, Turner RM, Cust AE, Morton RL, Irwig L, Guitera P, Soyer HP, Mar V, Hersch JK, Low D, Low C, Saw RPM, Scolyer RA, Drabarek D, Espinoza D, Azzi A, Lilleyman AM, Smit AK, Murchie P, Thompson JF, Bell KJL. Assessing the Potential for Patient-led Surveillance After Treatment of Localized Melanoma (MEL-SELF): A Pilot Randomized Clinical Trial. JAMA Dermatol 2022; 158:33-42. [PMID: 34817543 PMCID: PMC8771298 DOI: 10.1001/jamadermatol.2021.4704] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Patient-led surveillance is a promising new model of follow-up care following excision of localized melanoma. OBJECTIVE To determine whether patient-led surveillance in patients with prior localized primary cutaneous melanoma is as safe, feasible, and acceptable as clinician-led surveillance. DESIGN, SETTING, AND PARTICIPANTS This was a pilot for a randomized clinical trial at 2 specialist-led clinics in metropolitan Sydney, Australia, and a primary care skin cancer clinic managed by general practitioners in metropolitan Newcastle, Australia. The participants were 100 patients who had been treated for localized melanoma, owned a smartphone, had a partner to assist with skin self-examination (SSE), and had been routinely attending scheduled follow-up visits. The study was conducted from November 1, 2018, to January 17, 2020, with analysis performed from September 1, 2020, to November 15, 2020. INTERVENTION Participants were randomized (1:1) to 6 months of patient-led surveillance (the intervention comprised usual care plus reminders to perform SSE, patient-performed dermoscopy, teledermatologist assessment, and fast-tracked unscheduled clinic visits) or clinician-led surveillance (the control was usual care). MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of eligible and contacted patients who were randomized. Secondary outcomes included patient-reported outcomes (eg, SSE knowledge, attitudes, and practices, psychological outcomes, other health care use) and clinical outcomes (eg, clinic visits, skin surgeries, subsequent new primary or recurrent melanoma). RESULTS Of 326 patients who were eligible and contacted, 100 (31%) patients (mean [SD] age, 58.7 [12.0] years; 53 [53%] men) were randomized to patient-led (n = 49) or clinician-led (n = 51) surveillance. Data were available on patient-reported outcomes for 66 participants and on clinical outcomes for 100 participants. Compared with clinician-led surveillance, patient-led surveillance was associated with increased SSE frequency (odds ratio [OR], 3.5; 95% CI, 0.9 to 14.0) and thoroughness (OR, 2.2; 95% CI, 0.8 to 5.7), had no detectable adverse effect on psychological outcomes (fear of cancer recurrence subscale score; mean difference, -1.3; 95% CI, -3.1 to 0.5), and increased clinic visits (risk ratio [RR], 1.5; 95% CI, 1.1 to 2.1), skin lesion excisions (RR, 1.1; 95% CI, 0.6 to 2.0), and subsequent melanoma diagnoses and subsequent melanoma diagnoses (risk difference, 10%; 95% CI, -2% to 23%). New primary melanomas and 1 local recurrence were diagnosed in 8 (16%) of the participants in the intervention group, including 5 (10%) ahead of routinely scheduled visits; and in 3 (6%) of the participants in the control group, with none (0%) ahead of routinely scheduled visits (risk difference, 10%; 95% CI, 2% to 19%). CONCLUSIONS AND RELEVANCE This pilot of a randomized clinical trial found that patient-led surveillance after treatment of localized melanoma appears to be safe, feasible, and acceptable. Experiences from this pilot study have prompted improvements to the trial processes for the larger trial of the same intervention. TRIAL REGISTRATION http://anzctr.org.au Identifier: ACTRN12616001716459.
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Affiliation(s)
- Deonna M. Ackermann
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mbathio Dieng
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ellie Medcalf
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marisa C. Jenkins
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robin M. Turner
- Biostatistics Centre, University of Otago, Dunedin, Otago, New Zealand
| | - Anne E. Cust
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael L. Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Les Irwig
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - H. Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
| | - Victoria Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jolyn K. Hersch
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Donald Low
- Cancer Voices New South Wales, Sydney, New South Wales, Australia
| | - Cynthia Low
- Cancer Voices New South Wales, Sydney, New South Wales, Australia
| | - Robyn P. M. Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A. Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- New South Wales Health Pathology, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Dorothy Drabarek
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Espinoza
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, New South Wales, Australia
| | | | - Amelia K. Smit
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Murchie
- Academic Primary Care Research Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - John F. Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Katy J. L. Bell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Davari DR, Orlow I, Kanetsky PA, Luo L, Edmiston SN, Conway K, Parrish EA, Hao H, Busam KJ, Sharma A, Kricker A, Cust AE, Anton-Culver H, Gruber SB, Gallagher RP, Zanetti R, Rosso S, Sacchetto L, Dwyer T, Ollila DW, Begg CB, Berwick M, Thomas NE. Disease-Associated Risk Variants in ANRIL Are Associated with Tumor-Infiltrating Lymphocyte Presence in Primary Melanomas in the Population-Based GEM Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2309-2316. [PMID: 34607836 PMCID: PMC8643342 DOI: 10.1158/1055-9965.epi-21-0686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/19/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genome-wide association studies have reported that genetic variation at ANRIL (CDKN2B-AS1) is associated with risk of several chronic diseases including coronary artery disease, coronary artery calcification, myocardial infarction, and type 2 diabetes mellitus. ANRIL is located at the CDKN2A/B locus, which encodes multiple melanoma tumor suppressors. We investigated the association of these variants with melanoma prognostic characteristics. METHODS The Genes, Environment, and Melanoma Study enrolled 3,285 European origin participants with incident invasive primary melanoma. For each of ten disease-associated SNPs at or near ANRIL, we used linear and logistic regression modeling to estimate, respectively, the per allele mean changes in log of Breslow thickness and ORs for presence of ulceration and tumor-infiltrating lymphocytes (TIL). We also assessed effect modification by tumor NRAS/BRAF mutational status. RESULTS Rs518394, rs10965215, and rs564398 passed false discovery and were each associated (P ≤ 0.005) with TILs, although only rs564398 was independently associated (P = 0.0005) with TILs. Stratified by NRAS/BRAF mutational status, rs564398*A was significantly positively associated with TILs among NRAS/BRAF mutant, but not wild-type, cases. We did not find SNP associations with Breslow thickness or ulceration. CONCLUSIONS ANRIL rs564398 was associated with TIL presence in primary melanomas, and this association may be limited to NRAS/BRAF-mutant cases. IMPACT Pathways related to ANRIL variants warrant exploration in relationship to TILs in melanoma, especially given the impact of TILs on immunotherapy and survival.
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Affiliation(s)
- Danielle R. Davari
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter A. Kanetsky
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Sharon N. Edmiston
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Conway
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eloise A. Parrish
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Honglin Hao
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ajay Sharma
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Kricker
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anne E. Cust
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, Irvine, California
| | | | - Richard P. Gallagher
- BC Cancer and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roberto Zanetti
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Stefano Rosso
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Lidia Sacchetto
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Turin, Italy
| | - Terence Dwyer
- Murdoch Children's Research Institute, Melbourne, Australia
- The Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
- Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - David W. Ollila
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Colin B. Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Watts CG, McLoughlin K, Goumas C, van Kemenade CH, Aitken JF, Soyer HP, Fernandez Peñas P, Guitera P, Scolyer RA, Morton RL, Menzies SW, Caruana M, Kang YJ, Mann GJ, Chakera AH, Madronio CM, Armstrong BK, Thompson JF, Cust AE. Association Between Melanoma Detected During Routine Skin Checks and Mortality. JAMA Dermatol 2021; 157:1425-1436. [PMID: 34730781 DOI: 10.1001/jamadermatol.2021.3884] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Early melanoma diagnosis is associated with better health outcomes, but there is insufficient evidence that screening, such as having routine skin checks, reduces mortality. Objective To assess melanoma-specific and all-cause mortality associated with melanomas detected through routine skin checks, incidentally or patient detected. A secondary aim was to examine patient, sociodemographic, and clinicopathologic factors associated with different modes of melanoma detection. Design, Setting, and Participants This prospective, population-based, cohort study included patients in New South Wales, Australia, who were diagnosed with melanoma over 1 year from October 23, 2006, to October 22, 2007, in the Melanoma Patterns of Care Study and followed up until 2018 (mean [SD] length of follow-up, 11.9 [0.3] years) by using linked mortality and cancer registry data. All patients who had invasive melanomas recorded at the cancer registry were eligible for the study, but the number of in situ melanomas was capped. The treating doctors recorded details of melanoma detection and patient and clinical characteristics in a baseline questionnaire. Histopathologic variables were obtained from pathology reports. Of 3932 recorded melanomas, data were available and analyzed for 2452 (62%; 1 per patient) with primary in situ (n = 291) or invasive (n = 2161) cutaneous melanoma. Data were analyzed from March 2020 to January 2021. Main Outcomes and Measures Melanoma-specific mortality and all-cause mortality. Results A total of 2452 patients were included in the analyses. The median age at diagnosis was 65 years (range, 16-98 years), and 1502 patients (61%) were men. A total of 858 patients (35%) had their melanoma detected during a routine skin check, 1148 (47%) self-detected their melanoma, 293 (12%) had their melanoma discovered incidentally when checking another skin lesion, and 153 (6%) reported "other" presentation. Routine skin-check detection of invasive melanomas was associated with 59% lower melanoma-specific mortality (subhazard ratio, 0.41; 95% CI, 0.28-0.60; P < .001) and 36% lower all-cause mortality (hazard ratio, 0.64; 95% CI, 0.54-0.76; P < .001), adjusted for age and sex, compared with patient-detected melanomas. After adjusting for prognostic factors including ulceration and mitotic rate, the associations were 0.68 (95% CI, 0.44-1.03; P = .13), and 0.75 (95% CI, 0.63-0.90; P = .006), respectively. Factors associated with higher odds of routine skin-check melanoma detection included being male (female vs male, odds ratio [OR], 0.73; 95% CI, 0.60-0.89; P = .003), having previous melanoma (vs none, OR, 2.36; 95% CI, 1.77-3.15; P < .001), having many moles (vs not, OR, 1.39; 95% CI, 1.10-1.77; P = .02), being 50 years or older (eg, 50-59 years vs <40 years, OR, 2.89; 95% CI, 1.92-4.34; P < .001), and living in nonremote areas (eg, remote or very remote vs major cities, OR, 0.23; 95% CI, 0.05-1.04; P = .003). Conclusions and Relevance In this cohort study, melanomas diagnosed through routine skin checks were associated with significantly lower all-cause mortality, but not melanoma-specific mortality, after adjustment for patient, sociodemographic, and clinicopathologic factors.
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Affiliation(s)
- Caroline G Watts
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Surveillance, Epidemiology and Research Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kirstie McLoughlin
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia
| | - Chris Goumas
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia
| | | | - Joanne F Aitken
- School of Public Health, The University of Queensland, Brisbane, Australia.,Cancer Council Queensland, Brisbane, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Pablo Fernandez Peñas
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Hospital, Westmead, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia
| | - Yoon Jung Kang
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Annette H Chakera
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Christine M Madronio
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Bruce K Armstrong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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Abstract
Acral melanomas are a unique subset of melanomas occurring on the palms, soles, and nails. There is poor prognosis with surgery alone and no specific guidelines for the treatment of metastatic acral melanoma. This meta-analysis explored the systemic therapy outcomes for metastatic acral melanoma. Medline, Pubmed, EMBASE, and the grey literature were searched from 2010 to August 2020 for studies specifying the treatment outcome of metastatic acral melanoma. Studies were assessed by two investigators. A random-effects meta-analysis was performed and pooled Kaplan-Meier curves for progression-free survival and overall survival were created. Critical appraisal was performed using the Newcastle-Ottawa Scale. Nineteen nonrandomized studies were included, comprising 646 patients with acral melanomas and 1609 patients with nonacral melanomas treated with systemic therapy including chemotherapy, KIT-targeted drugs, as well as anti-CTLA-4 and anti-PD-1 checkpoint inhibitor therapy. Thirteen studies included Kaplan-Meier curves for progression-free survival or overall survival and 11 studies reported treatment responses. Patients with acral melanomas had worse prognosis than nonacral cutaneous melanoma (acral overall survival: median 15 months, 95% CI, 13.7-16.3 months; nonacral cutaneous: median 24 months, 95% CI, 22.6-25.4 months, P < 0.001). Acral melanoma patients treated with anti-PD-1 monotherapy had higher overall survival at 12 months (53%) compared with anti-CTLA-4 monotherapy (34%; P < 0.001). This study provides estimates of treatment response for metastatic acral melanoma, demonstrating low activity across a breadth of approved drug therapies, including anti-PD-1, the most active therapy in melanoma to date. Further research into treatments for metastatic acral melanoma is needed.
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Affiliation(s)
- Kenneth K Cho
- Department of Surgery, The Whiteley-Martin Research Centre, Nepean Clinical School, University of Sydney, Penrith
- School of Medicine, Western Sydney University, Campbelltown
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW
- Melanoma Institute Australia, The University of Sydney
| | - Yun Megan Foo
- School of Medicine, Western Sydney University, Campbelltown
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney
- Royal North Shore and Mater Hospitals
- Sydney Medical School, The University of Sydney
- Charles Perkins Centre, The University of Sydney
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney
- Royal North Shore and Mater Hospitals
- Sydney Medical School, The University of Sydney
| | - Guy D Eslick
- Department of Surgery, The Whiteley-Martin Research Centre, Nepean Clinical School, University of Sydney, Penrith
- Centre for Digestive Health, Hunter Medical Research Institute, The University of Newcastle, Sydney, NSW, Australia
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Bakshi A, Yan M, Riaz M, Polekhina G, Orchard SG, Tiller J, Wolfe R, Joshi A, Cao Y, McInerney-Leo AM, Yanes T, Janda M, Soyer HP, Cust AE, Law MH, Gibbs P, McLean C, Chan AT, McNeil JJ, Mar VJ, Lacaze P. Genomic Risk Score for Melanoma in a Prospective Study of Older Individuals. J Natl Cancer Inst 2021; 113:1379-1385. [PMID: 33837773 PMCID: PMC8921762 DOI: 10.1093/jnci/djab076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/16/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Recent genome-wide association meta-analysis for melanoma doubled the number of previously identified variants. We assessed the performance of an updated polygenic risk score (PRS) in a population of older individuals, where melanoma incidence and cumulative ultraviolet radiation exposure is greatest. METHODS We assessed a PRS for cutaneous melanoma comprising 55 variants in a prospective study of 12 712 individuals in the ASPirin in Reducing Events in the Elderly Trial. We evaluated incident melanomas diagnosed during the trial and prevalent melanomas diagnosed preenrolment (self-reported). Multivariable models examined associations between PRS as a continuous variable (per SD) and categorical (low-risk [0%-20%], medium-risk [21%-80%], high-risk [81%-100%] groups) with incident melanoma. Logistic regression examined the association between PRS and prevalent melanoma. RESULTS At baseline, mean participant age was 75 years; 55.0% were female, and 528 (4.2%) had prevalent melanomas. During follow-up (median = 4.7 years), 120 (1.0%) incident cutaneous melanomas occurred, 98 of which were in participants with no history. PRS was associated with incident melanoma (hazard ratio = 1.46 per SD, 95% confidence interval [CI] = 1.20 to 1.77) and prevalent melanoma (odds ratio [OR] = 1.55 per SD, 95% CI = 1.42 to 1.69). Participants in the highest-risk PRS group had increased risk compared with the low-risk group for incident melanoma (OR = 2.51, 95% CI = 1.28 to 4.92) and prevalent melanoma (OR = 3.66, 95% CI = 2.69 to 5.05). When stratifying by sex, only males had an association between the PRS and incident melanoma, whereas both sexes had an association between the PRS and prevalent melanoma. CONCLUSIONS A genomic risk score is associated with melanoma risk in older individuals and may contribute to targeted surveillance.
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Affiliation(s)
- Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mabel Yan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Galina Polekhina
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne G Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Tiller
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amit Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; MGH Cancer Center, Boston, MA, USA
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA
| | - Aideen M McInerney-Leo
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, USA
| | - Tatiane Yanes
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, USA
| | - Monika Janda
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, USA
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, USA
| | - Anne E Cust
- Sydney School of Public Health and Melanoma Institute Australia, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Matthew H Law
- Statistical Genetics Lab, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Biomedical Sciences, Faculty of Health, and Institute of health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia, Personalised Oncology Division, Walter and Eliza Hall Institute Medical Research and Faculty of Medicine University of Melbourne, Australia
| | - Peter Gibbs
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; MGH Cancer Center, Boston, MA, USA
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Victoria J Mar
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Victorian Melanoma Service, Alfred Health, Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Guitera P, Menzies SW, Coates E, Azzi A, Fernandez-Penas P, Lilleyman A, Badcock C, Schmid H, Watts CG, Collgros H, Liu R, van Kemenade C, Mann GJ, Cust AE. Efficiency of Detecting New Primary Melanoma Among Individuals Treated in a High-risk Clinic for Skin Surveillance. JAMA Dermatol 2021; 157:521-530. [PMID: 33729464 DOI: 10.1001/jamadermatol.2020.5651] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance A previous single-center study observed fewer excisions, lower health care costs, thinner melanomas, and better quality of life when surveillance of high-risk patients was conducted in a melanoma dermatology clinic with a structured surveillance protocol involving full-body examinations every 6 months aided by total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI). Objective To examine longer-term sustainability and expansion of the surveillance program to numerous practices, including a primary care skin cancer clinic setting. Design, Setting, and Participants This prospective cohort study recruited 593 participants assessed from 2012 to 2018 as having very high risk of melanoma, with a median of 2.9 years of follow-up (interquartile range, 1.9-3.3 years), from 4 melanoma high-risk clinics (3 dermatology clinics and 1 primary care skin cancer clinic) in New South Wales, Australia. Data analyses were conducted from February to September 2020. Exposures Six-month full-body examination with the aid of TBP and SDDI. For equivocal lesions, the clinician performed SDDI at 3 or 6 months. Main Outcomes and Measures All suspect monitored or excised lesions were recorded, and pathology reports obtained. Outcomes included the incidence and characteristics of new lesions and the association of diagnostic aids with rates of new melanoma detection. Results Among 593 participants, 340 (57.3%) were men, and the median age at baseline was 58 years (interquartile range, 47-66 years). There were 1513 lesions excised during follow-up, including 171 primary melanomas. The overall benign to malignant excision ratio, including keratinocyte carcinomas, was 0.8:1.0; the benign melanocytic to melanoma excision ratio was 2.4:1.0; and the melanoma in situ to invasive melanoma ratio was 2.2:1.0. The excision ratios were similar across the 4 centers. The risk of developing a new melanoma was 9.0% annually in the first 2 years and increased with time, particularly for those with multiple primary melanomas. The thicker melanomas (>1-mm Breslow thickness; 7 of 171 melanomas [4.1%]) were mostly desmoplastic or nodular (4 of 7), self-detected (2 of 7), or clinician detected without the aid of TBP (3 of 7). Overall, new melanomas were most likely to be detected by a clinician with the aid of TBP (54 of 171 [31.6%]) followed by digital dermoscopy monitoring (50 of 171 [29.2%]). Conclusions and Relevance The structured surveillance program for high-risk patients may be implemented at a larger scale given the present cohort study findings suggesting the sustainability and replication of results in numerous settings, including a primary care skin cancer clinic.
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Affiliation(s)
- Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Elliot Coates
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Pablo Fernandez-Penas
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Alister Lilleyman
- Newcastle Skin Check, Newcastle, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Caro Badcock
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helen Schmid
- Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Caroline G Watts
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helena Collgros
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rose Liu
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Clinical School, The University of Sydney, Sydney, Australia
| | | | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
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50
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Ni Y, Cust AE, Lo S. 1330Is Prognosis Worse for People with Multiple Versus Single Primary Melanoma? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with a primary melanoma may develop more than one in their lifetime. It is unclear whether mortality is worse after diagnosis of multiple primary melanoma (MPM) compared with single primary melanoma (SPM).
Methods
We analysed data from a population-based cohort of 3,869 patients diagnosed with primary in situ or invasive cutaneous melanoma in New South Wales, Australia in 2006-07 and followed up until 2018 (median 11.9 years) using linked mortality and cancer registry data. We compared overall mortality and melanoma-specific mortality for patients with SPM versus MPM, adjusting for other clinico-pathological prognostic indicators, using Cox proportional hazard models. The primary analysis was based on pathological features from the thickest tumour for MPM patients, however sensitivity analyses were performed using the first and last primary melanoma.
Results
The cohort consisted of 3,869 patients (2,929 SPM and 940 MPM) and 5,504 melanoma lesions (including 2,575 lesions from MPM patients). The primary multivariable analysis showed MPM was associated with lower mortality from all causes and melanoma compared with SPM with a hazard ratio of 0.62 (95% CI: 0.54-0.71, p < 0.001) and 0.37 (95% CI: 0.32-0.43, p < 0.001) respectively. These findings were also supported by the sensitivity analyses.
Conclusions
The diagnosis of MPM does not worsen mortality compared to a SPM, in fact it was associated with improved survival. This finding might be related to skin examination behaviours, biological or clinical factors.
Key messages
MPM patients have a better prognosis than SPM patients.
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Affiliation(s)
- Yuan Ni
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Anne E Cust
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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