Anatomic Region of Cutaneous Melanoma Impacts Survival and Clinical Outcomes: A Population-Based Analysis

PURPOSE

The objective was to determine the effects of the anatomic site of a cutaneous melanoma on the survival outcomes of diagnosed individuals.

METHODS

We conducted a cross-sectional study using data from the Surveillance, Epidemiology, and End Results Program (SEER) Database from 2004-2014 and included 178,892 cases of individuals diagnosed with cutaneous melanoma. Overall survival (OS) for each anatomic site as well as associated demographics, primary site, stage, and pathologic prognostic factors (Breslow's depth of invasion (DOI), level of mitoses, and ulceration), were analyzed.

RESULTS

Lower extremity melanoma (LEM) was the most likely to have locoregional nodal spread, yet head and neck melanoma (HNM) was the most likely to present at the most advanced stage of disease (IV). Independent of other factors, HNM was associated with the greatest risk of death (HR 1.90 [95% CI, 1.85-1.96]) compared to other sites, and males experienced worse overall survival (OS) (HR 1.74 [95% CI, 1.70-1.78]) compared to females. The last and greatest risk of death is associated with LEM and HNM, respectively.

CONCLUSION

Given these survival differences, consideration should be given to incorporating the primary site of melanoma into staging to ensure treatment is efficacious as possible.

Characteristics of 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database

BACKGROUND AND OBJECTIVE

Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined.

PATIENTS AND METHODS

Six hundred and thirty-seven melanomas treated by 27 Australasian GPs during 2013 and documented on the Skin Cancer Audit Research Database (SCARD) were analysed by anatomical site, subtype, Breslow thickness, diameter, associated naevi and linked adverse outcomes.

RESULTS

Most melanomas (59.7%) were on males, mean age at diagnosis being 62.7 years (range 18-96). Most (65.0%) were in situ, with a high incidence of lentiginous melanoma (LM) (38.8%) and 32% were naevus associated. Most LM (86.4%) were in situ, compared to 55% of superficial spreading melanoma (SSM) (P < 0.0001). There was male predominance on the head, neck and trunk and female predominance on extremities. There was no significant association between Breslow thickness and diameter, with small melanomas as likely to be thick as large melanomas, and melanomas ≤3 mm diameter, on average, more likely to be invasive than larger melanomas. There was a positive correlation between age and both melanoma diameter and Breslow thickness. Seven cases progressed to melanoma-specific death: Five nodular melanoma (NM) and two SSM, one of which was thin (Breslow thickness 0.5 mm).

CONCLUSIONS

A large series of melanomas treated by Australasian GPs were predominantly in situ, with a high proportion of LM subtype. With implications for GP training, NM linked to death was over-represented and there was a novel finding that older patients had larger diameter melanomas.

Risk factors for melanoma by anatomical site: an evaluation of aetiological heterogeneity

BACKGROUND

Melanoma aetiology has been proposed to have two pathways, which are determined by naevi and type of sun exposure and related to the anatomical site where melanoma develops.

OBJECTIVES

We examined associations with melanoma by anatomical site for a comprehensive set of risk factors including pigmentary and naevus phenotypes, ultraviolet radiation exposure and polygenic risk.

METHODS

We analysed harmonized data from 2617 people with incident first invasive melanoma and 975 healthy controls recruited through two population-based case-control studies in Australia and the UK. Questionnaire data were collected by interview using a single protocol, and pathway-specific polygenic risk scores were derived from DNA samples. We estimated adjusted odds ratios using unconditional logistic regression that compared melanoma cases at each anatomical site with all controls.

RESULTS

When cases were compared with control participants, there were stronger associations for many naevi vs. no naevi for melanomas on the trunk, and upper and lower limbs than on the head and neck (P-heterogeneity < 0·001). Very fair skin (vs. olive/brown skin) was more weakly related to melanoma on the trunk than to melanomas at other sites (P-heterogeneity = 0·04). There was no significant difference by anatomical site for polygenic risk. Increased weekday sun exposure was positively associated with melanoma on the head and neck but not on other sites.

CONCLUSIONS

We found evidence of aetiological heterogeneity for melanoma, supporting the dual pathway hypothesis. These findings enhance understanding of risk factors for melanoma and can guide prevention and skin examination education and practices.

Chinese Cancer Research in 2009-18 and the Disease Burden

Objective

We investigated the correlation of cancer research in China with its disease burden and national or provincial wealth. We also compared China’s research output with that of other Asian countries.

Methods

Chinese publications on cancer research for 2009–18 were retrieved from the Web of Science with a special filter giving high precision and recall. Their volume relative to gross domestic product (GDP) was compared with those of 14 Asian countries, and provincial outputs with provincial GDPs. Their distribution by anatomical site was compared with China’s disease burden, and by research type with that of Europe.

Results

Chinese cancer research publications (including those from Taiwan) have grown rapidly in the last 10 years, and overtook those of the USA in 2018. Relative to other Asian countries, Chinese output was approximately proportionate to its wealth. Relative to its cancer burden (as a percentage of the total disease burden), China published an appropriate amount of cancer research in 2009–13, but almost one-third more in 2014–18. Its distribution between the provinces reflected their wealth, but with comparatively greater outputs from Beijing and Shanghai. The distribution of China’s cancer research portfolio by anatomical site corresponded to its disease burden quite well, with a heavy emphasis on liver and stomach cancer. However, China did relatively less research on screening, diagnosis, palliative care, or quality of life.

Conclusion

The national and provincial cancer research in China in the past 10 years correlated relatively well with its disease burden and economic level, but over-emphasised basic research compared with prevention, screening and end-of-life care.

The presenting features of melanoma in New Zealand: implications for earlier detection

OBJECTIVE

To examine the relationship between presenting features and histological characteristics of melanomas in New Zealand.

METHODS

Cases were participants in a national melanoma case-control study. Histological data were extracted from a Cancer Registry download. Associations between categorical variables were assessed using the χ2 test; linear regression was used for continuous variables and multinomial logistic regression for non-binary categorical dependent variables.

RESULTS

Most melanomas were self-detected. Lesions >2mm depth took longer to diagnose, predominantly due to patient delay. The commonest presenting feature was colour. After adjustment for depth, nodular melanomas were less likely than superficial spreading melanomas to present because of shape or colour, but more likely to be raised. After adjustment for subtype, thick melanomas were significantly more likely to be bigger, raised, bleeding or crusting, and inflamed, itchy or sore.

CONCLUSIONS

Nodular and thick melanomas failed to fulfil the ABCDE criteria: the 'A', 'B' and 'C' discriminated poorly; and 'D' for diameter may exclude small but thick lesions. The 'E' criterion (elevation/enlargement/evolution) was perhaps best for detecting these melanomas. Implications for public health: Public education for earlier diagnosis in New Zealand needs to include the presenting features of nodular and thick melanomas and to strongly encourage seeking early physician advice.

Microbes, Transmission Routes and Survival Outside the Body

Microbes like bacteria, virus, parasites and fungi may naturally colonize skin and mucous membranes without any sign of illness, for a longer or shorter period, in all humans, animals, fish, parasites, plants and all other living beings. Some types may be more invasive in human tissue than others. Many microbes are free-living in the environment—in water, soil and air and on equipment—as a part of the normal microbial flora on the Earth. Most of them are not dangerous and live in peaceful symbiosis with other living beings and may also be transferred between living species, from man to animal or man to plants and environment—and vice versa. New and old human pathogenic microbes are increasing all over the world. Some agents, like drug-resistant bacteria and highly pathogenic viruses, are more dangerous than others, and some microbes may cause chronic devastating diseases. Transmission routes depend on the robustness of the microbe in the environment, virulence, infectious dose, anatomical site in the body, etc. Pathogenic microbes are spread by contact, air, water, food, beverages, contaminated equipment and environment and are more seldom vector-borne, by insects or animals. The following chapter is focused on the most frequent pathogenic microbes, their preselected localization in the body, transmission routes and survival in the environment.

The reactivity of the back revisited. Are there differences in reactivity in different parts of the back?

BACKGROUND

In the contact dermatitis literature, it is regularly stated that the patch test reactivity on various areas of the back differs, which might have a large impact on the reproducibility of patch testing.

OBJECTIVES

To investigate the reproducibility of patch testing on the upper back with regard to the left as opposed to the right side, and the medial as opposed to the lateral part of the upper back. The reproducibility over time and with regard to the reactivity pattern was also investigated.

METHODS

Thirty-one subjects with contact allergy to the metals gold (n = 19) or nickel (n = 12) were patch tested with serial dilutions, in triplicate applications, on different locations on the upper back. The Friedman test was used for statistical calculations.

RESULTS

No significant differences in the reactivity of the back were found. In all gold-allergic patients and 11 of 12 nickel-allergic patients, the allergy could be reproduced with regard to previous patch testing, but the degree of reactivity differed.

CONCLUSIONS

When a high level of standardization of the patch test technique with the same test system was used, there were no differences in patch test reactions and sites of application on the upper back.

Topographic measurement of skin color by narrow-band reflectance spectrophotometer and minimal erythema dose (MED) in Koreans

BACKGROUND/AIMS

Narrow-band reflectance spectrophotometer is one of the objective and quantitative devices for measuring the skin colors. There has been some controversy concerning the relationship between the objectively measured skin color and cutaneous responsiveness to ultraviolet radiation, including minimal erythema dose (MED). The aims of this study were to compare the color of Korean brown skin with that of Caucasians by objective measurement with the narrow-band reflectance spectrophotometer, and to determine whether the skin color has any correlation with MED in Koreans, and demonstrate differences in this correlation according to the anatomical sites.

METHODS

With narrow-band reflectance spectrometer, skin colors were measured at 17 body sites of 20 healthy Korean male volunteers after measuring MED for the same subjects.

RESULTS

The constitutional skin color, as measured by the melanin index of the nonexposed sites, showed a statistically significant correlation with MED values, whereas the facultative skin color did not. The Korean brown skin showed higher melanin index and lower erythema index compared with that of Caucasians.

CONCLUSIONS

We confirmed significant differences in the correlation between MED and melanin indices, depending on the anatomic sites. This suggests that selection from various sites, even among the nonexposed sites, is quite important and deserves further evaluation.

Skin thickness and echographic density of 22 anatomical sites

BACKGROUND/AIMS

Variation in skin thickness relative to anatomical site was little studied in the past. Biopsy cutting and histological processing change tissue geometry. High-frequency ultrasound allows in vivo measurement of skin thickness of multiple sites. The object was to map regional differences in skin thickness.

METHODS

22 different anatomical sites were studied. The Dermascan C (20 MHz) was used. The acoustic density of the dermis and the epidermal entrance echo was analyzed by the in-built image analysis software. 18 healthy volunteers aged 24-41 years were studied.

RESULTS

Extremity skin was thinner than truncal skin, and acoustically dense. Females had thinner and more dense skin in comparison with males. Skin of the palm, sole and the head was thick but weak in density, and the biological variation in the dermis/subcutaneous tissue interphase does not allow highly accurate evaluation in these special sites. There was an overall inverse correlation between skin thickness and acoustic density with thin skin being dense and thick skin being relatively echo-poor.

CONCLUSIONS

Skin thickness and acoustic density reflecting intradermal structure exhibit systematic regional variation with thin and dense skin on extremities in comparison with the trunk and special ultrasound profiles in selected sites such as the face, the palp and sole. Female skin is thinner and more dense in comparison with male skin.