Beverly A. Raasch

Incidence rates of skin cancer in Townsville, Australia

Worldwide, incidence rates of skin cancer are increasing alarmingly in populations of predominantly Caucasian origin. A prospective population‐based survey, set up to collect epidemiological information on all excised and histologically confirmed skin cancers, started in Townsville, Australia (population of 127,000) in December 1996. Data on the anatomical distribution of skin cancer has been collected using a detailed body map. Estimations of type‐specific and site‐specific incidence rates were age‐standardized according to world standard population. Site‐specific incidence rates were adjusted for surface proportion of the body site and are given per 100,000 body units. Between December 1996 and December 1997, a total of 3,536 patients with 5,945 histologically confirmed skin cancer lesions were recorded. Age‐standardized incidence rates of basal cell carcinoma were 2,058.3 for men and 1,194.5 for women, 1,332.3 for men and 754.8 for women for squamous cell carcinoma, and 49.1 for men and 41.7 for women for cutaneous melanoma (CM). Site‐specific incidence rates of non‐melanocytic skin cancer were extreme on sun‐exposed areas of the face, whereas site‐specific incidence rates of CM were highest for neck, posterior trunk and face. Less exposed body sites, such as unexposed upper limbs or thighs, showed reduced incidence rates for all types of skin cancer. Tropical North Queensland has the worlds highest incidence rates of skin cancer of all types. Site‐specific incidence rates demonstrate that highly sun‐exposed body sites are at high risk of developing skin cancer and provide, therefore, strong indirect evidence for the causal relationship between sun exposure and skin cancer. Int. J. Cancer 78:587–593, 1998.

Can sutures get wet? Prospective randomised controlled trial of wound management in general practice

Abstract Objective To compare standard management of keeping wounds dry and covered with allowing wounds to be uncovered and wet in the first 48 hours after minor skin excision. Design Prospective, randomised controlled, multicentre trial testing for equivalence of infection rates. Setting Primary care in regional centre, Queensland, Australia. Participants 857 patients randomised to either keep their wound dry and covered (n = 442) or remove the dressing and wet the wound (n = 415). Results The incidence of infection in the intervention group (8.4%) was not inferior to the incidence in the control group (8.9%) (P < 0.05). The one sided 95% confidence interval for the difference of infection rates was ∞ to 0.028. Conclusion These results indicate that wounds can be uncovered and allowed to get wet in the first 48 hours after minor skin excision without increasing the incidence of infection.

Multiple nonmelanoma skin cancer in an exposed Australian population

Background Patients with nonmelanoma skin cancer (NMSC) frequently develop multiple skin cancers. The study presents incidence rates and rates of excision of NMSC for a population living in a high‐risk environment for skin cancer.

Body site specific incidence of basal and squamous cell carcinoma in an exposed population, Townsville, Australia

Most data on body site distribution of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) do not take into account the surface proportion occupied by body sites experiencing differing amounts of ultraviolet radiation. The recording of BCC and SCC is heterogenous and body sites are not standardized. This study was undertaken to assess the magnitude of the incidence rates of skin cancers at different body sites in a population which experiences high ultraviolet exposure and involved all primary care services in Townsville over 6 weeks in June 1993. The annual site-specific age-standardized (World Population) incidence rates of histologically diagnosed lesions, determined from data where lesions were recorded on a body map, were adjusted for surface area and expressed per 100,000 body units (BU). Relative site densities of lesions were also calculated. Annual incidence rates for BCC per 100,000 BU on the most exposed face (ears, nose and cheeks) were 25,893 (95% confidence interval (c.i.) 18,837-32,950), 13,222 (95% c.i., 8273-18,171) on the less exposed face (forehead,eyebrow, chin and jaw) and 27,837 (95% c.i., 12,560-43,115) on the least exposed face (area within the orbit and nasolabial fold). Incidence rates for SCC rates were highest on the less exposed face, 5843 (95% c.i., 2627-9058) most exposed face, 4200 (95% c.i., 1274-7126) and the exposed upper limb, 3786 (95% c.i., 2783-4789). The relative site density of histologically confirmed BCC was 14 on the most exposed face in males compared with 5 in females and 11 around the eyes (least exposed) in males and 9 in females compared with the body as a whole. Adjustment for body surface proportion demonstrates that highly exposed body sites are at very high risk. The magnitude of the incidence rates on these sites is attributed to the combination of a susceptible population and high ambient ultraviolet radiation (UVR).

Agreement between histological diagnosis of skin lesions by histopathologists and a dermato-histopathologist

Background  Skin cancer is an increasing problem in fair‐skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately, and this is supported by accurate histological diagnosis.

Knowledge and perceptions about sunburn and solar keratoses in Australia

An omnibus telephone survey of 1200 adult Australians determined self‐reported prevalence of and attitudes to sunburn and sunspots, knowledge of the term solar keratosis and prevalence of skin checks. Half reported they had been sunburnt in the previous year. Seventy‐eight per cent considered sunburn to be extremely or very serious, while 73% considered sunspots as serious or very serious. While 29% reported currently having sunspots, 69% had never heard of the term solar keratosis, 30% had never had a skin check and 28% had their last skin check more than 12 months ago. Respondents 18–29 years old (odds ration [OR] = 2.6; P = 0.002) and men (OR = 2.4; P < 0.001) were most likely to experience multiple sunburn. Persons living in capital cities (OR = 0.63; P = 0.006) and having a university degree (OR = 0.52; P = 0.001) had reduced OR for multiple sunburns. Men (OR = 0.45; P < 0.001) were less likely to consider sunburn serious or extremely serious than women. Compared with respondents 18–29 years old, those 55 years or older were 7.4‐fold more likely to have had a skin check (P < 0.001). Sun‐protection campaigns need to continue using evidence‐based interventions targeting younger people and men to reduce sunburn. The terms used in health promotion need to be understood by the target audience.

Erratum in: Buettner PG, Raasch BA. Incidence rates of skin cancer in Townsville, Australia. Int J Cancer 1998;78:587–93.

We would like to draw your attention to an error that occurred during the analysi s of the data of a prospective population-base d survey on the incidence of skin cancer in Townsville, Queensland , Australia. The survey commence d in Decembe r 1996 and finished in late 1999. The data collected during the first year were analyzed and published in your journal.1 During a recent analysi s of the entire data set, we discovered an error in the recoding procedures that had been used in the previous analysis. We found out that part of the recorded cases of squamous-cel l carcinoma in situ had been previousl y counted as cases of invasive squamous-cel l carcinoma (SCC). Naturally, this error led to an overestimation of incidence rates of SCC that we would like to correct. The interested reader is kindly referred to the original publication for all methodologica l details.1 Between Decembe r 1996 and Decembe r 1997, 1,185 patients (63.9% male) with at least 1 histologically confirmed SCC were recorded. Age-specifi c incidence rates of basal-cell carcinoma (BCC) and SCC rose steadil y and almost parallel for both gender s to the age category of 40–49 years (Fig. 1). From the age of 50 years onward, age-specifi c incidence rates of BCC and SCC for men exceede d the rates for women. Averaged age-standardize d (world standard) incidence rates per 100,000 inhabitantsof SCC were found to be1,075. 7 (95% CI 5 998.0, 1,153.4; originally stated wrong rate: 1,332.3) for men and 517.7 (95% CI 5 465.9, 569.5; originally stated wrong rate: 754.8) for women. For both genders, body-sitespecific incidence rates of SCC showed extreme variation with clear preference for chronically sun-expose d sites, such as the face and the exposed parts of the upper limbs (Table I). For all body-sites incidencerateswerehigher in males than in females (Table I). The relative body-site-specifi c densities of SCC showed clear exces for the facial subsites and neck (Fig. 2). The relative body-site-specifi c densities of SCC were higher in