David Peng

The expanding melanoma burden in California hispanics: Importance of socioeconomic distribution, histologic subtype, and anatomic location.

The incidence patterns and socioeconomic distribution of cutaneous melanoma among Hispanics are poorly understood.

Efficacy of skin self-examination for the early detection of melanoma

The National Cancer Institutes “Melanoma Action Plan” calls for reduction of melanoma mortality through early detection. Routine skin self‐examination (SSE) has the potential to increase chances of early detection and treatment and may be the key to melanoma survival. We provide a focused review of the accuracy of SSE for detecting premalignant lesions and cutaneous risk factors for melanoma, with suggestions for future directions for enhancing measurement of SSE accuracy and ways in which to improve the publics perceptions of melanoma efficacy. We examined published data on the efficacy of skin self‐examination for the early detection of melanoma. We searched the MEDLINE database for publications between January 1, 1987 and June 1, 2007 using search terms for “melanoma” and “self‐examination.” We found that sensitivity of skin self‐examination is low, ranging from 25% to 93%, while specificity is generally higher (83% to 97%). Attempts to increase improve the lay publics perceptions of the early signs of melanoma have proved effective, while those aimed at increasing accuracy of SSE with targeted interventions have been moderately successful. SSEs insensitivity for detection of pigmented lesions should prompt further investigation of educational interventions to enhance its accuracy and lead to its adoption as a cheap, simple screening tool. Assessment of the accuracy and efficacy of SSE should proceed using standardized definitions and measurements such that it is easier to pool data on the overall value of SSE as a screening modality.

Prevalence and predictors of skin self‐examination: prospects for melanoma prevention and early detection

The benefits of routine screening for melanoma have not been established. Although the overall goal of screening for melanoma is earlier detection and decreased mortality, there have been no randomized controlled trials demonstrating that screening does indeed reduce mortality from melanoma. Such trials are unlikely to be performed because of the relative rarity of melanoma in most populations, requiring a large sample size and prolonged follow-up. The effect of skin self-examination (SSE) on melanoma incidence and stage at presentation was examined in a landmark case–control study by Berwick et al ., 1 who found that SSE may decrease mortality from melanoma by 63%. In contrast with routine clinical skin examination and specialized melanoma screening programs (in Italy, Australia, and Scotland, it has been shown that both increased proportions of thinner tumors and a decrease in melanoma mortality rates have followed broad public health campaigns 2–6 aimed at increasing screening behavior among the general population), SSE is conducted with unknown prevalence, accuracy, and outcome. Reflecting this uncertainty are conflicting guidelines for melanoma screening. Both the American Cancer Society and the National Institutes of Health recommend routine screening for skin cancer, and promote SSE for all individuals beginning at 20 years of age. 7,8 By contrast, the United States Preventive Services Task Force and the Canadian Task Force on Preventive Health Care neither recommend nor are against routine screening of the general population for skin cancer, citing a lack of sufficient evidence. 9,10 Like other screening approaches, SSE has potential adverse effects, such as an increased number of skin surgical procedures for benign lesions with their accompanying costs, as well as the psychologic impact of a possible diagnosis of melanoma. Thus, it is unclear whether the benefits of SSE outweigh the risks. A formal study of the potential impact of SSE on melanoma incidence and mortality is unlikely to be forthcoming in the short term; therefore, it is important to understand the prevalence and predictors of SSE in general populations in the meantime. In this article, we provide a review of the current knowledge of the prevalence of SSE in general and special populations, summarize what is known about individuals’ success in adopting SSE, and comment on the scarce literature linking SSE to melanoma outcomes (decrease in incidence and mortality).

Skin Disease and Stigma in Emerging Adulthood: Impact on Healthy Development:

Background: Visible skin disorders can limit healthy psychosocial development in several domains owing to the stigma these disorders create. Objective: To assess if emerging adults with acne and eczema perceive stigma in diverse developmental domains resulting from their visible skin conditions. Methods: A convenience sample of 336 emerging adults attending a diverse public university in northern California completed a Web-based survey. Multivariate modeling was used to determine if eczema and acne result in perceived stigma. Results: The mean (SD) age of respondents was 20.1(1.5) years; most were white (43.2%) and female (62.5%). Almost half (47%) reported acne and 16.4% reported eczema. The likelihood of experiencing perceived stigma was 1.6 (95% CI 1.13–2.27, p < .001) times higher for those with eczema compared to those without eczema, and the likelihood of experiencing perceived stigma was 3.19 (95% CI 2.41–4.22, p < .0001) times higher for those with acne compared to those without acne. Conclusions: Our findings indicate that emerging adults perceive stigma as a result of their acne and eczema in several important developmental domains. The results suggest that acne may have a stronger relationship with perceived stigma than eczema, perhaps owing to its greater visibility on the body. University-based activities are recommended to support those with skin disease.

Cutaneous Conditions Leading to Dermatology Consultations in the Emergency Department

Introduction We established the most common cutaneous diseases that received dermatology consultation in the adult emergency department (ED) and identified differentiating clinical characteristics of dermatoses that required hospital admission. Methods A retrospective chart review of 204 patients presenting to the ED who received dermatology consultations at Los Angeles County/University of Southern California Medical Center, an urban tertiary care teaching hospital. Results Of all patients, 18% were admitted to an inpatient unit primarily for their cutaneous disease, whereas 82% were not. Of nonadmitted patients, the most commonly diagnosed conditions were eczematous dermatitis not otherwise specified (8.9%), scabies (7.2%), contact dermatitis (6.6%), cutaneous drug eruption (6.0%), psoriasis vulgaris (4.2%), and basal cell carcinoma (3.6%). Of patients admitted for their dermatoses, the most highly prevalent conditions were erythema multiforme major/Stevens-Johnson syndrome (22%), pemphigus vulgaris (14%), and severe cutaneous drug eruption (11%). When compared with those of nonadmitted patients, admitted skin conditions were more likely to be generalized (92% vs 72%; P = 0.0104), acute in onset (<1 month duration) (81% vs 51%; P = 0.0005), painful (41% vs 15%; P = 0.0009), blistering (41% vs 7.8%; P < 0.0001), and ulcerated or eroded (46% vs 7.8%; P < 0.0001). They were more likely to involve the mucosa (54% vs 7.2%; P < 0.0001) and less likely to be pruritic (35% vs 58%; P = 0.0169). Conclusion We have described a cohort of patients receiving dermatologic consultation in the ED of a large urban teaching hospital. These data identify high-risk features of more severe skin disease and may be used to refine curricula in both emergency and nonemergency cutaneous disorders for emergency physicians.

A follow-up survey of the integrity of the dermatology National Resident Matching Program

BACKGROUND Our groups 2009 study of the integrity of the dermatology match revealed that some dermatology program directors violated National Resident Matching Program (NRMP) policy during their communications with applicants. Our groups article concluded with recommendations to change this behavior. OBJECTIVE We repeated a survey of dermatology applicants to understand if dermatology program personnel behavior has changed since our groups 2009 study of the dermatology match. METHODS We surveyed 2011 applicants to Department of Dermatology, Stanford University, Palo Alto, CA. The survey was anonymous and available online. RESULTS Of applicants, 14% were asked to reveal how they intended to rank a program before match day. Of applicants, 32% felt pressured to reveal how they intended to rank programs. Of applicants, 90% were asked about interviews at other programs. Of applicants, 44% were asked about their marital status and 19% were asked if they had children or intended to have children. LIMITATIONS The response rate for applicants was 53%. CONCLUSION Although our previous study increased knowledge about the problems within the dermatology match, dermatology program personnel continue to violate NRMP policy. The most widespread violations are asking applicants where they will interview, asking applicants if they are married, and pressuring applicants to reveal how they intend to rank programs. We continue to recommend that programs avoid postinterview contact, and recommend that the NRMP create training videos for applicants and interviewers.

Measurement of Ultraviolet Exposure in Epidemiological Studies of Skin and Skin Cancers

As our understanding of the role of UV in causing skin cancer continues to expand, researchers and clinicians must continue to remain up to date on the various means by which UV exposure can be quantified. The purpose of this article was to review the current methods used to measure lifetime exposure to UV and to summarize the strengths and weaknesses of each of these approaches. Thus we include here a review of research articles that deal with questionnaire reliability and physical examination. We also review more technologically advanced techniques used to measure chronic UV exposure; these include microtopography, histology, gene studies and spectroscopy. Both the utility of using a specific measurement technique and the accuracy of particular techniques are explored. Finally, we touch upon the results of articles that link UV exposure to skin cancer and what this means for the future of UV‐induced skin cancer research.

A novel BAP1 mutation is associated with melanocytic neoplasms and thyroid cancer

Germline mutations in the tumor suppressor gene, BRCA-1 associated protein (BAP1), underlie a tumor predisposition syndrome characterized by increased risk for numerous cancers including uveal melanoma, melanocytic tumors and mesothelioma, among others. In the present study we report the identification of a novel germline BAP1 mutation, c.1777C>T, which produces a truncated BAP1 protein product and segregates with cancer. Family members with this mutation demonstrated a primary clinical phenotype of autosomal dominant, early-onset melanocytic neoplasms with immunohistochemistry (IHC) of these tumors demonstrating lack of BAP1 protein expression. In addition, family members harboring the BAP1 c.1777C>T germline mutation developed other neoplastic disease including thyroid cancer. IHC analysis of the thyroid cancer, as well, demonstrated loss of BAP1 protein expression. Our investigation identifies a new BAP1 mutation, further highlights the relevance of BAP1 as a clinically important tumor suppressor gene, and broadens the range of cancers associated with BAP1 inactivation. Further study will be required to understand the full scope of BAP1-associated neoplastic disease.

Mucosal melanomas in the racially diverse population of California

Background: Mucosal melanomas are rare, poorly understood neoplasms without a consensus standard of care. Objective: We sought to define mucosal melanoma tumor characteristics and the racial/ethnic attributes of patients with mucosal melanomas. Methods: We analyzed 130,920 cutaneous melanomas and 1919 mucosal melanomas recorded in the population‐based California Cancer Registry from 1988 to 2013. Results: Although only 1% of melanomas occurring in nonHispanic whites were mucosal, other racial/ethnic groups had a higher proportion of mucosal melanomas (15% for Asian/Pacific Islanders, 9% for nonHispanic blacks, and 4% for Hispanics). Anorectal mucosal melanomas were most common in female Asian/Pacific Islanders, whereas genitourinary mucosal melanomas were highest in nonHispanic whites, and head and neck tumors were most common among Hispanics. Stage at presentation was not uniform among racial/ethnic groups, with Asian/Pacific Islanders having the highest rates of metastasis. Limitations: The lack of a standardized staging system for mucosal melanomas confounds classification and knowledge regarding metastasis. Small sample size limits comparative analysis across race, stage, site, and depth. Conclusion: Mucosal melanomas differ by race/ethnicity with regard to anatomic site, stage, and depth. Because early detection offers the best chance of increased survival, greater awareness will aid clinicians who care for patients at risk for these aggressive tumors.

Imaging of Disorders Affecting the Bone and Skin

There are a variety of conditions that manifest not only in bone but also in skin. Bone and skin structures can share common embryologic origins, and genetic defects that occur early in cell differentiation may lead to disease in both organ systems. Alternatively, diseases of bone and skin may be caused by defects in genes that participate in directing or controlling both systems. Many diseases of bone and skin can manifest with atypical radiologic findings or mimic malignant bone lesions. Upon encountering such a disease process, a radiologist who is familiar with both aspects of the disorder and consequently looks for associated skin findings can greatly benefit the patient by making a definitive diagnosis. Similarly, a clinician who encounters suggestive skin lesions should be prompted to look for concomitant skeletal lesions. By synthesizing knowledge of bone and skin manifestations, radiologists and clinicians can help correctly diagnose a number of these disease processes, thereby helping patients avoid further, often nonspecific invasive workup and advancing patient care.