Hugh Roberts

Nodular melanoma: A distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia

BACKGROUND There is a growing body of evidence that nodular melanoma (NM), because of its association with increased growth rate and thickness at diagnosis, accounts for a substantial proportion of melanoma deaths. OBJECTIVE We sought to assess the contribution of NM to melanoma deaths in comparison with other tumor subtypes. METHODS Four cohorts were established comprising 5775 cases of invasive primary cutaneous melanoma reported to the Victorian Cancer Registry during 1989, 1994, 1999, and 2004. Original pathology reports were reviewed. Age-standardized melanoma incidence rates were compared from 1989 to 2004 with annual percentage change using Poisson regression. RESULTS The incidence of thick tumors (>4 mm) increased by 3.8% (95% confidence interval 1.4 to 6.2) and 2.5% (95% confidence interval -0.5 to 5.5) per year for male and female patients, respectively. The median thickness of NM at diagnosis was 2.6 mm compared with 0.6 mm for superficial spreading melanoma. A third of patients who died from melanoma during the follow-up period had thick tumors (>4 mm), most of which were nodular subtype (61%). NM accounted for 14% of invasive melanomas, but was responsible for 43% of melanoma deaths in a total of 57,461 person-years of follow-up. By comparison, superficial spreading melanoma contributed 56% of invasive melanoma but only 30% of deaths. LIMITATIONS Pathology review was limited to reports only. Mortality information relied mostly on death certificate information. CONCLUSION The incidence of thick melanomas continues to increase. Nodular melanoma is clinically distinct and the predominant contributor to melanoma-related deaths, representing a public health challenge in reducing skin cancer mortality.

Knowledge of skin hazards and the use of gloves by Australian hairdressing students and practising hairdressers

Occupational contact dermatitis is common amongst hairdressers. In this population‐based study, 193 trainee hairdressers and 184 practising hairdressers completed a questionnaire detailing their knowledge of skin hazards, the skills they practised and the frequency of glove use. Knowledge of skin hazards was poor in both groups. While up to 70% of participants correctly identified hairdressing chemicals as potential skin hazards, less than 15% correctly identified the role of wet work. Only a small proportion recognized that hairdressing chemicals could cause allergy. Contrary to findings elsewhere, less‐experienced hairdressers often handled chemicals, particularly hair dyes containing p‐phenylene diamine. The use of gloves was inadequate, particularly when performing work at the basin, which both junior and senior hairdressers did on a regular basis. Recommended strategies for the prevention of hand dermatitis in hairdressers include improved student education, appropriate glove use and the application of after‐work moisturizing creams.

Hairdressers presenting to an occupational dermatology clinic in Melbourne, Australia

Background. Hairdressers constitute one of the largest occupational groups attending our occupational dermatology clinic in Melbourne, Australia.

Prevalence of atopy in a population of hairdressing students and practising hairdressers in Melbourne, Australia

Hairdressers are one of the largest groups affected by occupational contact dermatitis. In this population‐based study, 193 trainee hairdressers and 184 practising hairdressers each completed a questionnaire and had their hands examined. Participants were asked about past or present atopy including eczema, asthma or hayfever, which occurred in 59.2%, and were individually correlated with a history of occupational skin problems. Almost 60% of hairdressers and trainees had experienced changes on their hands since commencing hairdressing, while 29% had evidence of abnormal skin on examination on the day of participation. Atopic individuals, who plan to work in a career such as hairdressing with known high rates of occupational contact dermatitis, should be advised to care for and protect their skin from the outset to prevent the development of this condition. There has been little awareness of this issue in Australia, despite longstanding knowledge of the association of hairdressing and contact dermatitis.

Allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion

Dexpanthenol is the alcohol corresponding to pantothenic acid (the water‐soluble vitamin B5). Although it is a common ingredient in many pharmaceuticals and cosmetics, contact allergy is relatively uncommon. Cocamidopropyl PG dimonium chloride phosphate is a phospholipid complex derived from pure coconut oil, and contact allergy is rare. We report a case of allergic contact dermatitis to panthenol and cocamidopropyl PG dimonium chloride phosphate in a facial hydrating lotion.

Successful treatment of lymphomatoid papulosis with photodynamic therapy

A 40‐year‐old woman presented with a prolonged history of recurrent crops of erythematous papules and nodules on her abdomen, arms and legs. Histological examination of a cutaneous biopsy revealed Type A lymphomatoid papulosis. Over a 3‐year period, some of the patients lesions had proven to be resistant to treatment with topical and intralesional corticosteroids and systemic agents including methotrexate, tetracycline and nicotinamide. These resistant lesions were treated with two sessions of methyl aminolevulinate photodynamic therapy given 1 week apart. Review 11 months post‐photodynamic therapy demonstrated complete clinical clearance at the treatment site. While photodynamic therapy is considered a standard non‐surgical treatment option for non‐melanoma skin cancers and has been described in a number of non‐oncological indications, this is the first report of its use in lymphomatoid papulosis.

Nickel allergy presenting as mobile phone contact dermatitis.

A 39‐year‐old man presented with a 6‐month history of a treatment‐resistant facial dermatitis. The patient regularly used his mobile phone, predominantly on the left cheek. Patch testing confirmed the clinical suspicion of mobile phone contact dermatitis from nickel contained in the phone casing. Although infrequently reported, with the trend towards metallic mobile phone casings and the high incidence of nickel sensitization in the community, the incidence of mobile phone contact dermatitis is likely to increase.

Severe toxic epidermal necrolysis precipitated by amphetamine use

A 48‐year‐old man presented with a maculopapular truncal rash 9 days following intravenous amphetamine use. He subsequently developed widespread bullae over his trunk and upper limbs. Treatment was initially commenced with intravenous hydrocortisone. A diagnosis of toxic epidermal necrolysis was made and the treatment was changed to intravenous immunoglobulin at a lower dose than requested. At the height of the reaction, there was 90% body surface area involvement with tri‐mucosal involvement. His response to the intravenous immunoglobulin was poor and was complicated by infection with methicillin‐resistant Staphylococcus aureus, Candida albicans and Pseudomonas aeruginosa. Gradual re‐epithelialization took place over the next 6 weeks.