Melody J. Eide

Actinic keratoses: Natural history and risk of malignant transformation in the Veterans Affairs Topical Tretinoin Chemoprevention Trial.

Actinic keratoses (AKs) are established as direct precursors of squamous cell carcinoma (SCC), but there is significant controversy regarding the rate at which AKs progress to SCC. The authors of this report studied a high‐risk population to estimate the risk of progression of AK to SCC and to basal cell carcinoma (BCC) and the risk of spontaneous regression of untreated AKs.

Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006

BACKGROUND Most melanoma studies use data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program or individual cancer registries. Small numbers of melanoma cases have limited in-depth analyses for all racial and ethnic groups. OBJECTIVE We sought to describe racial and ethnic variations in melanoma incidence and survival. METHODS Incidence for invasive melanoma and 5-year melanoma-specific survival were calculated for whites, blacks, American Indians/Alaskan Natives, Asians/Pacific Islanders (API), and Hispanics using data from 38 population-based cancer registries. RESULTS Incidence rates of melanoma were significantly higher for females than males among whites and Hispanics under 50 years of age and APIs under 40 years of age. White and black patients were older (median age: 59-63 years) compared with Hispanics, American Indians/Alaskan Natives, and API (median age: 52-56 years). The most common histologic type was acral lentiginous melanoma among blacks and superficial spreading melanoma among all other racial and ethnic groups. Hispanics had the highest incidence rate of acral lentiginous melanoma, significantly higher than whites and API. Nonwhites were more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites. LIMITATIONS Over 50% of melanoma cases did not have specified histology. The numbers of nonwhite patients were still relatively small despite broad population coverage (67% of United States). CONCLUSIONS Racial and ethnic differences in age at melanoma diagnosis, anatomic sites, and histologic types suggest variations in etiologic pathways. The high percentages of advanced and thicker melanomas among nonwhites highlight the need to improve melanoma awareness for all race and ethnicity in the United States.

Update on the Current State of Melanoma Incidence

The incidence of melanoma is rising worldwide, and in the United States has increased by approximately 2.8% annually since 1981. Melanoma is more common in whites, and is generally more prevalent in men. However, there is a 6.1% annual increase in US incidence of melanomas in white women younger than age 44, with growing concern that increases in skin cancer in younger women may reflect recent trends in indoor tanning. Melanoma incidence is also greater in higher economic groups. Globally, melanoma incidence is highest in Australia, followed by the United States and parts of Europe.

Tanning beds, skin cancer, and vitamin D: an examination of the scientific evidence and public health implications

Indoor tanning has become increasingly popular over the past decades, despite evidence of an increased risk of melanoma and, possibly, nonmelanoma skin cancer. Tanning bed proponents cite the health benefits of vitamin D to support indoor tanning, including concerns that reduced vitamin D levels or certain vitamin D receptor polymorphisms may be associated with increased incidence of various cancers, including cutaneous melanoma. However, most tanning devices primarily emit ultraviolet A, which is relatively ineffective in stimulating vitamin D synthesis. Health benefits can be fully dissociated from the ultraviolet exposure risks with vitamin D supplementation, although optimal levels remain to be established. Indoor tanning represents an avoidable risk factor for skin cancer, and education of the general public as well as the enactment and stricter enforcement of indoor tanning legislation are a public health imperative.

Association of cutaneous melanoma incidence with area-based socioeconomic indicators-United States, 2004-2006.

BACKGROUND Socioeconomic status (SES) has been associated with melanoma incidence and outcomes. Examination of the relationship between melanoma and SES at the national level in the United States is limited. Expanding knowledge of this association is needed to improve early detection and eliminate disparities. OBJECTIVE We sought to provide a detailed description of cutaneous melanoma incidence and stage of disease in relationship to area-based socioeconomic measures including poverty level, education, income, and unemployment in the United States. METHODS Invasive cutaneous melanoma data reported by 44 population-based central cancer registries for 2004 to 2006 were merged with county-level SES estimates from the US Census Bureau. Age-adjusted incidence rates were calculated by gender, race/ethnicity, poverty, education, income, unemployment, and metro/urban/rural status using software. Poisson multilevel mixed models were fitted, and incidence density ratios were calculated by stage for area-based SES measures, controlling for age, gender, and state random effects. RESULTS Counties with lower poverty, higher education, higher income, and lower unemployment had higher age-adjusted melanoma incidence rates for both early and late stage. In multivariate models, SES effects persisted for early-stage but not late-stage melanoma incidence. LIMITATIONS Individual-level measures of SES were unavailable, and estimates were based on county-level SES measures. CONCLUSION Our findings show that melanoma incidence in the United States is associated with aggregate county-level measures of high SES. Analyses using finer-level SES measures, such as individual or census tract level, are needed to provide more precise estimates of these associations.

Incidence of nonmelanoma skin cancer in a cohort of patients with vitiligo

BACKGROUND Nonmelanoma skin cancer (NMSC) incidence in patients with vitiligo has not been studied. OBJECTIVE We sought to quantify the incidence of NMSC in patients with vitiligo. METHODS A cohort of 477 patients with vitiligo and no history of NMSC seen in an outpatient academic center between January 2001 and December 2006 was established. All charts for patients with vitiligo were reviewed for incident NMSC, and histopathology verified. Age-adjusted (2000 US Standard Million) incidence rates were calculated and compared to US rates. RESULTS Six patients with NMSC were identified; all were Caucasian (>61 years). Age-adjusted incidence rates were: basal cell carcinoma, male 1382/100,000; basal cell carcinoma, female 0; squamous cell carcinoma, male 465/100,000; squamous cell carcinoma, female 156/100,000. Except for basal cell carcinoma in females, all rates were higher than US rates but not statistically significant. LIMITATIONS Comparison incidence rates from the general patient population during the same time period were unavailable. CONCLUSION Health care providers should be aware of the possible risk of NMSC in Caucasian patients with vitiligo.

Skin Cancer Education for Primary Care Physicians: A Systematic Review of Published Evaluated Interventions

ABSTRACTBACKGROUNDEarly detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting.OBJECTIVEWe conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma.DESIGNRelevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary.APPROACHStudies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes.KEY RESULTSAll interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics.CONCLUSIONSDespite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.

Demographic and socioeconomic predictors of melanoma prognosis in the United States.

Studies suggest sociodemographic factors may influence melanoma prognosis. Our objective was to quantify sociodemographic predictors of U.S. melanoma. Data from 17,702 melanoma cases reported to the Surveillance Epidemiology and End Results (SEER) program from 1988–1993 were merged with sociodemographic data (1990 U.S. Census). Regression analysis was used to model prognosis: melanoma mortality to incidence ratio. Prognosis was significantly associated with neighborhood racial heterogeneity, education and income. Melanoma patients who resided in areas with higher education (OR 0.4, 95% CI 0.3–0.5), more White residents (OR 0.7, 95% CI 0.5–0.8), or higher incomes (OR 0.4, 95% CI 0.2–0.5) were less likely to have poor prognosis. Education explained 3.3 times more variance than race and 1.9 times more than income. Sociodemographic factors were associated with stage and tumor thickness. Neighborhood sociodemographic variables were predictive of melanoma prognosis, and suggest an important direction for targeting public health efforts to reach those in at-risk communities.

The association of physician-specialty density and melanoma prognosis in the United States, 1988 to 1993

BACKGROUND Studies suggest physician workforce may influence cancer outcomes. OBJECTIVE We sought to quantify the effect of physician-specialty density on melanoma prognosis. METHODS Data from 17,702 melanoma cases reported to the Surveillance, Epidemiology, and End Results program from 1988 to 1993 were merged with sociodemographic data (1990 US Census) and dermatologist, family practitioner, and internist density data (Area Resource File). Linear and logistic regression analyses were used to model prognosis (melanoma mortality to incidence ratio). RESULTS A higher density of dermatologists was associated with better prognosis (lower mortality to incidence ratio) (beta = -50 x 10(-4); SE 8 x 10(-4)). Internist density was also a significant predictor of better prognosis whereas increased family practitioner density was associated with worse prognosis. Controlling for sociodemographics, physician density remained a significant predictor of the mortality to incidence ratio. LIMITATIONS Socioeconomic factors were estimated. Physician density was examined by county. CONCLUSION Controlling for sociodemographic factors, physician-specialty density predicted melanoma prognosis. This suggests that specialist health care availability may affect melanoma outcomes.

Photodynamic therapy for actinic keratoses: Survey of patient perceptions of treatment satisfaction and outcomes

Background: While there are many available treatments for actinic keratoses (AKs), patient‐preferred treatment options remain undefined. Objective: To quantify patient perceptions and preferences in the management of AKs, including comparison of photodynamic therapy (PDT) with other therapies. Methods: A self‐administered questionnaire was mailed to 45 patients who had received PDT for AKs in 2005–2006 in the Henry Ford Health System. A series of indicators for each treatment were surveyed, including: recovery time, cosmetic appearance, patient cost, effectiveness, patient satisfaction, treatment option preference, and perceived burden of treatment. Results: A total of 39 of the 45 patients participated (86.7%). A patients reported recovery time was significantly more likely to be 1 week or less for PDT when compared with cryotherapy (p = 0.02) and surgical excision (p = 0.02). Borderline significance was found for the improved cosmetic outcome in PDT vs. surgical excision (p = 0.058) and for patient satisfaction with PDT compared with 5‐fluorouracil (p = 0.058). Patients significantly preferred PDT to 5‐fluorouracil (p<0.001) or imiquimod (p = 0.031). Conclusion: While the effectiveness of lesion clearance with PDT for AKs has been well proven in the literature, this is the first study to evaluate patient perception of the effectiveness, side‐effect profile and benefits of PDT relative to several standard treatment approaches for AKs. PDT was found to have equivalent or improved recovery times, cosmetic outcomes, patient satisfaction and preference as a treatment for AKs by patients compared with other options.