Petra G. Buettner

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.

Basal cell carcinoma : histological classification and body-site distribution

Background  Basal cell carcinoma (BCC) is the most common cancer worldwide in white‐skinned populations. Recent studies suggest that BCC is not a single entity and that different histological subtypes show different clinical behaviour and might have different aetiology.

Time trends of cutaneous melanoma in Queensland, Australia and Central Europe

The objective of this study was to describe recent developments in cutaneous melanoma from the German speaking countries in Europe (Germany, Austria, and Switzerland) and from Queensland, Australia.

Head lice in pupils of a primary school in Australia and implications for control

Background Anecdotal reports suggest that head lice infestations are a common problem in school‐aged children in Australia; however, only a few data are available. The present study aimed to determine the prevalence of infestation with head lice in children in an urban Australian school.

Prognostic Factors of Thin Cutaneous Melanoma: An Analysis of the Central Malignant Melanoma Registry of the German Dermatological Society

PURPOSE The increasing number of thin cutaneous melanomas (CM) with tumor thickness up to 1 mm demands a detailed analysis of prognostic factors for the classification and grading of these tumors. The aim of the present study was to identify prognostic factors in thin CM. PATIENTS AND METHODS A series of 12,728 patients with thin incident primary invasive CM and follow-up data recorded between 1976 and 2000 by the German-based Central Malignant Melanoma Registry was analyzed using the multivariate Cox proportional hazard model to evaluate prognostic factors, and classification and regression trees analysis (CART) to define prognostic groups. RESULTS Multivariate analysis found tumor thickness, sex, age, body site, and histopathologic subtype to be significant prognostic factors of thin CM. Ulceration and regression did not affect prognosis significantly. Prognostic classification based on the results of CART analysis resulted in three groups defined by tumor thickness, age, and sex. Ten-year survival rates of these groups varied between 91.8% and 98.1%, with improved classification as compared with subgroups by tumor thickness alone. CONCLUSION Classification by tumor thickness identified prognostic subgroups with highest significance in thin CM, and the classification was improved by the introduction of age and sex. However, neither ulceration nor the level of invasion included in the new American Joint Committee on Cancer TNM system classification, revealed statistical significance as prognostic factors in thin CM.

Risk factors for preterm, low birth weight and small for gestational age birth in urban Aboriginal and Torres Strait Islander women in Townsville

Objectives: To assess the characteristics of Indigenous births and to examine the risk factors for preterm (<37 weeks), low birth weight (<2,500 g) and small for gestational age (SGA) births in a remote urban setting.

Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials

AimsThis review compares the most popular techniques in managing the wounds after excisional haemorrhoidectomy, which are either to lay the wounds open or to close them.MethodsRandomized controlled trials were identified from the major electronic databases using the search terms “hemorrhoid*” and “haemorrhoid*.” Duration of operation, pain, length of hospital stay, time off work, time for wound healing, patient satisfaction, continence, manometry findings and complications were assessed. Quantitative meta-analysis was performed as appropriate or possible.ResultsSix trials including 686 patients met the inclusion criteria. The median follow-up time ranged from 1.5 to 19.5 months. Quantitative meta-analysis showed that there was no significant difference in cure rates between the two techniques (relative risk, 1.4; 95% CI, 0.86 to 2.2; p=0.191). Open haemor-rhoidectomy was more quickly performed (weighted mean difference, 1.03 min; 95% CI, 0.51 to 1.54; p<0.001). Closed haemorrhoidectomy wounds showed faster healing (weighted mean difference, 1.2 weeks; 95% CI, 0.88 to 1.55; p<0.001). Hospital stay, maximum pain score, total and individual complication rates were not significantly different.ConclusionsApart from faster wound healing after closed haemorrhoidectomy, open and closed techniques appeared equally effective and safe. However, there were only a few studies which presented information in different ways, and statistical heterogeneity was high.

Does single application of topical chloramphenicol to high risk sutured wounds reduce incidence of wound infection after minor surgery? Prospective randomised placebo controlled double blind trial

Objective To determine the effectiveness of a single application of topical chloramphenicol ointment in preventing wound infection after minor dermatological surgery. Design Prospective randomised placebo controlled double blind multicentre trial. Setting Primary care in a regional centre in Queensland, Australia. Participants 972 minor surgery patients. Interventions A single topical dose of chloramphenicol (n=488) or paraffin ointment (n=484; placebo). Main outcome measure Incidence of infection. Results The incidence of infection in the chloramphenicol group (6.6%; 95% confidence interval 4.9 to 8.8) was significantly lower than that in the control group (11.0%; 7.9 to 15.1) (P=0.010). The absolute reduction in infection rate was 4.4%, the relative reduction was 40%, and the relative risk of wound infection in the control group was 1.7 (95% confidence interval 1.1 to 2.5) times higher than in the intervention group. The number needed to treat was 22.8. Conclusion Application of a single dose of topical chloramphenicol to high risk sutured wounds after minor surgery produces a moderate absolute reduction in infection rate that is statistically but not clinically significant. Trial registration Current Controlled Trials ISRCTN73223053.

Hazard rates for recurrent and secondary cutaneous melanoma: An analysis of 33,384 patients in the German Central Malignant Melanoma Registry

BACKGROUND Knowledge about the risk for recurrence and secondary cutaneous melanoma (CM) is an important basis for patient counseling and planning of follow-up examinations. OBJECTIVES This study aimed to analyze stage- and time-dependent hazard rates (HR) and discusses current surveillance recommendations. METHODS Follow-up data of 33,384 patients with incident CM in stages I to III (American Joint Committee on Cancer 2002) were recorded by the German Central Malignant Melanoma Registry in 1976 through 2007. Survival was based on Kaplan-Meier estimates and HRs were calculated. RESULTS Recurrences were recorded in 4999 patients (stage I, 7.1%; stage II, 32.8%; and stage III, 51.0%). Ten-year recurrence-free survival was 78.9% (95% confidence interval 73.1-90.5); in stage I, 89.0%; stage II, 56.9%; and stage III, 36.0%. Whereas HR for recurrent CM showed a constantly low level less than or equal to 1:125 per year for stage IA, clearly higher HRs of greater than or equal to 1:40 were recorded in stage IB for the first 3 years and generally in stages II to III. Of all patients 2.3% developed secondary melanomas, with a consistently low HR of less than 1:220 per year. LIMITATIONS As German recommendations discontinued regular follow-up examinations after 10 years, no information can be given beyond this time point. Follow-up data of longer than 5 years were available in 41.4% of patients. CONCLUSION For patients at stage IA with thin melanoma and low HR for recurrent CM the need for surveillance remains questionable. For patients with higher HR greater than 1:40 per year, intensified surveillance strategies should be taken into account.

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.