Rachel E. Neale

The skin awareness study: Promoting thorough skin self-examination for skin cancer among men 50 years or older

BACKGROUNDnIncidence and mortality from skin cancers including melanoma are highest among men 50 years or older. Thorough skin self-examination may be beneficial to improve skin cancer outcomes.nnnOBJECTIVESnTo develop and conduct a randomized-controlled trial of a video-based intervention to improve skin self-examination behavior among men 50 years or older.nnnMETHODSnPilot work ascertained appropriate targeting of the 12-minute intervention video towards men 50 years or older. Overall, 968 men were recruited and 929 completed baseline telephone assessment. Baseline analysis assessed randomization balance and demographic, skin cancer risk and attitudinal factors associated with conducting a whole-body skin self-examination or receiving a whole-body clinical skin examination by a doctor during the past 12 months.nnnRESULTSnRandomization resulted in well-balanced intervention and control groups. Overall 13% of men reported conducting a thorough skin self-examination using a mirror or the help of another person to check difficult to see areas, while 39% reported having received a whole-body skin examination by a doctor within the past 12 months. Confidence in finding time for and receiving advice or instructions by a doctor to perform a skin self-examination were among the factors associated with thorough skin self-examination at baseline.nnnCONCLUSIONSnMen 50 years or older can successfully be recruited to a video-based intervention trial with the aim to reduce their burden through skin cancer. Randomization by computer generated randomization list resulted in good balance between control and intervention group and baseline analysis determined factors associated with skin cancer early detection behavior.

Clinical skin examination outcomes after a video-based behavioral intervention: analysis from a randomized clinical trial.

IMPORTANCEnOlder men are at risk of dying of melanoma.nnnOBJECTIVEnTo assess attendance at and clinical outcomes of clinical skin examinations (CSEs) in older men exposed to a video-based behavioral intervention.nnnDESIGN, SETTING, AND PARTICIPANTSnThis was a behavioral randomized clinical trial of a video-based intervention in men aged at least 50 years. Between June 1 and August 31, 2008, men were recruited, completed baseline telephone interviews, and were than randomized to receive either a video-based intervention (nu2009=u2009469) or brochures only (nu2009=u2009461; overall response rate,u200937.1%) and were again interviewed 7 months later (nu2009=u2009870; 93.5% retention).nnnINTERVENTIONSnVideo on skin self-examination and skin awareness and written informational materials. The control group received written materials only.nnnMAIN OUTCOMES AND MEASURESnParticipants who reported a CSE were asked for the type of CSE (skin spot, partial body, or whole body), who initiated it, whether the physician noted any suspicious lesions, and, if so, how lesions were managed. Physicians completed a case report form that included the type of CSE, who initiated it, the number of suspicious lesions detected, how lesions were managed (excision, nonsurgical treatment, monitoring, or referral), and pathology reports after lesion excision or biopsy.nnnRESULTSnOverall, 540 of 870 men (62.1%) self-reported a CSE since receiving intervention materials, and 321 of 540 (59.4%) consented for their physician to provide medical information (received for 266 of 321 [82.9%]). Attendance of any CSE was similar between groups (intervention group, 246 of 436 [56.4%]; control group, 229 of 434 [52.8%]), but men in the intervention group were more likely to self-report a whole-body CSE (154 of 436 [35.3%] vs 118 of 434 [27.2%] for control group; Pu2009=u2009.01). Two melanomas, 29 squamous cell carcinomas, and 38 basal cell carcinomas were diagnosed, with a higher proportion of malignant lesions in the intervention group (60.0% vs 40.0% for controls; Pu2009=u2009.03). Baseline attitudes, behaviors, and skin cancer history were associated with higher odds of CSE and skin cancer diagnosis.nnnCONCLUSIONS AND RELEVANCEnA video-based intervention may increase whole-body CSE and skin cancer diagnosis in older men.nnnTRIAL REGISTRATIONnanzctr.org.au Identifier: ACTRN12608000384358.

Vitamin D and pancreatic cancer

Pancreatic cancer is currently the fourth leading cause of cancer-related death, and it is projected that within the next two decades it will become the second most common cause of death due to cancer. Few patients are diagnosed when surgical resection is feasible and the efficacy of existing chemotherapeutic agents for advanced/metastatic cancer is limited. Thus, there is a need to identify agents that can prevent pancreatic cancer or improve survival in those affected. Vitamin D and its analogues, with their ability to regulate cell growth, differentiation, apoptosis and angiogenesis, may be promising agents. This review explores the published literature about the potential role of vitamin D and its analogues in preventing or treating pancreatic cancer. The vitamin D system is altered in pancreatic cancer. Pancreatic cancer tissue expresses vitamin D receptors, but the calcitriol analogues may affect pancreatic cancer tissue by mechanisms that do not involve interaction with its receptors. Experimental evidence postulates multiple potential mechanisms by which calcitriol analogues may exert their anti-cancer effect, the most common being by action on cyclin-dependent kinases p21 and p27. Use of calcitriol analogues in pancreatic cancer remains largely underexplored and warrants further clinical trials.

Basal cell carcinomas on sun‐protected vs. sun‐exposed body sites: a comparison of phenotypic and environmental risk factors

Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in White populations. There are indications that risk factors for BCC may differ according to the anatomic site of the tumour but this is not well understood.

Uptake of Skin Self-examination and Clinical Examination Behavior by Outdoor Workers

ABSTRACT This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

Comparison of PTCH1, COX‐2, p53, and Ki‐67 protein expression in basal cell carcinomas of nodular and superficial subtypes arising on the head and trunk

There is some evidence that basal cell carcinomas (BCCs) arising on different anatomic sites and developing to different histological subtypes differ in their pathophysiology. The expression of a number of proteins, including PTCH1, COX‐2, p53, and Ki‐67, is frequently altered in BCC development.