Shasa Hu

Disparity in Melanoma: A Trend Analysis of Melanoma Incidence and Stage at Diagnosis Among Whites, Hispanics, and Blacks in Florida

OBJECTIVE To examine and compare the temporal trends in melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida from 1990 to 2004. DESIGN Cross-sectional and retrospective analysis. SETTING Florida Cancer Data System. PATIENTS Melanoma cases with known stage and race/ethnicity reported from 1990 to 2004. MAIN OUTCOME MEASURES Age-adjusted melanoma incidence and stage at diagnosis. RESULTS Of 41 072 cases of melanoma, 39 670 cases were reported for white non-Hispanics (WNHs), 1148 for white Hispanics (WHs), and 254 for blacks. Melanoma incidence rates increased by 3.0% per year among WNH men (P < .001), 3.6% among WNH women (P < .001), 3.4% among WH women (P = .01), and 0.9% among WH men (P = .52), while remaining relatively stable among black men and women. Both WHs and blacks had significantly more advanced melanoma at presentation: 18% of WH and 26% of black patients had either regional or distant-stage melanoma at diagnosis compared with 12% of WNH patients. The proportion of distant-stage melanoma diagnosed among WHs and blacks changed little from 1990 to 2004, compared with a steady decrease in the percentage of melanoma cases diagnosed at distant stage among WNHs (P < .001). Such differences in the time trends of the proportion of distant-stage melanoma remained after excluding in situ cases. CONCLUSIONS The rising melanoma incidence among WNHs and WHs emphasizes the need for primary prevention. The persistence of disparity in melanoma stage at diagnosis among WHs, blacks, and WNHs warrants closer examination of secondary prevention efforts in minority groups.

Evaluation of Apligraf® persistence and basement membrane restoration in donor site wounds: a pilot study

Apligraf® is a bilayered tissue‐engineered product consisting of a bovine collagen matrix with neonatal fibroblasts, overlaid by a stratified epithelium containing living keratinocytes. The United States Food and Drug Administration has approved its use for venous leg ulcers and neuropathic diabetic foot ulcers. Apligraf® provides a dermal matrix and produces cytokines similar to the human skin. However, its mechanism of action and ultimate fate in host wounds are unclear. The aim of this study was to evaluate the persistence of Apligraf® fibroblasts and keratinocytes in human acute partial‐thickness wounds (split‐thickness donor sites) treated with Apligraf®. In an open‐label, within‐patient, three‐centered, controlled pilot study, 10 patients were treated with Apligraf®, Apligraf® dermis only (without epidermis), and a polyurethane film for donor site wounds of the same size, depth, and anatomical location. Apligraf® DNA persistence was the primary outcome measure. Basement membrane components, cosmetic outcome, time to wound healing, and safety parameters were secondary outcome measures. One week after the initial treatment, reverse transcription polymerase chain reaction analysis found that two Apligraf® and two Apligraf® dermis‐only‐treated sites had Apligraf® DNA present. Four weeks posttreatment, only one Apligraf® and one Apligraf® dermis‐only sites showed the presence of Apligraf® DNA. There was no difference between the three treatment modalities in establishing basement membrane in donor site wounds. No differences in other secondary outcomes were found. Apligraf® DNA persisted in a minority of patients at 4 weeks in acute partial‐thickness wounds. Apligraf®s success in speeding healing of acute wounds appears to be related to factors other than the persistence of donor DNA or effect on basement membrane restoration.

Melanoma in Hispanic and Black Americans

BACKGROUND Although age-adjusted incidence rates (per 100,000) for melanoma are lower among Hispanics and blacks (4.5 and 1.0, respectively) compared with white non-Hispanics (21.6), melanomas among minority populations in the United States are more likely to metastasize and have poorer outcomes. METHODS A review of the literature was conducted on melanomas affecting Hispanic and black Americans. RESULTS Because of the low index of suspicion in both the medical community and these ethnic populations, diagnosis is often delayed, resulting in advanced presentation and a poorer prognosis. CONCLUSIONS More comprehensive medical training, expanded public educational campaigns, and increased awareness among patients of all skin types to perform self skin checks are recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are warranted.

Ultraviolet Radiation and Incidence of Non-Hodgkin’s Lymphoma among Hispanics in the United States

Non-Hodgkin’s lymphoma (NHL) is one of the most common cancers among American Hispanics. Several studies suggest that solar UV radiation (UVR) may be an environmental risk contributing to the rise of NHL over the past decades. These studies focused primarily on light-skinned Caucasian populations; it is unknown what role UVR plays in NHL for Hispanics. We described the incidence of NHL in Hispanics from selected states in the United States between 1989 and 2000. To evaluate the role of UVR, we correlated cancer rates with the UV index and latitude of residency. Variations in NHL incidence rates with estimated amount of UVR among whites and blacks from the selected states were also analyzed. We found that NHL occurred less frequently in Hispanics than in whites. Hispanic men had higher incidence of NHL than Hispanic women. Incidence rates of NHL in Hispanics were inversely associated with estimated amount of UVR as an increase in NHL was observed with decreasing UV index (r = −0.7 in men; r = −0.41 in women) or increasing latitude of residency (r = 0.59 in men; r = 0.48 in women). This trend, although it did not reach statistical significance, was also observed in whites and blacks. Our findings do not support previous reports of a positive association between solar radiation and NHL. The inverse relationship between UVR and incidence of NHL is unexplained but presents the need for generation of hypotheses regarding the epidemiology of causal factors for NHL in the United States. Additional studies should be conducted to clarify whether sunlight exposure contributes to the development of NHL.

The Amino-terminal Heptad Repeats of the Coiled-coil Neck Domain of Pulmonary Surfactant Protein D Are Necessary for the Assembly of Trimeric Subunits and Dodecamers

Pulmonary surfactant protein D (SP-D), a lung host defense protein, is assembled as multimers of trimeric subunits. Trimerization of SP-D monomers is required for high affinity saccharide binding, and the oligomerization of trimers is required for many of its functions. A peptide containing the α-helical neck region can spontaneously trimerize in vitro. However, it is not known whether this sequence is necessary for the complete cellular assembly of disulfide-cross-linked, trimeric subunits and dodecamers. For the present studies, we synthesized mutant cDNAs with deletions or site-directed substitutions in the neck domain of rat SP-D, and examined the assembly of the newly synthesized proteins after transfection of CHO-K1 cells. The neck domain contains three “classical” heptad repeat motifs with leucine residues at the “d position,” and a distinctive C-terminal repeat previously suggested to drive trimeric chain association. Deletion of the highly conserved core of the latter repeat (FSRYLKK) did not interfere with the secretion of dodecamers with lectin activity. By contrast, deletion of the entire neck domain or deletion of one or two amino-terminal repeats resulted in defective molecular assembly. The secreted proteins eluted in the position of monomers by gel filtration under nondenaturing conditions. In addition, the neck + carbohydrate recognition domain of SP-D was necessary and sufficient for the trimerization of a heterologous collagen sequence located amino-terminal to the trimeric coiled-coil. These studies provide strong evidence that the amino-terminal heptad repeats of the neck domain are necessary for the intracellular, trimeric association of SP-D monomers and for the assembly and secretion of functional dodecamers.

Netherton syndrome and trichorrhexis invaginata--a novel diagnostic approach.

To the Editor: Netherton syndrome (NS) is a rare autosomal recessive disease that is characterized by trichorrhexis invaginata (TI), erythroderma, ichthyosis linearis circumflexa, atopy, and failure to thrive (1). Chronic skin inflammation resulting in scaling with exfoliation is also prevalent and can lead to life-threatening infection and dehydration in severe presentations (2). Trichorrhexis invaginata is a condition in which the proximal portion of the hair overlaps the distal portion, resulting in the appearance of ‘‘bamboo hair’’ (2,3). Typically, the diagnosis of NS is delayeduntil the appearanceofTI,which is characteristic of NS (1). Genetic studies have linked NS to a mutation in the SPINK5 gene at chromosome 5q31-32 that encodes the serine protease inhibitor LEKTI (1,4). Defective expression of LEKTI in the epidermis is a common feature in NS patients. In addition to the presence of the classic clinical features, SPINK5 testing can be used to support the diagnosis of NS. With the use of dermatoscopy, a noninvasive technique that has predominantly been used to enhance the diagnosis of melanocytic lesions, we were able to detect TI, which led to the confirmatory diagnosis of NS in our patient. Dermatoscopic examination of the hair shaft provides a quick and more cost-efficient method of early diagnosis. We report a 7-year-oldHondurian girl who presented to the pediatric dermatology clinic with a history of chronic, painful, exfoliative erythroderma of her body and scalp as well as short, sparse scalp hair since birth (Fig. 1). She also had a history of pneumonia and failure to thrive, although her developmental milestones were unremarkable. Previous biopsy specimens from her left abdomen and thigh revealed psoriasiform dermatitis. Of note, examination of her hair shafts at the age of 2 and 4 years showed them to be reportedly normal. A presumed diagnosis ofNSwasmade based upon her clinical features, and the patient was started on daily fluocinolone acetonide topical oil to the scalp anda 1:1mixture of Aquaphor and pimecrolimus cream three times daily to her body. At a follow-up visit, we easily appreciated the presence of TI via examination of her hair shaft with a dermatoscope (Fig. 2). The diagnosis of NS in our patient was subsequently confirmed by positive SPINK5 testing. Dermatoscopic detection of TI is a quick, effective, inoffice diagnostic tool. It has been reported that the hair shaft anomaly is more prominent and easier to detect on the eyebrows than on scalp hair, which can also be examined with the aid of a dermatoscope (2). We believe that dermatoscopy could serve as a painless, noninvasive, affordable, and accurate diagnostic tool in the evaluation of erythrodermic and ichthyotic infants and children. Trichorrhexis invaginata is a constant feature in NS, thus misdiagnosis can be avoided if this feature is accurately identified. However, the differential diagnosis of small black nodules on the hair shaft also includes trichorrhexis nodosa, monilethrix, and black piedra. Traditionally, sequential hair clippings

Papuloerythroderma 2009: Two New Cases and Systematic Review of the Worldwide Literature 25 Years after Its Identification by Ofuji et al.

Background: Even after the description of papuloerythroderma of Ofuji (PEO) in 1984, little is known about this clinical entity. Objective:To report on 2 new cases of PEO and review of the worldwide literature on this topic. Methods: Article citations were searched on several biomedical search engines (PubMed, EMBASE, SCOPUS, Google Scholar). Papers were retrieved either online or in print. Results: A grand total of 170 PEO cases were identified. Most patients were older than 55 years and of Asian or white descent, with an overall male/female ratio of 4.0. Itch and the deck-chair sign were observed in all patients. Peripheral eosinophilia, lymphocytopenia and increased serum IgE were common findings. Histopathology mostly showed aspecific inflammation, while 17 showed histological features of cutaneous T-cell lymphoma (CTCL). Atopy, malignancies, infections and drugs were rarely linked to PEO. Conclusion: PEO represents a rather monomorphous entity both clinically and, with the remarkable exception of CTCL, also histologically. Nonetheless, no causative factor could be identified in the vast majority of cases. An etiological classification and diagnostic criteria are proposed in the attempt to contribute framing this puzzling clinical entity.

Google Search Trends and Skin Cancer: Evaluating the US Population’s Interest in Skin Cancer and Its Association With Melanoma Outcomes

ues decreased, MI values increased monotonically. We then analyzed how these measurements correlated after raw values were categorized. Although ITA and MI values place individuals into 1 of 6 skin types, these classification systems are currently unrelated, with no consensus about which MI values belong to which FST group.4,5 We found that by placing participants with MI values of 750.0 or greater in FST VI, we observed a very strong correlation between these unrelated classification systems (Spearman ρ = 0.95; P < .001) (Figure, B).

Skin cancer awareness, attitude, and sun protection behavior among medical students at the University of Miami Miller School of Medicine.

Comment. Desmoplastic melanoma is an important subtype of melanoma because it represents a diagnostic pitfall and has a distinct clinical behavior. It has a higher rate of local recurrence and lower incidence of sentinel lymph node involvement than conventional melanoma, especially if the DM is histopathologically pure in appearance. It is of interest that the DMs of the 3 African American women described herein lacked an associated intraepidermal (in situ) melanoma component as well as evidence of solar elastosis, which suggests a cause independent of chronic sun damage. Most melanomas in African Americans are acral tumors or melanomas of superficial spreading type. Based on Surveillance, Epidemiology, and End Results (SEER) data (1992-2002), 7 of 251 primary invasive melanomas of African Americans were reported as desmoplastic. However, they were not further characterized with regard to histopathologic subtype (pure vs mixed) or anatomic site. One case report of a tumor said to be desmoplastic was an acral melanoma. After review of its histopathologic illustrations, we interpret it as a mixed DM. Herein, we report for the first time to our knowledge the occurrence of pure DMs at nonacral sites in African American women.

Predictors of Neighborhood Risk for Late-Stage Melanoma: Addressing Disparities through Spatial Analysis and Area-Based Measures

Minority populations have disproportionately more advanced stage melanoma and worse survival. To clarify the impact of race and ethnicity on late-stage melanoma diagnosis, we performed spatial analysis of geocoded melanoma cases diagnosed in Florida, 1999-2008, to identify geographic clusters of higher-than-expected incidence of late-stage melanoma and developed predictive models for melanoma cases in high-risk neighborhoods accounting for area-based poverty, race/ethnicity, patient insurance status, age, and gender. In the adjusted model, Hispanic ethnicity and census tract-level poverty are the strongest predictors for clustering of late-stage melanoma. Hispanic whites were 43% more likely to live in neighborhoods with excessive late-stage melanoma (P<0.001) compared with non-Hispanic whites (NHW). For every 1% increase in population living in poverty, there is a 2% increase in late-stage melanoma clustering (P<0.001). Census tract-level poverty predicted late-stage melanoma similarly among NHW and Hispanic whites. The impact of insurance coverage varied among populations; the most consistent trend was that Medicaid coverage is associated with higher odds for late-stage melanoma. The finding that Hispanics are most likely to reside in high-risk neighborhoods, independent of poverty and insurance status, underscores the importance of addressing, and overcoming community-level barriers to melanoma care.