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Epidemiology of melanoma

  1. Top of page
  2. Epidemiology of melanoma
  3. Efficacy of a general practitioner training campaign for melanoma diagnosis
  4. What is the natural course of early-onset atopic dermatitis?
  5. A clinical adjunct for mole screening campaigns. Observational study on 292 patients

This commissioned scholarly review by Nikolaou and Stratigos from Athens starts by stating that cutaneous melanoma has shown a consistent increase in incidence among white populations over the past four decades. −Despite improved survival rates due to early detection of thin melanomas, which have been observed in several countries, the rate of thick melanomas has remained constant or has continued to increase, especially in the older age group. Current considerations in the epidemiology of melanoma focus on the observed survival benefit of women compared with men, the contributing role of indoor tanning in melanoma risk and the diverse effect of sun exposure in the development of different types of melanoma with respect to their clinical and mutational profile. Certain well-known risk factors, such as skin, hair and eye pigmentation and −melanocytic naevi, have been validated in large-scale association studies, while additional lifestyle factors and iatrogenic exposures, such as −immunosuppressive agents and nonsteroidal anti-inflammatory drugs, are being investigated. In addition, genome-wide −association studies have revealed genetic loci that underlie the genetic susceptibility of melanoma, some of which are related to known risk factors. This review article provides a timely update in the epidemiology of cutaneous melanoma and discusses recent developments in the field. It concludes by summarizing the main trends of current melanoma epidemiology as being increasing incidence, stable mortality and persistence of thick tumours, with a disproportionate burden of disease in men aged >60 years. The review highlights excess ultraviolet radiation exposure interacting with genetically determined phenotypic characteristics through different oncogenetic pathways as being the major predisposing factor for melanoma development. The authors discuss the trends of melanoma incidence and mortality and review current data on established and potentially novel risk factors and disease −associations for melanoma.

Nikolaou V, Stratigos AJ. Emerging trends in the epidemiology of melanoma. Br J Dermatol 2014; 170: 11–19.

Efficacy of a general practitioner training campaign for melanoma diagnosis

  1. Top of page
  2. Epidemiology of melanoma
  3. Efficacy of a general practitioner training campaign for melanoma diagnosis
  4. What is the natural course of early-onset atopic dermatitis?
  5. A clinical adjunct for mole screening campaigns. Observational study on 292 patients

In this study by Grange et al., a strategy for −improving early diagnosis of melanoma was evaluated on a population basis in France. Their aim was to evaluate the efficacy of a general practitioner (GP; family doctor) awareness and training campaign in a pilot French geographical region (Champagne-Ardenne) with 1·34 million inhabitants, 1241 GPs, 56 dermatologists and a population-based melanoma registry. All GPs received repeated awareness postal mailings in 2008, and 398 (32·1%) attended training sessions organized by 27 dermatologists. The pre- (2005–7) and postcampaign (2009–11) periods were compared for incidence of very thick melanomas. Secondary end points were the mean Breslow thickness, the proportions of very thick melanomas and thin (<1 mm) −melanomas among invasive cases, and the ratio of in situ/all melanoma cases. Similar measures were −performed in the control area of Doubs/Belfort territory, where no equivalent campaign was carried out. The incidence of very thick melanoma decreased from 1·07 to 0·71 per 100 000 habitants per year (P = 0·01), the mean Breslow thickness from 1·95 mm to 1·68 mm (P = 0·06) and the proportion of very thick melanomas from 19·2% to 12·8% (P = 0·01). The proportions of thin and in situ melanomas increased from 50·9% to 57·4% (P = 0·05) and from 20·1% to 28·2% (P = 0·001), respectively. No significant variation was observed in Doubs/Belfort territory. The authors concluded that these results strongly support the efficacy of such a campaign targeting GPs and provide the rationale for a larger public health campaign in France, including training of GPs by dermatologists and encouraging patients to ask their GP for a systematic skin examination.

Grange F, Woronoff AS, Bera R et al. Efficacy of a general practitioner training campaign for early detection of melanoma in France. Br J Dermatol 2014; 170: 123–129.

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What is the natural course of early-onset atopic dermatitis?

  1. Top of page
  2. Epidemiology of melanoma
  3. Efficacy of a general practitioner training campaign for melanoma diagnosis
  4. What is the natural course of early-onset atopic dermatitis?
  5. A clinical adjunct for mole screening campaigns. Observational study on 292 patients

Hua et al. attempt to answer this important question in a population-based cohort study from Taiwan. They comment that previous studies regarding the natural course of atopic dermatitis (AD) have usually been of small sample size and were not based on nationwide populations. Their aim was to find out the disease duration and remission rate of children with early-onset AD (onset in the first 2 years of life) in Taiwan, and to determine whether the presence of allergic rhinitis or asthma affected the course of the disease. Patients with early-onset AD in a nationally representative cohort were selected using the National Health Insurance Research Database of Taiwan and were followed from birth to 10 years of age. The authors utilized Kaplan–Meier survival analysis to analyse disease duration and remission of AD. Between-group analysis using the log-rank test was carried out to analyse the influence of risk factors on the disease course. Of the 1404 children with early-onset AD, 19·4% had disease duration <1 year and 48·7% had disease duration <4 years. The study concluded that children in Taiwan with early-onset AD had disease of variable natural course, and a median disease duration of 4·2 years. About 70% of the patients went into remission eventually. The presence of allergic rhinitis or asthma did not affect the disease course of AD.

Hua T-C, Hwang C-Y, Chen Y-J et al. The natural course of early-onset atopic dermatitis in Taiwan: a population-based cohort study. Br J Dermatol 2014; 170: 130–135.

A clinical adjunct for mole screening campaigns. Observational study on 292 patients

  1. Top of page
  2. Epidemiology of melanoma
  3. Efficacy of a general practitioner training campaign for melanoma diagnosis
  4. What is the natural course of early-onset atopic dermatitis?
  5. A clinical adjunct for mole screening campaigns. Observational study on 292 patients

Echeverría et al. state that the use of whole body naevus count to identify at-risk patients when screening for melanoma is −impractical. The objectives of their study were to identify a valid anatomical predictor of total naevus count and to determine the numbers of naevi that most accurately predict total naevus counts above 25, 50 and 100. In addition, they aimed to evaluate the determinants of multiple melanocytic naevi and atypical naevi. Clinical data from 292 consecutive Spanish patients consulting for skin lesions were collected. Correlations between site-specific and whole body naevus counts were analysed. Cut-off values to predict total naevus counts were determined using the area under the receiver operating characteristic curve. The studied population was young (median age 31 years, interquartile range 28–43). The naevus count on the right arm correlated best with the total naevus count (R2 = 0·80 for men, 0·86 for women). The presence of at least five naevi on the right arm was the strongest determinant of a total naevus count above 50 [odds ratio (OR) 34·4, 95% confidence interval (CI) 13·9–85·0] and of having at least one atypical naevus (OR 5·7, 95% CI 2·4–13·5). Cut-off values of 6, 8 and 11 naevi on the right arm best predicted total naevus counts above 25, 50 and 100, respectively. The authors concluded that the arm is a practical and reliable site with which to estimate the total naevus count when screening or phenotyping large populations. Threshold values for the number of naevi on the arm are −proposed to help identify patients for melanoma screening.

Echeverría B, Bulliard J-L, Guillén C, Nagore E. Indicators for the total number of melanocytic naevi: an adjunct for screening campaigns. Observational study on 292 patients. Br J −Dermatol 2014; 170: 144–149.