2023 Virtual Grand Rounds Session 8: May 31, 2023 - Skin Cancer Prevention

Skin Cancer

WEDNESDAY, May 24, 2023 (HealthDay News) -- For patients undergoing skin cancer surgery, microdosed incisional clindamycin reduces the rate of surgical site infections (SSIs), according to a study published online May 24 in JAMA Surgery.Maple Goh, M.B.Ch.B., from the University of Auckland in New Zealand, and colleagues conducted a randomized controlled trial to examine whether microdosed incisional antibiotics reduce the rate of SSIs among adult patients undergoing any form of skin cancer surgery. Patients received an incision site injection of buffered local anesthetic alone (control) or buffered local anesthetic with microdosed flucloxacillin (500 μg/mL) or microdosed clindamycin (500 μg/mL). A total of 681 patients returned for postoperative assessments (721 presentations and 1,133 total lesions).The researchers found that the proportion of lesions exhibiting a postoperative wound infection score of 5 or greater was 5.7, 5.3, and 2.1 percent in the control, flucloxacillin, and clindamycin arms, respectively. After adjustment for baseline differences among the arms, the results were similar. Significantly fewer lesions in the clindamycin and flucloxacillin arms required postoperative systemic antibiotics compared with lesions in the control arm (2.1 and 4.0 percent, respectively, versus 8.0 percent)."These results establish evidence-based guidelines for antibiotic prophylaxis in one of the most common surgical interventions performed worldwide, where they have been previously absent," the authors write.

Significantly fewer lesions receiving microdosed clindamycin, flucloxacillin required postoperative systemic antibiotics

Microdosed Incisional Clindamycin Cuts SSI After Skin Cancer Surgery

WEDNESDAY, May 3, 2023 -- Cooperation of dermatologists with a convolutional neural network (CNN) improves diagnostic performance for suspect melanocytic lesions, according to a study published online May 3 in JAMA Dermatology.Julia K. Winkler, M.D., from the University of Heidelberg in Germany, and colleagues conducted a prospective diagnostic study in which dermatologists performed skin cancer screenings using naked-eye examination and dermoscopy. Suspect melanocytic lesions were graded by the probability of malignancy. Dermoscopic images of suspect lesions were then examined using a market-approved CNN. Reference diagnoses were based on histopathologic examination in 54.8 percent of lesions or on clinical follow-up and expert consensus in the case of nonexcised lesions.Twenty-two dermatologists detected 228 suspect melanocytic lesions in 188 patients. The researchers found that when dermatologists additionally integrated CNN results into decision-making, diagnostic sensitivity and specificity improved significantly (mean sensitivity improved from 84.2 to 100.0 percent; mean specificity from 72.1 to 83.7 percent; mean accuracy from 74.1 to 86.4 percent; mean receiver operator characteristic area under the curve from 0.895 to 0.968). For classifying melanocytic lesions, CNN alone achieved comparable sensitivity, higher specificity, and higher diagnostic accuracy than dermatologists alone. Furthermore, unnecessary excisions of benign nevi were reduced by 19.2 percent with dermatologist cooperation with CNN. The most diagnostic improvement was seen for dermatologists with less dermoscopy experience cooperating with the CNN compared with more experienced dermatologists."These results indicate that a broader application of this human with machine approach, particularly in nonspecialized institutions, could be beneficial to clinicians and patients," the authors write.Two authors disclosed financial ties to the pharmaceutical and medical device industries. &nbsp;

The most diagnostic improvement was seen for dermatologists with less dermoscopy experience cooperating with the CNN

Convolution Neural Network Aids Diagnosis for Melanocytic Lesions by Dermatologists

Local recurrence rates are low for patients with invasive head and neck melanoma treated with Mohs micrographic surgery (MMS), according to a study published online Jan. 12 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Brandon T. Beal, M.D., from Jacksonville Skin Cancer Specialists in Florida, and colleagues examined local recurrence, nodal recurrence, and distant recurrence rates and disease-specific survival for invasive melanoma of the head and neck treated with MMS in a retrospective multicenter study involving 785 cases.




 The researchers found that the local recurrence, nodal recurrence, and distant recurrence rates were 0.51, 1.0, and 1.1 percent, respectively, in the overall cohort. Local recurrence was 0.16, 1.18, 2.22, and 5.26 percent for T1, T2, T3, and T4 tumors, respectively. Disease-specific survival was 96.8 and 93.4 percent at five and 10 years, respectively.




 "These data support modification to the National Comprehensive Cancer Network guidelines for the treatment of invasive melanoma of the head and neck," the authors write. "The clear advantage of MMS revolves around complete peripheral and deep margin assessment. Applying this paradigm to the treatment of melanoma, and surgical oncology in general, will improve oncological cure rates and outcomes for our patients."




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Disease-specific survival was 96.8 and 93.4 percent at five and 10 years, respectively

Local Recurrence Rate Low With Mohs for Invasive Head, Neck Melanoma

In an expert consensus panel report published in the January issue of
 
 SKIN,
 
 clinical management recommendations are presented for the use of gene expression profile (GEP) testing in the assessment of cutaneous melanoma (CM).




 Danny Zakria, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues created updated guidelines and consensus statements for optimal use of commercially available GEP tests, used in prognostic assessment of CM. Twenty-two articles were included that validated the 31-GEP test, two that validated the 11-GEP test, and seven that validated the 8-GEP clinicopathologic test.




 The researchers generated six usage guidelines and five consensus statements, which were unanimously approved. Usage guidelines with a Strength of Recommendation Taxonomy (SORT) level of A included integration of GEP results for patients with T1a tumors at least 0.3 mm in depth, T1b tumors, or any tumor in which there is significant uncertainty about adequacy of microstaging to improve prognostic assessment. For traditionally assessed low-risk patients, a high-risk subset for recurrence, distant metastasis, or death can be identified by GEP testing. GEP testing provides useful information to augment risk-aligned management decisions to rule in or rule out the need for sentinel lymph node biopsy and subsequent management plans. Guidelines with a SORT level of B include adding GEP results to clinicopathologic information to improve CM prognosis assessment and adding GEP results to the American Joint Committee on Cancer classification to improve prognostic assessment of cutaneous melanoma.




 "The expert consensus guidelines and support statements presented here will hopefully provide a framework for the clinician to integrate GEP testing into their CM patient management," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Castle Biosciences, which partially funded the study.




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GEP results can improve prognostic assessment for patients with tumors with uncertainty about adequacy of microstaging

Guidelines Issued for Gene Expression Profiling in Cutaneous Melanoma

For patients with a history of facial keratinocyte carcinoma (KC), nonablative fractional laser (NAFL) treatment is associated with a reduced risk for subsequent development of facial KC, according to a study published online Dec. 6 in
 
 Dermatologic Surgery
 
 .




 Travis A. Benson, M.D., from Harvard Medical School in Boston, and colleagues conducted a retrospective cohort study involving patients with a history of facial KC treated between 2005 and 2021 to examine whether NAFL treatment is associated with a decrease in subsequent facial KC development. The study included 43 NAFL-treated patients with a history of facial KC and 52 matched controls.




 The researchers found that the rate of subsequent facial KC development was 20.9 and 40.4 percent in NAFL-treated patients and controls. Compared with NAFL-treated patients, controls developed new facial KC significantly earlier. Controls were more likely to develop new facial KC than NAFL-treated patients when controlling for age, gender, and skin type (hazard ratio, 2.65).




 "These findings suggest that NAFL treatment may have an important role in protecting against subsequent keratinocyte carcinomas," a coauthor said in a statement. "While the mechanism of NAFL's protective effect is not completely understood, it is suspected that NAFL treatment reduces the overall burden of photo damaged keratinocytes and may promote a wound healing response, which gives healthy skin cells a selective advantage."




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Nonablative fractional laser-treated patients had lower rate of subsequent facial keratinocyte carcinoma development

Risk for Subsequent Facial Keratinocyte Carcinoma Lower With Laser Treatment

The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been revised to simplify diagnoses into four classes, according to a consensus statement published online Jan. 11 in
 
 JAMA Network Open
 
 .




 Raymond L. Barnhill, M.D., from the Institut Curie in Paris, and colleagues revised the MPATH-Dx version 1.0 classification tool using feedback from dermatopathologists and members of the International Melanoma Pathology Study Group. All feedback was integrated into an updated and refined MPATH-Dx version 2.0.




 The researchers note that in order to improve diagnostic concordance and provide more explicit guidance for treatment, the new MPATH-Dx version 2.0 schema simplifies the original five-class hierarchy into four classes. Histopathological criteria for classification of classes I and II lesions are clearly defined in the new version; specific provisions are made for the most frequently encountered low-cumulative sun damage pathway of melanoma progression and other less common pathways to melanoma; guidance is provided for classifying intermediate class II tumors versus melanoma; and a subset of pT1a melanomas with very low risk is recognized.




 "We expect that the implementation of the new revised MPATH-Dx V2.0 schema into routine practice will provide a robust tool and adjunct for standardized diagnostic reporting of melanocytic lesions and management of patients to the benefit of both health care practitioners and patients," the authors write.




 Several authors disclosed financial ties to the biotechnology and pharmaceutical industries.




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Updated version simplifies original five-class hierarchy into four classes, including clearly defining classes I and II lesions

MPATH-Dx Version 2.0 Simplifies Classification of Melanoma

Adolescents and young adults (AYA) with melanoma have worse survival than older adults, according to a study published online Jan. 4 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Katherine Y. Wojcik, Ph.D., from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues examined factors associated with differences in melanoma survival among AYA (ages 15 to 39 years) and older adults (ages 40 to 64 years) in a population-based registry study involving 81,597 cases of melanoma diagnosed from 2004 to 2015.




 The researchers found that AYA with stage IV melanoma had worse survival than that seen for older adults in the adjusted age group-specific models (hazard ratios for all-cause death, 20.39 versus 10.79). For AYAs, thicker tumors and public insurance were also associated with worse survival than that observed in models for older adults. When detected at earlier stages, AYAs experienced better survival.




 "Although more aggressive tumors were present in AYA patients, there was no overall delay in time to treatment, suggesting potentially delayed diagnosis," the authors write. "A public health campaign to improve awareness of AYA melanoma, including in young persons of color, may disrupt potential delays in diagnosis and reduce the excess burden of mortality in young people."




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Adolescents and young adults with stage IV melanoma have worse survival than that seen for older adults in adjusted age group-specific models

Is Melanoma Survival Worse for Adolescents, Young Adults Versus Older Adults

Survival rates for children and adolescents with melanomas are high, according to a study published online Dec. 9 in the
 
 Journal of the American Academy of Dermatology
 
 .




 Mary-Ann El Sharouni, Ph.D., from the University of Sydney, and colleagues assessed clinicopathologic features and survival of 62 children (aged 11 years and younger) and 452 adolescents (aged 12 to 19 years) diagnosed with melanoma.




 The researchers found that melanoma subtypes were conventional melanoma (superficial spreading, nodular, desmoplastic, and acral lentiginous; 428 patients), spitzoid melanoma (78 patients), and melanoma associated with a congenital nevus (eight patients). Ten-year recurrence-free survival (RFS) was similar in children (91.5 percent) and in adolescents (86.4 percent), as was 10-year overall survival (OS; 100 and 92.7 percent, respectively). In adolescents, ulceration status and anatomic site were associated with RFS and OS, while age, sex, mitotic index, sentinel node status, and melanoma subtype were not. Worse RFS was seen with Breslow thickness &gt;4 mm.




 "Our data suggest that adolescent melanomas are often similar to adult-type melanomas, whilst those which occur in young children frequently occur via different molecular mechanisms," the authors write. "In the future it is likely that further understanding of these molecular mechanisms and ability to classify melanomas based on their molecular characteristics will assist in further refining prognostic estimates and [possibly] guiding treatment for young patients with melanoma."




 Two authors disclosed financial ties to the pharmaceutical industry.




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Primary tumor ulceration, head/neck location, and Breslow thickness &gt;4 mm predict worse survival in teens

Survival Rates High for Children, Teens With Melanoma

Several risk factors have been identified that are associated with poor outcomes in primary cutaneous squamous cell carcinoma, according to a systematic review and meta-analysis published online Dec. 28 in
 
 JAMA Dermatology
 
 .




 George A. Zakhem, M.D., M.B.A., from NYU Langone Health in New York City, and colleagues examined all evidence-based reports of patient risk factors and tumor characteristics associated with poor outcomes in primary cutaneous squamous cell carcinoma. The meta-analysis included data from 129 studies with 137,449 patients with primary cutaneous squamous cell carcinoma and 126,553 tumors.




 The researchers identified several patient risk factors and tumor characteristics that were associated with local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death. Among the factors reported by more than one study, the risks for local recurrence and disease-specific death were highest in association with tumor invasion beyond subcutaneous fat (risk ratios, 9.1 and 10.4, respectively), while the risk for any metastasis was highest in association with perineural invasion (risk ratio, 5.0). The lowest incidence of nearly all poor outcomes was seen for patients who received Mohs micrographic surgery.




 "These tumor characteristics should be considered in future staging systems, workup protocols, and treatment algorithms," the authors write.




 Several authors disclosed financial ties to the pharmaceutical and other life science industries.




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Risks for local recurrence, disease-specific death highest in association with tumor invasion beyond subcutaneous fat

Can Certain Factors Predict Poor Outcomes in Cutaneous Squamous Cell Carcinoma?

Two pharmaceutical companies said Tuesday that they have made notable progress with a vaccine that could prevent melanoma.




 Moderna, well known for its work on the COVID-19 vaccine, and Merck, which makes the cancer immunotherapy drug Keytruda (pembrolizumab), announced that the combination performed well in a small study of patients who had the cancer surgically removed.




 "Today's results are highly encouraging for the field of cancer treatment. mRNA has been transformative for COVID-19, and now, for the first time ever, we have demonstrated the potential for mRNA to have an impact on outcomes in a randomized clinical trial in melanoma," Moderna CEO Stéphane Bancel said in a company news release. "We will begin additional studies in melanoma and other forms of cancer with the goal of bringing truly individualized cancer treatments to patients."




 Study participants experienced a statistically significant improvement in survival with a combination of the vaccine and Keytruda before the cancer returned in patients who had advanced melanoma.




 "These positive findings represent an important milestone in our collaboration with Moderna," said Dean Li, M.D., president of Merck Research Laboratories. "Over the last six years, our teams have worked closely together combining our respective expertise in mRNA and immuno-oncology with a focus on improving outcomes for patients with cancer."




 Researchers compared the combination of the vaccine and Keytruda to Keytruda alone in a midstage clinical trial that included 157 patients. Those who had the combination had a 44 percent reduction in the risk for death or the cancer returning when compared with Keytruda alone. Researchers administered the treatments for about a year in both groups, with exceptions made for severe side effects or disease return.




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Companies announced that the vaccine performed well in a small study of patients who had the cancer surgically removed

Moderna, Merck Report on Promising Melanoma Vaccine

The introduction of new melanoma treatments coincided with a reduction in the melanoma mortality rate (MMR) in the United States, according to a study published online Dec. 6 in
 
 JAMA Network Open
 
 .




 Navkirat Kahlon, M.D., M.P.H., from the University of Toledo College of Medicine and Life Sciences in Ohio, and colleagues reviewed changes in the long-term MMR trends in adult patients in the United States using data from the Surveillance, Epidemiology, and End Results database. Outcomes were examined in association with U.S. Food and Drug Administration approval of new drugs for melanoma.




 The researchers found that for the first time in the past 40 years, there was a significant reduction in MMR from 2013 to 2017, after the introduction of new treatments in 2011 (most after 2013). From 1975 to 1988, the rates increased (annual percent change, 1.65 percent; 95 percent confidence interval, 1.30 to 2.00 percent; P &lt; 0.001). From 1988 to 2013, there was no significant change in MMR (annual percent change, 0.01 percent; 95 percent confidence interval, −1.10 to 0.12 percent; P = 0.85). From 2013 to 2017, there was a significant decrease in MMR (annual percent change, −6.28 percent; 95 percent confidence interval, −8.52 to −3.97 percent; P &lt; 0.001).




 "The effectiveness of new and innovative therapeutics for melanoma is likely represented by the remarkable and statistically significant drop in population-level melanoma mortality in the last decade," the authors write. "These are very encouraging data and support the continued development of such therapies."




 One author disclosed financial ties to the pharmaceutical industry.




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Significant reduction seen in mortality rate from 2013 to 2017, after the introduction of new treatments in 2011 (most after 2013)

2013 to 2017 Saw Significant Drop in U.S. Melanoma Mortality Rates

A high number of moles and a high genetic predisposition are more strongly associated with second than first primary melanomas, according to a study published online Nov. 23 in
 
 JAMA Dermatology
 
 .




 Catherine M. Olsen, Ph.D., from the QIMR Berghofer Medical Research Institute in Herston, Australia, and colleagues compared the clinical characteristics of first and second melanomas in a prospective cohort study involving men and women aged 40 to 69 years recruited in 2011 and followed until December 2018. Data were included for 38,845 patients.




 The researchers found that 3.1 and 0.6 percent of participants had a single primary melanoma diagnosis and a second primary melanoma diagnosis, respectively, during a median follow-up of 7.4 years. Compared with first melanomas, second melanomas were more likely to be in situ; for invasive tumors, second versus first melanomas were more likely to be thin (≤1 mm). Having many moles at age 21 years was more strongly associated with second than first primary melanomas (hazard ratio, 6.36 versus 3.46). Furthermore, a high genetic predisposition was more strongly associated with second versus first melanoma (hazard ratio, 3.28 versus 2.06). A history of multiple skin cancer excisions was also more strongly associated with second versus first melanomas (hazard ratio, 2.63 versus 1.86). Similarly elevated associations with first and second melanomas were seen for all other phenotypic characteristics and sun exposure measures.




 "Findings suggest that people who develop second primary melanomas have more nevi and greater genetic risk than people who develop only one melanoma," the authors write.




 Two authors disclosed financial ties to pharmaceutical companies.




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Association stronger with second versus first primary melanoma for having many moles at age 21 years, high genetic predisposition

Nevi, Genetic Predisposition More Strongly Linked to Second Melanoma

Melanoma diagnosis is associated with increased risk of subsequent prostate cancer, according to a study published online Nov. 1 in the
 
 British Journal of Cancer
 
 .




 Sam Egger, from the University of Sydney, and colleagues recruited men from 2006 to 2009 to examine the association between cutaneous melanoma and subsequent risk of prostate cancer. Data were included from 96,548 eligible men, of whom 1,899 were diagnosed with melanoma during the melanoma diagnosis period. During follow-up, 3,677 incident prostate cancers were diagnosed.




 The researchers found that the risk of a subsequent prostate cancer diagnosis was increased for men with a melanoma diagnosis versus those with no melanoma (fully adjusted hazard ratio, 1.32; 95 percent confidence interval, 1.09 to 1.60). Weak evidence was seen for higher risks of a subsequent prostate cancer diagnosis for men diagnosed with more than one versus one melanoma. The association was also seen if first melanoma diagnosis was 10 to 15 years before study recruitment (fully adjusted hazard ratio, 2.05; 95 percent confidence interval, 1.35 to 3.12).




 "Our study is the first to show that the positive association between melanoma and the subsequent risk of prostate cancer diagnosis is unlikely to be due to confounding from increased medical surveillance after a melanoma diagnosis," the authors write. "The positive association remained significant even after the over-adjustment for rate of prostate-specific antigen monitoring tests
 
 ."
 




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More than twofold increased risk of prostate cancer seen for men with first melanoma diagnosed 10 to 15 years before study recruitment

Melanoma Diagnosis Linked to Increased Risk of Prostate Cancer

For patients with high-risk resected melanoma, adjuvant pembrolizumab improves quality of life (QOL) compared with standard of care with ipilimumab or high-dose interferon α 2b (HDI), according to a study published online Nov. 23 in JAMA Oncology.

 Joseph M. Unger, Ph.D., from the Fred Hutchinson Cancer Center in Seattle, and colleagues compared QOL in patients with resected melanoma at high risk for relapse who were treated with adjuvant pembrolizumab or standard of care. A total of 832 patients from the S1404 phase 3 randomized clinical trial were included and were evaluable for the primary QOL end point at cycle 3.

 The researchers found that the adjusted Functional Assessment of Cancer Therapy (FACT) Biological Response Modifiers (FACT-BRM) trial outcome index (TOI) score at cycle 3 was 9.6 points higher for pembrolizumab versus ipilimumab/HDI, which exceeded the prespecified clinically meaningful difference. Differences by arm exceeded 5 points in favor of pembrolizumab in linear-mixed models through cycle 7. FACT-BRM TOI scores favored the pembrolizumab arm compared with the subset of patients receiving ipilimumab or HDI (differences, 6.0 and 17.0 points, respectively) in post-hoc analyses.

 "Physicians should be encouraged to incorporate and discuss treatment-related QOL issues with patients when making shared decisions regarding the risks and benefits of adjuvant therapy in resected melanoma," the authors write.

 Several authors disclosed financial ties to pharmaceutical companies, including Merck, which manufactures pembrolizumab and partially funded the study.




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Quality of life favored the pembrolizumab arm versus standard-of-care arm receiving ipilimumab, high-dose interferon α 2b

QOL Up With Pembrolizumab Versus Ipilimumab, HDI in Resected Melanoma

The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) is valid for assessing the risk for skin cancer among solid organ transplant recipients (SOTRs), according to a study published online Nov. 23 in JAMA Dermatology.

 Álvaro Gómez-Tomás, M.D., from Hospital Universitari Vall d'Hebron in Barcelona, Spain, and colleagues conducted a retrospective external validation study using data from European SOTRs from transplant centers in the Netherlands and Spain to validate the SUNTRAC tool. The discriminative ability of the SUNTRAC tool was examined and calibration was assessed by comparing projected skin cancer incidences.

 "Having a tool that can quickly and correctly stratify SOTRs according to their relative skin cancer risk is a great aid for the clinician and a fundamental step in defining guidelines to ensure adequate screening and dermatological follow-up of these patients," the authors write.

 Two authors disclosed financial ties to the pharmaceutical industry.

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SUNTRAC risk assessment calculator predicted incidence of skin cancer with predicted and observed incidence of 6.2 and 7.0 percent, respectively

Can Risk for Skin Cancer Be Predicted in Solid Organ Transplant Recipients?

For patients with previously untreated metastatic or unresectable melanoma, the combination of relatlimab nivolumab continues to demonstrate a progression-free survival (PFS) benefit over nivolumab alone, according to updated study results presented March 14 as part of the American Society for Clinical Oncology Plenary Series.




 Georgina V. Long, M.D., Ph.D., from the Melanoma Institute Australia at the University of Sydney, and colleagues randomly assigned patients with previously untreated metastatic or unresectable melanoma to receive either relatlimab nivolumab or nivolumab alone, given intravenously every four weeks (355 and 359 patients, respectively). Patients were followed for a median of 19.3 months.




 The researchers found that the updated median PFS was 10.2 and 4.6 months with relatlimab nivolumab and nivolumab alone, respectively (hazard ratio, 0.78; 95 percent confidence interval, 0.6 to 0.9). Median overall survival was not reached with relatlimab nivolumab and was 34.1 months with nivolumab alone (hazard ratio, 0.80; 95 percent confidence interval, 0.6 to 1.0; P = 0.0593). The overall survival rates were 77.0 and 71.6 percent at 12 months and 63.7 and 58.3 percent at 24 months, for relatlimab nivolumab and nivolumab alone, respectively. The confirmed overall response rates were 43.1 and 32.6 percent, respectively. More grade 3/4 treatment-related adverse events occurred in patients receiving relatlimab nivolumab versus nivolumab alone (21.1 versus 11.1 percent).




 "These findings provide additional evidence of the benefit of two checkpoint inhibitors over only one and supports the combination of nivolumab and relatlimab, which had a manageable safety profile, as a potential new treatment option for patients with advanced melanoma," Long said in a statement.




 Several authors disclosed financial ties to biopharmaceutical companies, including Bristol Myers Squibb, which manufactures relatlimab and funded the study.




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Progression-free survival prolonged with relatlimab nivolumab versus nivolumab alone for previously untreated advanced melanoma

Update Shows Relatlimab   Nivolumab Slows Advanced Melanoma

For older adults, vitamin D supplementation does not reduce the incidence of keratinocyte cancer (KC) or other actinic lesions, according to a study published in the November issue of the
 
 British Journal of Dermatology
 
 .




 Sitwat Ali, from QIMR Berghofer Medical Research Institute in Brisbane, Australia, and colleagues examined the effect of vitamin D supplementation on the risk for developing KC using data from the D-Health Trial, involving Australians aged 60 years and older. Participants were randomly assigned to receive either vitamin D supplementation or placebo. KC outcomes were captured through linkage to a national dataset for 20,334 participants (95 percent).




 The researchers found no reduction in the incidence of KC lesions treated by excision, the incidence of actinic lesions treated using other methods, or the time to first histologically confirmed KC excision with randomization to vitamin D supplementation. However, in a subgroup analysis, vitamin D was found to increase the incidence of KC excisions in adults aged 70 years and older.




 "Routine supplementation with vitamin D, including in those at highest risk of KC, is unlikely to reduce the very high incidence seen in the Australian population," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Researchers find no evidence that vitamin D supplementation reduces incidence of keratinocyte cancer

Can Vitamin D Supplementation Cut Incidence of Keratinocyte Cancer?

A subset of melanoma patients with stage I lesions and negative clinical nodes with very low risk for mortality from melanoma has been identified, according to a study published online Nov. 7 in
 
 Cancer
 
 .




 Megan M. Eguchi, M.P.H., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues selected melanoma patients diagnosed in 2010 and 2011 with stage I lesions ≤1.0 mm thick and negative clinical lymph nodes from the Surveillance, Epidemiology, and End Results database. Models were developed and validated for identifying patients with a very low risk for death from melanoma within seven years.




 The researchers found that a subset comprising 25 percent of the patients had a risk of &lt;1 percent for seven-year mortality from melanoma compared with an overall seven-year mortality from melanoma of 2.5 percent. In all models, younger age at diagnosis and Clark level II were associated with a low risk for death. Associations were also seen with lower mortality for Breslow thickness less than 0.4 mm, absence of mitogenicity, absence of ulceration, and female sex. A small subset of high-risk patients was also identified, with &gt;20 percent risk for death.




 "This study suggests there is a real subset of patients with very%u2010low risk of melanoma death; we hope this serves as a baseline to further develop the classification criteria to establish use of the melanocytic neoplasms of low malignant potential term in clinical practice," the authors write.




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Younger age at diagnosis, Clark level II linked to low risk for death among patients with stage I lesions, negative clinical nodes

Subset of Stage I Melanoma Patients ID'd With Very Low Mortality

For patients with resectable clinical stage III or oligometastatic stage IV melanoma, neoadjuvant relatlimab and nivolumab combination immunotherapy results in a 57 percent pathologic complete response rate, according to a study published online Oct. 26 in
 
 Nature
 
 .




 Rodabe N. Amaria, M.D., from The University of Texas MD Anderson Cancer Center in Houston, and colleagues examined the efficacy of relatlimab and nivolumab combination immunotherapy in patients with resectable clinical stage III or oligometastatic stage IV melanoma. Pathologic complete response was measured as the primary end point.




 The researchers found that among 30 patients treated, the combination resulted in 57 percent pathologic complete response rate and 70 percent overall pathologic response rate. Using Response Evaluation Criteria in Solid Tumors 1.1, the radiographic response rate was 57 percent. In the neoadjuvant setting, there were no grade 3 to 4 immune-related adverse events reported. The one- and two-year recurrence-free survival rate was 100 and 92 percent and 88 and 55 percent for patients with any and without a pathologic response, respectively. There were associations observed for increased immune cell infiltration at baseline and a reduction in M2 macrophages during treatment with pathologic response.




 "We're very pleased to see that the combination of relatlimab and nivolumab balanced safety and efficacy, and it did not result in any delays to surgery," Amaria said in a statement. "We want to provide patients with a treatment option that will help reduce the risk of their cancer returning after surgery."




 Several authors disclosed financial ties to pharmaceutical companies, including Bristol Myers Squibb, which manufactures nivolumab and relatlimab and funded the study.




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In phase 2 study, relatlimab and nivolumab combination immunotherapy resulted in pathologic complete response rate of 57 percent

Neoadjuvant Combo Immunotherapy Studied in Resectable Melanoma

For patients with advanced melanoma, response-adapted treatment de-escalation is cost-effective and offers an incremental net monetary benefit of $28,849 versus standard of care, according to a study published online Oct. 19 in
 
 JAMA Dermatology
 
 .




 Zachary Cartun, M.D., from University Hospital, LMU Munich in Germany, and colleagues conducted a cost-effectiveness analysis using data from the ADAPT-IT and CheckMate 067 trials as well as published literature to determine the cost-effectiveness of ipilimumab discontinuation for patients with interim imaging-confirmed tumor response in advanced melanoma treatment. A total of 355 patients with previously untreated melanoma were included in the analysis: 41 from the ADAPT-IT trial and 314 from the CheckMate 067 trial.




 The researchers found that in 94.0 percent of scenarios, response-adapted treatment was the cost-effective option based on Monte Carlo simulations, with a dominant incremental cost-effectiveness ratio and an incremental net monetary benefit of $28,849 versus standard of care. The estimated cost savings were $19,891 per patient compared with standard of care. Current standard of care was only considered as a cost-effective option under best survival assumptions in scenario analyses and if the willingness-to-pay threshold exceeded $630,000/quality-adjusted life year.




 "Response-adapted de-escalation of immunotherapy, as proposed by the ADAPT-IT trial, has the potential to alleviate the financial burden for patients with advanced melanoma," the authors write. "We hope that this study can inform future trial design to identify novel and more affordable treatment strategies."




 Several authors disclosed ties to the pharmaceutical industry.




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Response-adapted de-escalation of immunotherapy yielded incremental net monetary benefit of $28,849 versus standard of care

Response-Adapted Treatment De-escalation Cost-Effective in Melanoma

For patients with treatment-naive BRAFv600 mutant metastatic melanoma, treatment first with combination nivolumab/ipilimumab yields better overall survival than dual BRAF/MEK inhibition with dabrafenib/trametinib, according to a study published online Sept. 27 in the
 
 Journal of Clinical Oncology
 
 .




 Michael B. Atkins, M.D., from the Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C., and colleagues examined the optimal treatment sequence between combination nivolumab/ipilimumab checkpoint inhibitor immunotherapy and combination dabrafenib/trametinib molecularly targeted therapy for patients with treatment-naive BRAFv600 mutant metastatic melanoma. A total of 265 patients were randomly assigned to receive combination nivolumab/ipilimumab (arm A) or dabrafenib/trametinib (arm B) in step 1, and 73 received alternative therapy in step 2: dabrafenib/trametinib (arm C) or nivolumab/ipilimumab (arm D; 27 and 46 patients, respectively).




 Due to achievement of a clinically significant end point, the study was stopped early. The researchers found that two-year overall survival was 71.8 and 51.5 percent for those starting in arm A and arm B, respectively. Step 1 progression-free survival favored arm A. The objective response rates were 46.0, 43.0, 47.8, and 29.6 percent for arms A, B, C, and D, respectively. The median duration of response was not reached in arm A and was 12.7 months in arm B. In 52 percent of patients with documented disease progression, crossover occurred.




 "Combination immunotherapy, in contrast to targeted therapy, produces more long-lasting tumor shrinkage, reduces the risk of disease progression in the central nervous system, and doesn't interfere with the subsequent effectiveness of the alternative treatment approach," Atkins said in a statement.




 Bristol Myers Squibb and Novartis provided the study medications.




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Two-year overall survival higher for those initiating treatment with combo nivolumab/ipilimumab versus dual BRAF/MEK inhibition

Treatment Sequence Studied for Advanced BRAF-Mutant Melanoma

High sunburn frequency throughout life and a high-to-low trajectory are associated with an increased risk for cutaneous melanoma and squamous cell carcinoma (cSCC), according to a study published online Oct. 5 in
 
 JAMA Dermatology
 
 .




 Simon Lergenmuller, M.D., from the Cancer Registry of Norway in Oslo, and colleagues examined the lifetime trajectories of sunburns and compared the association between these trajectories and the subsequent risk for cutaneous melanoma and cSCC in a population-based cohort, established in 1991 with follow-up through 2018. Baseline questionnaires were administered in 1991 to 2007; follow-up questionnaires were completed every five to seven years.




 Of the 172,472 women who returned questionnaires, 169,768 completed questions about sunburns at study inclusion. The researchers identified five classes of individual lifetime sunburn trajectories (stable low, low-moderate-low, low-to-high, high-to-low, and stable high) in three samples up to 39 years, 49 years, and 59 years (159,773, 153,297, and 119,170 women, respectively). In the three samples, mean follow-up ranged from 14.3 to 19.5 years, during which 1,252 to 1,774 and 739 to 871 women were diagnosed with incident primary melanoma and cSCC, respectively. Compared with the stable low trajectory, the stable high and high-to-low trajectories showed statistically significant increased melanoma and cSCC risks across all samples (melanoma: hazard ratios, 1.50 and 1.44; cSCC: hazard ratios, 1.51 and 1.47, respectively, for up to 39 years).




 "Importantly, the present results suggest that childhood is a more susceptible phase with regard to sunburns and subsequent risk of these skin cancers. It is therefore crucial to emphasize the importance of avoiding sunburns throughout life, and in particular in childhood," the authors write.




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Stable high and high-to-low trajectories had increased risks compared with stable low trajectory

High Sunburn Frequency Through Life Linked to Melanoma, cSCC Risk

For patients with clinical stage IIB/C cutaneous melanoma, sentinel lymph node (SLN) biopsy provides essential prognostic information, according to a study published in the October issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Richard J. Straker III, M.D., from the University of Pennsylvania in Philadelphia, and colleagues examined the prognostic significance of SLN staging on disease-specific survival for clinical stage IIB/C primary cutaneous melanoma in the preimmunotherapy era. The analysis included patients who underwent excision of clinical stage IIB/C cutaneous melanoma, identified through the Surveillance, Epidemiology, and End Results database (2004 to 2011). Propensity-matched patients who did and did not undergo SLN biopsy wre compared; matched patients were then further stratified by SLN positive (SLN ) or negative (SLN–) status.




 The researchers report that 70.3 percent of patients (6,021 of 8,562) underwent SLN biopsy. There was a significant association observed between SLN positivity and reduced five-year disease-specific survival among matched patients who underwent SLN biopsy (47.1 percent SLN versus 75.5 percent SLN–). Even across matched T-stages, five-year disease-specific survival remained significantly different: T3b (54.2 percent SLN versus 64.8 percent SLN–), T4a (55.5 percent SLN versus 71.6 percent SLN–), and T4b (38.6 percent SLN versus 60.9 percent SLN–).




 "For patients with clinical stage IIB/C cutaneous melanoma, SLN status provides essential prognostic information and is an important factor for collective decision-making regarding adjuvant therapy administration based on risk assessment," the authors write.




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SLN positivity significantly associated with lower five-year disease-specific survival among patients with clinical stage IIB/C cutaneous melanoma

Sentinel Lymph Node Biopsy Status Predicts Melanoma Survival

Few Europeans use photoprotection all year round, according to a study presented at the annual meeting of the European Academy of Dermatology and Venereology, held from Sept. 7 to 10 in Milan.




 Thierry Passeron, M.D., Ph.D., from University Hospital Center Nice in France, and colleagues surveyed 6,000 participants in Germany, France, Spain, Italy, the United Kingdom, and Russia to examine knowledge and behaviors relating to sun exposure in Europe versus other continents. The survey was part of a broader survey, with 17,001 participants and conducted across five continents.




 The researchers found that 82 percent of Europeans stated that tanned skin looks attractive and 73 percent indicated that a tan creates a healthy look, compared with 67 and 59 percent, respectively, outside of Europe. Awareness of sun-related skin health issues was reported by 92 percent of Europeans compared with 86 percent of non-Europeans. Europeans were also more aware of their skin aging risk (86 versus 79 percent). However, only 56 percent of Europeans and 64 percent of non-Europeans were aware that sun protection is useful when the weather is overcast. Only 16 percent of Europeans said they used photoprotection all year round compared with 27 percent outside of Europe. Europeans were less likely to systematically/often use all protective measures (i.e., wear a hat/cap, wear protective clothes, or stay in the shade), but they were more likely to systematically/often apply sunscreen.




 "This research shows just how entrenched the 'healthy' suntan myth is," Passeron said in a statement. "We must drive awareness of the damage to skin cells caused by exposure to the sun, which can lead to photoaging and skin cancer."




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Only 56 percent of Europeans were aware that sun protection is useful when weather is overcast

Few Europeans Use Photoprotection All Year Round

Fifty-one percent of patients receiving neoadjuvant therapy with cemiplimab for resectable stage II, III, or IV (M0) cutaneous squamous cell carcinoma had a pathological complete response, according to a study published online Sept. 12 in the
 
 New England Journal of Medicine
 
 to coincide with the annual meeting of the European Society for Medical Oncology, held from Sept. 9 to 13 in Paris.




 Neil D. Gross, M.D., from the M.D. Anderson Cancer Center in Houston, and colleagues conducted a phase 2 multicenter, nonrandomized study to examine cemiplimab as neoadjuvant therapy prior to surgery with curative intent in patients with resectable stage II, III, or IV (M0) cutaneous squamous cell carcinoma.




 The researchers found that on independent review, 40 patients (51 percent) had a pathological complete response and 10 patients (13 percent) had a pathological major response. These results were consistent with the investigator assessment-determined pathological responses. In 54 patients (68 percent), an objective response was observed on imaging. Sixty-nine patients (87 percent) had adverse events of any grade, regardless of whether they were attributed to study treatment. During the study period, 14 patients (18 percent) had grade 3 or higher adverse events.




 "The potential for function-preserving surgery, together with the high frequency of a pathological complete response, supports the use of neoadjuvant therapy with cemiplimab in this patient population," the authors write.




 The study was funded by Regeneron and Sanofi, the manufacturers of cemiplimab.




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In phase 2 study, about half of patients with resectable stage II to IV cutaneous squamous cell carcinoma had pathological complete response

Cemiplimab Studied as Neoadjuvant Therapy for Cutaneous SCC

Two-photon fluorescence microscopy (TPFM) has high sensitivity, specificity, and accuracy for diagnosing nonmelanoma skin cancer (NMSC), according to a study published online Sept. 7 in
 
 JAMA Dermatology
 
 .




 Vincent D. Ching-Roa, from the University of Rochester in New York, and colleagues conducted a comparative effectiveness pilot study examining 29 freshly excised biopsies from confirmed NMSC lesions in patients presenting for treatment. Biopsies were imaged immediately using TPFM and were subsequently submitted for paraffin histology to produce coregistered images. Twelve (41.4 percent) of these coregistered image pairs comprised the training set, and 15 (51.7 percent) were used in masked evaluation by a dermatopathologist; two were excluded because they could not be coregistered.




 The researchers found that diagnosis was identical for 14 of 15 biopsy specimens (93.3 percent) using TPFM and paraffin histology. For basal cell carcinoma diagnosis, the TPFM had 100 percent sensitivity, 100 percent specificity, and 100 percent accuracy. For squamous cell carcinoma diagnosis, sensitivity, specificity, and accuracy were 89, 100, and 93 percent, respectively. For overall NMSC, TPFM had 93, 100, and 93 percent sensitivity, specificity, and accuracy, respectively. Mismatched imaging planes were identified as the source of error on examination of the discordant pair.




 "While these results suggest potential as a rapid, point-of-care diagnostic tool that requires no extensive sample preparation or retraining for image evaluation, further validation of TPFM imaging in a larger cohort is necessary to fully evaluate diagnostic accuracy," the authors write.




 One author reported a patent issued for aspects of histology with two-photon microscopy outside the submitted work.




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TPFM has high sensitivity, specificity, accuracy for basal cell carcinoma, squamous cell carcinoma diagnosis

Two-Photon Fluorescence Microscopy Promising for Nonmelanoma Skin Cancer

Patients with early-stage melanoma with low disease burden sentinel node (SN) micrometastases (American Joint Committee on Cancer [AJCC] stage IIIA disease) with SN tumor deposits ≥0.3 mm have lower survival, according to a study published online July 18 in the
 
 Journal of Clinical Oncology
 
 .




 Marc D. Moncrieff, M.D., from the Norfolk and Norwich University Hospital NHS Trust in the United Kingdom, and colleagues recruited 3,607 adult patients with pathologic stage pT1b/pT2a primary cutaneous melanomas who underwent SN biopsy between 2005 and 2020 from an intercontinental consortium of nine high-volume cancer centers. Patients were followed for a median of 34 months.




 The researchers found no significant survival differences between N1a and N2a subgroups. An SN tumor deposit maximum dimension of 0.3 mm was identified as the optimal cut point for stratifying survival. For patients with SN metastatic tumor deposits ≥0.3 mm and &lt;0.3 mm, five-year disease-specific survival rates were 80.3 and 94.1 percent, respectively (hazard ratio, 1.26). Findings were similar for overall disease-free and distant metastasis-free survival. No survival differences were seen between the AJCC IB patients and low-risk (&lt;0.3 mm) AJCC IIIA patients.




 "We suggest that early-stage, AJCC IIIA patients with micrometastases of maximum tumor dimension ≥0.3 mm should be considered for adjuvant systemic therapy or enrollment into a clinical trial, whereas patients with micrometastases of maximum tumor dimension &lt;0.3 mm can be managed in a similar fashion to their SN-negative, AJCC IB counterparts," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Patients with AJCC IIIA and sentinel node metastatic tumor deposits ≥0.3 mm have lower five-year disease-specific survival rates

Study Aims to Identify Melanoma Patients With High-Risk Disease

Skin cancer prevention is lacking among American Indian/Alaskan Native (AIAN) populations, according to a research letter published Aug. 15 in the
 
 Journal of the American Academy of Dermatology.
 




 Kevin Yang, from the Tufts University School of Medicine in Boston, and colleagues used data from the U.S. National Health Interview Survey (2005, 2008, 2010, 2013, and 2015) to assess skin cancer risk behaviors and prevention among AIAN versus other populations. The analysis included 360,573 participants.




 The researchers found that compared with other racial and ethnic groups, AIAN respondents reported less frequent sun-protective behaviors, including less wearing of hats when outside on a sunny day and a lower likelihood of seeking shade when outdoors. Sunscreen use was reported less frequently among AIAN respondents versus non-Hispanic Whites and Asians, but AIAN respondents reported sunscreen use more frequently than African Americans. AIAN respondents reported more frequent use of indoor tanning devices versus other minority groups (odds ratios, 17.4 versus African Americans and 14.8 versus Asians). While similar to other minority groups, fewer AIANs reported ever receiving full-body skin examinations by a dermatologist compared with non-Hispanic Whites (odds ratio, 0.42). Melanoma diagnosis was more frequently reported by AIAN respondents versus other groups.




 "This work's findings call for future studies to evaluate barriers to skin cancer screenings and for the design of initiatives to promote sun-protective behaviors for AIAN populations in the United States," the authors write.




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Lower hat use, sunscreen use reported, in addition to more frequent use of indoor tanning

Sun Protection Low Among American Indians/Alaskan Natives

When interpreting melanocytic skin biopsy specimens, knowledge of a prior diagnosis sways dermatopathologists to make more and less severe diagnoses and can also sway them from a correct to an incorrect diagnosis, according to a study published online Aug. 10 in
 
 JAMA Dermatology
 
 .




 Joann G. Elmore, M.D., from the University of California in Los Angeles, and colleagues measured the extent to which dermatopathologists' diagnoses are influenced by prior diagnostic information from another dermatopathologist. The analysis included 149 dermatopathologists providing 5,322 interpretations of study cases.




 The researchers found that participants were more likely to increase the severity of their diagnosis when the prior diagnosis was of greater severity versus interpretations with no prior diagnosis provided. Similarly, participants gave less severe diagnoses when prior diagnoses were of lesser severity. Findings were similar even among dermatopathologists who had reported they were "not at all influenced" by prior diagnoses. Dermatopathologists were swayed away from correct diagnoses by prior diagnoses.




 "In this randomized controlled trial, despite the preference of most dermatopathologists to receive prior diagnoses when providing second opinions, this information swayed them away from a correct diagnosis to an incorrect diagnosis," the authors write. "Dermatopathologists providing second opinions should be blinded to first opinions if the goal is to obtain an independent diagnostic opinion."




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Prior diagnoses swayed dermatopathologists from correct diagnosis to incorrect diagnosis in the interpretation of melanocytic lesions

Prior Diagnoses Influence Dermatopathologists' Interpretations

Hypericin photodynamic therapy (PDT) is effective for early-stage mycosis fungoides-cutaneous T-cell lymphoma (MF/CTCL), according to a study published online July 20 in
 
 JAMA Dermatology
 
 .




 Ellen J. Kim, M.D., from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues examined the efficacy and safety of topical synthetic hypericin ointment activated with visible light as a nonmutagenic PDT in early-stage MF/CTCL. One hundred sixty-nine patients were randomly assigned 2:1 to receive hypericin or placebo for three index lesions twice weekly for six weeks in cycle 1. All patients received the active drug to index lesions for six weeks in cycle 2. In cycle 3 (optional), patients received the active drug to index and additional lesions.




 The researchers found that hypericin PDT was more effective than placebo after six weeks of treatment (cycle 1 index lesion response rate [ILRR], 16 versus 4 percent). In patients who received two cycles of hypericin PDT, the ILRR increased to 40 percent and then to 49 percent after three cycles. Both patch- and plaque-type lesions showed significant clinical responses, and these responses were similar irrespective of age, sex, race, stage IA versus IB, time since diagnosis, and number of prior therapies. Mild local skin and application-site reactions were the most common treatment-related adverse events.




 "Given that MF/CTCL requires long-term disease management and that many patients using current skin-directed therapies experience short- and/or long-term adverse effects, limited access, and waning efficacy, these findings are an important contribution to MF/CTCL patient care," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Soligenix, which funded the study.




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Hypericin PDT more effective than placebo after six weeks of treatment; index lesion response rate increased with progressive cycles of treatment

Hypericin Photodynamic Therapy Effective for Early-Stage MF/CTCL

The diagnostic delay associated with COVID-19 did not result in relatively more unfavorable primary tumor (pT) characteristics of melanoma or cutaneous squamous cell carcinoma (cSCC), according to a study published in the August issue of the
 
 British Journal of Dermatology
 
 .




 Tobias E. Sangers, M.D., from the Erasmus MC Cancer Institute in Rotterdam, Netherlands, and colleagues compared pT stage, Breslow thickness, and invasion depth from before to after the first and second lockdown periods (including periods of pre-COVID-19; first lockdown; between first and second lockdowns; second lockdown; and after second lockdown) to examine the impact of delayed diagnostics on primary invasive melanoma and cSCC. Histopathology reports registered between Jan. 1, 2018, and July 22, 2021, were obtained from a nationwide histopathology registry for the Netherlands. Data were included for 20,434 primary invasive melanomas and 68,832 cSCCs.




 The researchers observed no significant difference in mean primary melanoma Breslow thickness between the pre-COVID-19 era and the following time periods. There was a small shift toward unfavorable pT stages noted during the first lockdown versus the pre-COVID-19 era (pT1, 52.3 versus 58.6 percent; pT2, 18.9 versus 17.8 percent; pT3, 13.2 versus 11.0 percent; pT4, 9.1 versus 7.3 percent). In subsequent periods, there were no relevant changes observed. For cSCCs, there were no significant changes seen in pT stage distribution between the pre-COVID-19 and subsequent periods.




 "This study revealed a limited impact of delayed diagnostics due to the COVID-19 pandemic on cSCC and melanoma tumor characteristics in the Netherlands," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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No significant differences seen in mean primary melanoma Breslow thickness for prepandemic era, subsequent periods

Did COVID-19 Diagnostic Delay Affect Melanoma, cSCC Characteristics?

Both readers and artificial intelligence predict melanoma thickness with fair to moderate accuracy using dermoscopy images, according to a study published online July 16 in the
 
 Journal of the European Academy of Dermatology and Venereology
 
 .




 Sam Polesie, M.D., from the Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues evaluated how accurately an international group of readers could discriminate between melanoma in situ (MIS) and invasive melanomas and estimate the Breslow thickness of invasive melanomas based on dermoscopy images. The analysis included 22,314 readings by 438 international readers.




 The researchers found that the overall accuracy for distinguishing melanoma thickness was 56.4 percent; the overall accuracy rates for correctly classifying MIS and invasive melanoma were 63.4 and 71.0 percent, respectively. For melanomas ≤1.0 mm (including MIS), readers accurately predicted the thickness in 85.9 percent of images compared with 70.8 percent of melanomas &gt;1.0 mm. For differentiating MIS from invasive melanoma, the reader collective outperformed a de novo convolutional neural network but not a pretrained convolutional neural network.




 "Our study highlights the difficulties of correctly assessing melanoma thickness on the basis of dermoscopic images," Polesie said in a statement. "In future studies, we aim to explore the usefulness of predefined dermoscopic structures for distinguishing. We also want to test whether clinical decision-making in this situation can be improved by means of machine learning algorithms."




 One author disclosed financial ties to the pharmaceutical industry.




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Readers most accurately discriminated between thin (≤1.0 mm) and thick melanomas (&gt;1.0 mm)

AI and Dermatologists Similarly Judge Melanoma Thickness

For patients with cutaneous squamous cell carcinoma (cSCC) of the scalp, margin status impacts disease-specific mortality but is not associated with the risk for local recurrence, according to a study published in the July issue of
 
 SKIN
 
 .




 Rajith L. Mendis, M.B.B.S., from Westmead Hospital in Sydney, and colleagues examined the risk for recurrence among 114 patients with scalp cSCCs, with a median age of 70 years, who had a median follow-up of 5.6 years.




 The researchers found that 46 percent of patients had clear margins after surgery and 52 percent had close (≤2 mm) or involved margins, yielding a significant difference in five-year disease-specific mortality of 20 and 35 percent, respectively. Overall, 25 percent of patients underwent surgery and adjuvant radiotherapy, most of whom had a close/involved margin. The risk for developing local recurrence was not significantly different for patients in whom a clear margin was obtained and for those in whom the margin was close/involved.




 "Margin status had a significant impact on disease specific mortality, but did not appear to be associated with the risk of developing local recurrence," the authors write. "The addition of adjuvant radiotherapy in select high-risk patients may improve outcome although this was not demonstrated in our study."




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No association seen with risk for local recurrence, but five-year disease-specific mortality lower for patients with clear margins versus close/involved margins

Does Margin Status Impact Recurrence in Scalp cSCC?

Surgical treatment delays are associated with worse mortality outcomes among patients with melanoma, according to a study published online June 30 in the
 
 Journal of the American Academy of Dermatology
 
 .




 David D. Xiong, M.D., from the University of Pittsburgh Medical Center, and colleagues examined the impact of surgical treatment delays on melanoma-specific mortality (MSM) and overall mortality (OM) among 108,689 patients with stage I to III cutaneous melanoma identified through the Surveillance, Epidemiology, and End Results database.




 The researchers found that treatment delays of three to five months were associated with worse MSM across all stages, and any delay beyond one month was associated with worse OM. Three- to five-month delays were associated with worse MSM, and any delay beyond one month was associated with worse OM in a subgroup analysis of stage I patients. Worse MSM was seen with delays of six months or longer and worse OM was seen with delays of three to five months among stage II patients. In stage III disease, there was no significant effect observed for treatment delays.




 "Timely treatment of cutaneous melanoma may be associated with improved all-cause mortality and reduced incidence of disease-specific death," the authors write. "Prompt treatment of surgically resectable melanomas may be associated with lowered incidence of MSM."




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Adjusted survival curves from the multivariable model for effectiveness showed higher drug survival for guselkumab

Do Melanoma Surgical Delays Impact Mortality Outcomes?

Many Generation Z adults, aged 18 to 25 years, are not aware of the dangers of overexposure to the sun and are not taking steps to protect themselves from it, according to the results of a survey of more than 1,000 U.S. adults released by the American Academy of Dermatology.




 The authors of the survey found that more than one-quarter of young respondents (27 percent) were under the false impression that having a base tan decreases the risk for developing skin cancer. More than one-third (38 percent) said tanning is safe as long as you do not burn. Half (49 percent) were unaware that you can get sunburned on a cloudy day. Additionally, more than one-third (37 percent) did not know that ultraviolet rays can penetrate clothing. Nearly one-quarter (23 percent) of respondents did not know sunscreen should be reapplied at least every two hours when outdoors. More than one in five respondents (22 percent) reported seeing signs of sun damage now, and 28 percent said they did not know sun exposure would age their skin.




 "It's frustrating that people still think a tan looks healthy and that a base tan is going to protect you," Brittany Craiglow, M.D., a board-certified dermatologist from the Yale University School of Medicine in New Haven, Connecticut, said in a statement. "Just because you're not burning doesn't mean your skin isn't getting damaged. All that ultraviolet damage is cumulative so what you're doing now will affect you in your future. As a dermatologist and a skin cancer survivor, I want to educate others so that they don't make the same mistakes that I did."




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Survey shows lack of knowledge may lead to behaviors that contribute to sun damage, skin cancer

Many Younger Adults Lack Sun Protection Knowledge

You might think everyone knows by now to protect against the sun's rays, but many Gen Zers apparently haven't gotten the message.




 In a recent survey of 1,000 U.S. adults by the American Academy of Dermatology, many of these 18- to 25-year-olds were unaware of the risks from
 <a class="rm-stats-tracked" href="https://medlineplus.gov/tanning.html" target="_blank">
 tanning
 </a>
 .




 About 60% of Gen Z respondents said they got a tan in 2021. About 27% said they thought having a base tan decreased the risk of developing skin cancer (it doesn't). Another 38% said tanning was safe as long as they didn't burn -- another fallacy.




 "It's frustrating that people still think a tan looks healthy and that a base tan is going to protect you," said Dr. Brittany Craiglow, associate professor of dermatology at Yale University School of Medicine. "Just because you're not burning doesn't mean your skin isn't getting damaged."




 In fact, it only takes one blistering sunburn during childhood or adolescence to nearly double a person's odds of developing
 <a class="rm-stats-tracked" href="https://www.cancer.org/cancer/melanoma-skin-cancer.html?utm_source=google&amp;utm_medium=cpc&amp;utm_campaign=Google Grants - Cancer Type - Exact&amp;utm_term=melanoma%20skin%20cancer&amp;utm_id=go_cmp-10033843576_adg-97799930061_ad-434766942716_kwd-29163250_dev-c_ext-_prd-_mca-_sig-CjwKCAjwwo-WBhAMEiwAV4dybb6nUnHmh6igS3aA1B0nQ6us8Ek9TW3S6EojA6-DnCBClPRn_EqRpBoCMwkQAvD_BwE&amp;gclid=CjwKCAjwwo-WBhAMEiwAV4dybb6nUnHmh6igS3aA1B0nQ6us8Ek9TW3S6EojA6-DnCBClPRn_EqRpBoCMwkQAvD_BwE" target="_blank">
 melanoma
 </a>
 , the deadliest form of skin cancer, the academy said. Tanning of any kind, whether from the sun, tanning beds or sun lamps, increases your skin cancer risk.




 "All that UV damage is cumulative so what you're doing now will affect you in your future," Craiglow said in an academy news release.




 The survey showed some other key misconceptions about sun protection among Gen Zers: 54% thought an SPF 30 offers twice as much protection as SPF 15; 39% say high SPF can be applied less often, and 23% were unaware that sunscreen should be reapplied at least every two hours when outdoors.




 In addition, almost half didn't know you can get sunburned on a cloudy day. About 37% were unaware that the sun's UV rays can penetrate clothing, and almost 3 in 10 didn't know that shade protects against UV rays.




 Craiglow offered her own cautionary tale. She said she didn't think much about the multiple sunburns she had as a child until she was diagnosed with skin cancer in her mid-20s.




 "When I was in medical school, I went to a dermatologist for a non-healing spot on my back," she said. "My dermatologist performed a biopsy, and I was diagnosed with basal cell skin cancer. Since then, I have had regular skin exams."




 Once she became a dermatologist, Craiglow knew the signs of skin cancer to look for. Over the years, she has had multiple basal cell skin cancers and then, a year ago, she was diagnosed with melanoma.




 More than half of Gen Z survey respondents said they wished they had done more to protect themselves when they were younger. About 22% said they already see signs of sun damage. About 28% were unaware that sun exposure would age their skin.




 "Not many people want wrinkles and age spots on their skin," Craiglow said. "But the 4-inch scar on my arm from my melanoma surgery is even scarier than these signs of premature aging."




 If you notice a spot on your skin that is different from others or that changes, itches or bleeds, you should see a
 <a class="rm-stats-tracked" href="https://medlineplus.gov/lab-tests/skin-cancer-screening/" target="_blank">
 dermatologist,
 </a>
 Craiglow said.
 
 
 In the meantime, seek shade when you can, especially when the sun's rays are strongest, between 10 a.m. and 2 p.m.




 Wear sun-protective clothing, such as a lightweight and long-sleeved shirt, pants, a wide-brimmed hat and sunglasses with UV protection, when possible. Select clothing with an ultraviolet protection factor (UPF) number on the label.




 Apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to all skin not covered by clothing. Reapply every two hours or after swimming or sweating.




 Visit the academy's PracticeSafeSun.org to learn more about safe sun habits.




 
 More information
 




 The U.S. Centers for Disease Control and Prevention has more on
 <a class="rm-stats-tracked" href="https://www.cdc.gov/cancer/skin/basic_info/index.htm" target="_blank">
 skin cancer
 </a>
 .








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Many Gen Z Americans Have Sun Safety All Wrong

For patients with high-risk cutaneous squamous cell carcinoma (cSCC), Mohs micrographic surgery (MMS) yields high five-year disease-specific survival, local recurrence (LR)-free survival, and regional/distant metastasis-free survival, according to research published online June 24 in the
 
 Journal of the American Academy of Dermatology.
 




 Teo Soleymani, M.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues examined the clinical outcomes of high-risk cSCCs treated with MMS alone in terms of LR, nodal metastasis (NM), distant metastasis, and disease-specific death in a retrospective review of high-risk cSCC patients treated from Jan. 1, 2000, to Jan. 1, 2020. A total of 581 high-risk primary cSCCs were identified in 527 patients; follow-up data were available for 579 tumors.




 The researchers found that the mean survival time was 18.6 years, with five-year disease-specific survival of 95.7 percent. Five-year LR-free survival, regional NM-free survival, and DM-free survival was 96.9, 93.8, and 97.3, respectively. Progression-free survival from metastatic disease was 92.6 and 90.0 percent, respectively, at five- and 10-years. The two-year disease-specific survival was 90.5 percent for patients who experienced regional nodal metastases and underwent salvage head and neck dissection ± radiation.




 "By improving local tumor control, MMS appears to reduce the frequency of regional metastatic disease and may confer a survival advantage even for those patients who develop regional nodal metastases, as evidenced by our postsalvage disease-specific survival outcomes," the authors write.




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(22)02217-4/pdf" target="_blank">
 Abstract/Full Text
 </a>

Mohs yields high five-year disease specific survival, local recurrence-free survival, and regional/distant metastasis-free survival

Is Mohs Micrographic Surgery Beneficial for High-Risk cSCC?

It's an icky truth: Everyone has millions of tiny mites living and mating on their skin.




 Not to worry, though --
 
 Demodex folliculorum
 
 skin mites actually help keep your pores clean and your skin healthy, stressed Alejandra Perotti, an associate professor of invertebrate biology with the University of Reading in the United Kingdom.




 However, her team's recent research suggests the helpful mites might be on the verge of extinction.




 The first-ever genome sequencing study of
 <a class="rm-stats-tracked" href="https://my.clevelandclinic.org/health/diseases/22775-demodex-face-mites" target="_blank">
 
 Demodex
 
 mites
 </a>
 has revealed that their isolated existence has caused them to shed so many unnecessary genes and cells that they're now wholly dependent on humans for their existence, Perotti said.




 "It will likely happen that we will lose them within several human generations," Perotti noted.




 Researchers say that if they do survive, it will be because they transition from external parasites to internal symbionts – organisms that survive wholly off their hosts, essentially becoming one with them. The bacteria in your gut are one example of a human symbiont.




 These mites are about 1/64 of an inch long, and are found in
 <a class="rm-stats-tracked" href="https://medlineplus.gov/ency/imagepages/9703.htm" target="_blank">
 hair follicles
 </a>
 on the face and eyelashes, the researchers said in background notes. It would take several of them to cover the head of a pin.




 Most of these mites have a life cycle of around two weeks, leading a nocturnal existence during which they hatch, migrate, feed and mate before dying off, experts say.




 "During the day, they [are] inside the pores," Perotti said. "So when we are awake, they are sleeping. When we are sleeping, they are awake."




 More than 90% of humans carry these mites on their faces, and the mites generally maintain a peaceful co-existence with humans, she noted.




 You inherited your skin mites from your mother, and new moms pass them on to their children, Perotti explained. The density of mites on your skin peaks in your 20s and 30s, when your skin is typically at its oiliest.




 
 Keeping pores clean
 




 "They are present in all people with healthy skin. They are helpful because they maintain the health of the pores of our skin," Perotti said.




 
 Demodex
 
 mites only cause skin problems in rare instances for people who are immune-suppressed or have other skin conditions. The weakened immune system allows the mites to multiply out of control, and the heavy mite populations produce skin irritation.




 To learn more about these tiny passengers on your body, Perotti and her colleagues examined hundreds of
 
 Demodex
 
 mites collected from the forehead and nose of a single person with the help of a blackhead remover.




 The mites were put under a microscope to make sure they were
 
 Demodex
 
 , and then cleaned and prepared for DNA analysis.




 The researchers found that because the mites lead an isolated existence, they have evolved to become incredibly simple organisms. For example, their eight tiny legs are powered by just three single-cell muscles.




 Evolutionary gene reduction also explains why they're nocturnal, the researchers noted. They lack protection against the UV rays in sunlight and have lost the gene that causes animals to be awakened by daylight. They also are unable to produce
 <a class="rm-stats-tracked" href="https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know" target="_blank">
 melatonin
 </a>
 , a biochemical that promotes nighttime activity in small invertebrates but causes mammals like humans to nod off.




 Luckily for them, they have your melatonin to fuel their nocturnal pursuits.




 "They depend more on us than we on them," Perotti said. "For example, they take the melatonin they need from their host. We secrete melatonin massively at dusk, which puts us to sleep, and the mites use ours because they are no longer able to produce it."




 The new study also found that
 
 Demodex
 
 mites have gotten a bum rap when it comes to skin problems.




 Earlier research had thought that the mites lack an anus and, given that, accumulate feces throughout their two-week life cycle. The assumption was that the mites release a lifetime's worth of feces upon death, causing skin inflammation.




 However, this new study discovered that
 
 Demodex
 
 mites do indeed have anuses, and so have been unfairly blamed for many skin problems.




 
 Programmed for extinction?
 




 The findings were published June 21 in the journal
 
 <a class="rm-stats-tracked" href="https://academic.oup.com/mbe/advance-article/doi/10.1093/molbev/msac125/6604544?login=false" target="_blank">
 Molecular Biology and Evolution
 </a>
 
 .




 Whether you see
 
 Demodex
 
 as creepy or clever, you might not have these little mites to kick around for much longer, the researchers concluded. Because they have evolved to depend so heavily on humans and have a lack of exposure to potential mates from other hosts, the mites appear to be on course for potential extinction.




 Perotti doesn't think losing the mites would necessarily impact human health, but she's still unhappy about the prospect.




 "We probably can survive without them," Perotti said. "But I'm not sure. I would like to keep them. They keep your skin healthy, and that's why I would like to keep them with us."




 Skin expert Dr. Christopher Bunick doesn't necessarily agree that
 
 Demodex
 
 are wholly benign.




 "One of the most common dermatologic diseases is
 <a class="rm-stats-tracked" href="https://www.rosacea.org/patients/all-about-rosacea" target="_blank">
 rosacea
 </a>
 , and rosacea has long been linked to humans having a robust immune response to the
 
 Demodex
 
 ," said Bunick, an associate professor of dermatology at Yale School of Medicine, in New Haven, Conn.




 Bunick estimated that between 3% and 10% of people have rosacea potentially linked to the skin mites.




 "The idea that it never causes a problem is just not true. It can cause lots and lots of issues for people in terms of their skin," Bunick said.




 So, the idea of
 
 Demodex
 
 mites either going extinct or becoming more symbiotic with humans isn't a bad thing to Bunick.




 "Over time, the human body may learn to accept the
 
 Demodex
 
 more, so this subset of people that tend to develop inflammation in reaction to the
 
 Demodex
 
 , maybe that reaction continues to diminish as
 
 Demodex
 
 continues to have whatever selective pressure to become more symbiotic," Bunick said. "This data suggests the
 
 Demodex
 
 will become less problematic in triggering rosacea and other diseases."




 
 More information
 




 The Cleveland Clinic has more about
 <a class="rm-stats-tracked" href="https://my.clevelandclinic.org/health/diseases/22775-demodex-face-mites" target="_blank">
 
 Demodex
 
 mites
 </a>
 .




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Tiny Mites Are Feeding on Your Skin, But for How Long?

It may seem tempting to remove a&nbsp;<a href="https://www.aad.org/public/diseases/a-z/moles-types" class="rm-stats-tracked" target="_blank">mole</a>&nbsp;or&nbsp;<a href="https://my.clevelandclinic.org/health/diseases/21528-skin-tags-acrochordons#:~:text=Skin%20tags%20(acrochordons)%20are%20small,large%20as%20a%20few%20centimeters." class="rm-stats-tracked" target="_blank">skin tag</a>&nbsp;you don't like with a product that promises to make them disappear quickly.Don't do it, experts say.Dermatologists and the U.S. Food and Drug Administration both warn about the dangers of using unregulated products for do-it-yourself removal of moles, skin tags and another type of growth known as&nbsp;<a href="https://my.clevelandclinic.org/health/diseases/21721-seborrheic-keratosis" class="rm-stats-tracked" target="_blank">seborrheic keratoses</a>.
 Not only could doing so cause scarring and infection, but it can also mask skin cancer and make it harder for doctors to identify and treat promptly.




 "There are several reasons that patients should avoid trying to treat moles at home. And that is certainly the most concerning... that cancer patients often mistake skin cancer for benign moles," said Dr. Chad Prather, a board-certified dermatologist in Baton Rouge, La. "We commonly see patients who have a skin cancer. It's been diagnosed and their initial process was to try to treat that at home with either physical means or sometimes these over-the-counter products."




 That can cloud the diagnosis of very serious skin cancers, such as
 <a class="rm-stats-tracked" href="https://my.clevelandclinic.org/health/diseases/14391-melanoma#:~:text=Melanoma%2C%20which%20means%20%22black%20tumor,that%20gives%20skin%20its%20color." target="_blank">
 melanoma
 </a>
 , Prather said.




 The FDA released an advisory earlier this month warning that there is no approved prescription or over-the-counter drug for treating moles, skin tags or seborrheic keratoses. Products sold for this purpose — such as ointments, gels, sticks and liquids — may contain high concentrations of
 <a class="rm-stats-tracked" href="https://medlineplus.gov/druginfo/meds/a607072.html" target="_blank">
 salicylic acid
 </a>
 and other harmful ingredients, the FDA warned.




 The agency has received reports about people who developed permanent skin injuries, it noted in a
 <a class="rm-stats-tracked" href="https://www.fda.gov/consumers/consumer-updates/products-marketed-removing-moles-and-other-skin-lesions-can-cause-injuries-scarring" target="_blank">
 news release
 </a>
 .




 Simply making the claim that it's "organic," "natural," "herbal" or "homeopathic" doesn't make it safe, according to the FDA.




 A biopsy can provide information on how deep and wide a pigmented mole diagnosed as melanoma is, Prather said. That size helps guide treatment.




 "We judge how bad a melanoma is by how deep it goes. And we really need that initial biopsy to know the true depth so that we can choose the most appropriate treatment method, whether it's surgery or checking lymph nodes or followed by
 <a class="rm-stats-tracked" href="https://www.cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html" target="_blank">
 immunotherapy
 </a>
 ," Prather said.




 Products that contain acids can be caustic to the skin and are not typically used in dermatology practices where there are so many other treatment options, said Dr. Cameron Rokhsar, an associate professor of dermatology at Mount Sinai Hospital in New York City.




 "I've seen non-healing ulcers that have taken months to heal and then permanent scars or pigmentary changes in the skin from it," Rokhsar said. "People don't have the medical expertise to distinguish benign skin tags and moles versus other dangerous things. And they may be putting this stuff on things that really should be shown to a doctor."




 Treatment or removal depends on the diagnosis.




 For a simple skin tag, a doctor may numb and snip it, finishing by applying medications to stop the bleeding, all of that in a sterile manner to minimize infection risk and scarring. Seborrheic keratosis may be removed with a blade, frozen or cauterized, if small. Sometimes even a laser is used.




 "We have a lot of modalities for treatment at our disposal, which are obviously safe and time-tested medically," Rokhsar said. "We just have such better modalities than acids."




 Whether to have something benign removed is up to the individual.




 A board-certified dermatologist can give someone a proper diagnosis and can advise someone on the right method for removing the lesion if a person doesn't like its appearance or it's bothering them.




 "Oftentimes, the insurance companies pay for that anyway if something is growing or something is getting irritated. These are covered issues," Rokhsar noted.




 Any new growth that lasts more than three or four weeks should be evaluated by a dermatologist, Prather said. Warning signs that would warrant a visit to a dermatologist include scaliness, a pearly or shiny look to the lesion and a change in pigmentation or color.




 "We recommend a once-a-year screening if the patient has no history of cancer or family history of cancer. For patients who have [a history of] skin cancer, which is the most common cancer, one in five patients will have some skin cancer in their life. For those patients, they're checked a little more frequently. Often every three to six months," Prather said.




 If someone has used one of these products and has had an adverse effect, they can use the FDA's
 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program" target="_blank">
 MedWatch Safety Information and Adverse Event Reporting Program
 </a>
 , completing and submitting a form online or calling the FDA at 1-800-332-1088 to request a form.




 
 More information
 




 The American Cancer Society has more information on
 <a class="rm-stats-tracked" href="https://www.cancer.org/cancer/skin-cancer.html" target="_blank">
 skin cancer
 </a>
 .




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Skin Tags? Moles? Products Promising to Treat Them Can Do Real Harm

Higher total fish intake is associated with increased risk for malignant melanoma and melanoma in situ, according to a study published online June 8 in
 
 Cancer Causes &amp; Control.
 




 Yufei Li, from Brown School of Public Health in Providence, Rhode Island, and colleagues examined the associations between intake of total fish and specific fish types and risk of melanoma among 491,367 participants of the U.S. National Institutes of Health-AARP Diet and Health Study.




 The researchers identified 5,034 cases of malignant melanoma and 3,284 cases of melanoma in situ during 6,611,941 person-years of follow-up. Positive associations were identified between higher total fish intake and risk of malignant melanoma and melanoma in situ (hazard ratios, 1.22 and 1.28, respectively, for top versus bottom quintiles). Across several demographic and lifestyle factors, the positive associations were consistent. Positive associations were also seen between intake of tuna and nonfried fish and risks of malignant melanoma and melanoma in situ. An inverse association was seen for fried fish intake with malignant melanoma but not melanoma in situ.




 "We speculate that our findings could possibly be attributed to contaminants in fish, such as polychlorinated biphenyls, dioxins, arsenic, and mercury," a coauthor said in a statement. "Previous research has found that higher fish intake is associated with higher levels of these contaminants within the body and has identified associations between these contaminants and a higher risk of skin cancer."




 <a class="rm-stats-tracked" href="https://link.springer.com/article/10.1007/s10552-022-01588-5" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>








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Higher total fish intake, tuna intake, nonfried fish intake positively linked to risks of malignant melanoma, melanoma in situ

Higher Fish Intake May Increase Melanoma Risk

Certain factors may predict compliance with skin self-examination (SSE) among melanoma patients, according to a study presented at the annual meeting of the Society for Investigative Dermatology, held May 18 to 21 in Portland, Oregon.




 Daniel J. Lewis, M.D., from the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues sought to identify factors associated with adherence to SSE recommendations. The analysis included 369 melanoma patients with their first melanoma within six months of an original Pigmented Lesion Clinic (PLC) visit and who were followed for at least 2.5 years (2012 to 2018).




 The researchers note that at their most recent visit during the study period, 60.5 percent of participants reported doing home SSE since their prior PLC visit. Factors significantly associated with SSE included younger age (odds ratio, 0.98 for each year increase in age), female sex (odds ratio, 1.60), increased disease severity as assessed by calculating expected eight-year survival (odds ratio, 2.17), and having a significant other to help with the examination (odds ratio, 2.51). Adherence was not associated with having had total body photography, having an increased number of nevi, or having had more than one melanoma.




 "Understanding which patients may be nonadherent allows us to improve targeting of efforts aimed towards increasing adherence to patient populations less likely to comply," the authors write.




 <a class="rm-stats-tracked" href="https://www.sidannualmeeting.org/wp-content/uploads/2022/05/SID_Abstracts-Booklet_r6.pdf" target="_blank">
 Abstract No. 372
 </a>




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 More Information
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Younger age, female sex, increased disease severity, and having a significant other to help with exams may improve compliance

Factors ID'd for Self-Exam Compliance Among Melanoma Patients

Many U.S. adults still believe tanning myths and are unaware of sunburn risks, according to the results of a survey released by the American Academy of Dermatology.




 The American Academy of Dermatology conducted a survey of more than 1,000 U.S. adults to understand their knowledge regarding tanning and sunburns.




 According to the results of the survey, 45 percent of U.S. adults believe one or more of the following tanning myths: A base tan will prevent sunburns (22 percent), tanning is safe as long as you do not burn (20 percent), a base tan decreases the risk for skin cancer (18 percent), or tanning is healthy (13 percent). Furthermore, 39 percent of respondents are unaware of one or more of the following sunburn facts: You can get sunburned on a cloudy day (24 percent are unaware), you can get burned through a car window (15 percent), people with dark skin can get a sunburn (9 percent), sunburns increase the risk for skin cancer (7 percent).




 "This increase in sunburns is very concerning," Elizabeth Bahar Houshmand, M.D., a board-certified dermatologist based in Dallas, said in a statement. "Both tanning and sunburning damage your skin. The more you tan and sunburn, the more this damage builds up over time, increasing your risk of premature skin aging, including age spots, sagging and wrinkling, and skin cancer."




 <a class="rm-stats-tracked" href="https://www.aad.org/news/new-survey-reveals-public-confusion-about-risks-of-tanning-and-sunburns" target="_blank">
 More Information
 </a>




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About four in 10 U.S. adults believe a common tanning myth or are unaware of sunburn risks

U.S. Adults Lack Knowledge on Tanning, Sunburn Risks

Older non-Hispanic White adults are more likely to use sunscreen if they believe it will prevent them from getting sunburned and if they believe their romantic partners think they should do so, according to a study published in the May/June issue of the
 
 Journal of the Dermatology Nurses' Association
 
 .




 Dawn M. Holman, M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues used online survey data to examine beliefs about sunscreen use among 237 non-Hispanic White adults aged 50 years or older.




 The researchers found that the likelihood of reporting sunscreen use was increased for those who believed sunscreen use would prevent them from getting sunburned and for those who believed their romantic partners thought that they should use sunscreen (odds ratios, 1.84 and 1.72, respectively). The likelihood of reporting sunscreen use was lower for those who believed sunscreen use would "take too much time" (odds ratio, 0.65).




 "The current findings can help to shape and inform the focus of such efforts, including the evaluation of messaging strategies that highlight the benefits of sunscreen use for sunburn prevention and address concerns about sunscreen use taking too much time," the authors write.




 <a class="rm-stats-tracked" href="https://journals.lww.com/jdnaonline/Fulltext/2022/05000/Beliefs_Associated_With_Sunscreen_Use_Among.2.aspxx?utm_source=press&amp;utm_medium=press&amp;utm_campaign=jdna_pr_051822" target="_blank">
 Abstract/Full Text
 </a>




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Odds of using sunscreen increased for those who believe it will prevent sunburn, those whose romantic partners think they should

Beliefs Associated With Sunscreen Use Identified for Over 50s

Older patients who undergo Mohs surgery for nonmelanoma skin cancer often have high functional status, according to a study published online May 25 in
 
 JAMA Dermatology
 
 .




 Amanda Maisel-Campbell, M.D., from the Feinberg School of Medicine in Chicago, and colleagues examined patient- and tumor-specific indications considered by clinicians for treatment of nonmelanoma skin cancer in older adults aged 85 years or older presenting for skin cancer surgery and referred for Mohs surgery. Data were included for 1,181 patients referred for Mohs surgery treated at 22 sites.




 The researchers found that 91.3 and 8.7 percent of the patients were treated by Mohs surgery and received alternative treatment, respectively. Patients receiving Mohs surgery were more likely to have tumors on the face (68.5 versus 25.2 percent) and to have high functional status (57.0 versus 15.5 percent). There were 15 possible reasons identified for selecting Mohs surgery; the most common reasons provided by surgeons for opting to proceed with Mohs surgery were patient desire for treatment with a high cure rate, good or excellent patient functional status for age, and higher risk associated with the tumor based on histology (66.0, 57.0, and 40.2 percent, respectively).




 "These findings suggest that patient functional status is associated with decisions on how cancers are treated, given that high-functioning status was among the most common reasons for surgery in patients older than age 85 years," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2792450" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Patients aged 85 years and older receiving Mohs surgery more likely to have tumors on the face and to have high functional status

What Are the Indicators for Mohs Surgery in Seniors?

Introducing a ban on commercial indoor tanning with an accompanying public health campaign would reduce melanoma and keratinocyte cancers and reduce health care costs, according to a study recently published in the
 
 British Journal of Dermatology
 
 .




 Martin Eden, Ph.D., from the University of Manchester in the United Kingdom, and colleagues examined the health costs and consequences of implementing a policy-based intervention to ban commercial indoor tanning with an accompanying public information campaign across England. A cost-effectiveness analysis was conducted, and the policy-based intervention was compared to the status quo of availability of commercial indoor tanning.




 The researchers found that over the lifetime of all 618,873 18-year-olds living in England in 2019, a ban on commercial indoor tanning combined with a public health campaign would result in 1,206 avoided cases of melanoma, 207 fewer melanoma deaths, and 3,987 averted cases of keratinocyte cancers compared with the current situation. This would yield an additional 497 quality-adjusted life years (QALYs) and health care cost savings of £697,858. The net monetary benefit of the intervention would be £10.6 million and the net health benefit would be 530 QALYs. The likelihood of this policy-based intervention being cost-effective is 99 percent at a cost-effectiveness threshold of £20,000.




 "Introducing a ban on indoor tanning with a supporting public health campaign in England is cost-saving from a National Health Service perspective, resulting in health gain for a population of 18-year-olds," the authors write. "The implementation of a ban on the provision of indoor tanning should be given serious consideration."




 Several authors disclosed financial ties to the pharmaceutical industry.




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Intervention would yield net monetary benefit of £10.6 million and net health benefit of 530 QALYs

Ban of Indoor Tanning Beds Would Reduce Cancers, Cut Costs

Many U.S. adults misunderstand how to protect themselves from the sun to reduce their risk of skin cancer, according to a survey released by the American Academy of Dermatology.




 The results of the national survey were released in conjunction with the annual SPOT Skin Cancer campaign on Melanoma Monday, May 2. The survey of more than 1,000 U.S. adults was conducted from Jan. 24 to Feb. 7, 2022.




 The authors of the survey found that 62 percent of respondents gave themselves an overall grade of excellent or good for sun protection in 2021, yet 63 percent reported getting a tan (up from 54 percent in 2020), and one-third reported getting a sunburn (up from 25 percent in 2020). The survey also revealed knowledge gaps, with 67 percent incorrectly believing that sun protection factor (SPF) 30 sunscreen offers twice as much protection as SPF 15 sunscreen, and 43 percent unaware that shade protects a person from ultraviolet rays.




 "As we head into summer, it's important that the public practices safe sun to reduce their risk of skin cancer," Mark D. Kaufmann, M.D., president of the American Academy of Dermatology, said in a statement. "If you use sunscreen to protect yourself, it's essential that you use it correctly or it will not protect you from sunburn, skin aging, and skin cancer."




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Yet, six in 10 U.S. adults give themselves high marks for sun protection

Sun Protection Misinformation Still Common

For patients aged 70 years or older with basal cell carcinoma (BCC), the overall treatment burden is low and cosmetic results are good, according to a study published in the May issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Marieke E.C. van Winden, M.D., from the Radboud Institute for Health Sciences in Nijmegen, Netherlands, and colleagues examined and identified predictors of treatment burden (visual analog scale, 0 to 10 cm; lower scores indicating higher treatment burden), treatment outcomes, and overall survival in patients aged 70 years or older who underwent surgical treatment for BCC in the head and neck area. Data were included for 539 patients with a median age of 78 years.




 The researchers found that the overall treatment burden was low (median, 8.6) and cosmetic results were good. Instrumental activities of daily living (iADL) dependency, female sex, complications, larger tumor diameter, and polypharmacy were predictors of higher treatment burden. Within the follow-up period, 35 patients (6.5 percent) died; none of the deaths were attributed to BCC. Increasing comorbidity index and iADL dependency were predictors of mortality. After adjustment for covariates, there were no differences seen in these outcomes between Mohs micrographic surgery and conventional excision. There was no significant association observed for age with any outcome.




 "BCC management decisions merely based on age as the sole patient-related factor should be avoided, as chronological age showed no significant association with treatment burden, complications, cosmetic results, and overall mortality," the authors write. "Moreover, using advanced age as an exclusion criterion could result in a delay in adequate medical interference."




 One author disclosed financial ties to the pharmaceutical industry.




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Age was not associated with any outcome among patients aged 70 years and older with basal cell carcinoma

Should Basal Cell Carcinoma Management Be Based on Age?

Although many dermatopathologists perceive that melanocytic skin lesions are overdiagnosed, this perception does not alter diagnostic behaviors, according to a study published online April 20 in
 
 JAMA Dermatology
 
 .




 Kathleen F. Kerr, Ph.D., from the University of Washington in Seattle, and colleagues examined practicing U.S. dermatopathologists' perceptions of melanoma overdiagnosis in a survey study involving 115 board-certified and/or fellowship-trained dermatopathologists who viewed a set of 18 skin biopsy cases (five slide sets composed of 90 melanocytic skin lesions).




 The researchers found that 68, 47, and 35 percent of the dermatopathologists agreed that overdiagnosis is a public health issue for atypical nevi, melanoma in situ, and invasive melanoma, respectively. The likelihood of perceiving that atypical nevi are overdiagnosed was lower for dermatopathologists with more years in practice: Forty-six percent and 93 percent of dermatopathologists with 20 or more years of experience and with one to four years of experience, respectively, agreed that atypical nevi are overdiagnosed. Dermatopathologists who agreed that all three conditions were overdiagnosed were slightly more likely than other dermatopathologists to diagnose study cases as mild-to-moderate dysplastic nevi, but the difference was not statistically significant. There was no significant difference observed in diagnosing invasive melanoma for dermatopathologists who agreed and those who disagreed that invasive melanoma is overdiagnosed.




 "We did not find evidence that dermatopathologists who perceive overdiagnosis differ in their interpretative behavior," the authors write. "Awareness of overdiagnosis among pathologists may not be enough to reduce overdiagnosis."




 One author disclosed financial ties to Myriad Genetics.




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However, the perception of overdiagnosis of melanocytic skin lesions does not impact diagnosing behaviors

Dermatopathologists Perceive Overdiagnosis of Skin Lesions

"Almost 80 percent of tested children in the registry had positive patch test results. Most common allergens were hydroperoxides of linalool, hydroperoxides of limonene, and nickel," Yu said. "This study reinforces the important concept that children with difficult-to-treat dermatitis should be evaluated for allergic contact dermatitis with patch testing, because without patch testing, we may be missing an opportunity to treat a large portion of children."




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 In another presentation, Julian Trevino, M.D., of Wright State University in Dayton, Ohio, reviewed information on skin conditions caused by exposure to various plants, insects/arthropods, and aquatic organisms.




 The information presented was the result of an extensive review of the literature designed to provide attendees with relevant information to assist them in accurately diagnosing and treating such exposures as well as providing information to patients, particularly those engaged in activities where there is an increased likelihood of such hazardous exposure. Trevino noted that awareness of the wide variety of potential indoor and outdoor exposures to various plants, insects/arthropods, and aquatic organisms causing adverse skin reactions can assist clinicians and patients in avoiding such exposures and in properly identifying and managing such exposures when they occur.




 "Taking measures to prevent such exposures (in the home, at work, while engaging in leisure activities or while on vacation) can avoid the unpleasant, and in some cases life-threatening, consequences of these exposures," Trevino said. "Clinicians knowledgeable about [these] exposures can be a valuable resource to colleagues, patients, and community organizations. They can provide accurate information about recognition, treatment, and prevention of such exposures. They can also become engaged in designing better preventative strategies and treatments for these hazardous exposures."




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 AAD: Skin Videomicroscopy Biomarker May Help Predict Cancer Relapse
 




 WEDNESDAY, April 6, 2022 (HealthDay News) -- For patients who have undergone hematopoietic cell transplantation for hematologic cancer, leukocyte-endothelial interactions visualized directly in skin may help predict prognosis, according to a study published online March 26 in
 
 JAMA Dermatology
 
 to coincide with the annual meeting of the American Academy of Dermatology, held from March 25 to 29 in Boston.




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The 2022 American Academy of Dermatology Annual Meeting

American Academy of Dermatology, March 25 to 29

Primary care-based melanoma screening is associated with increased detection of thin melanomas, according to a study published online April 6 in
 
 JAMA Dermatology
 
 .




 Martha Matsumoto, M.D., from the University of Pittsburgh School of Medicine, and colleagues conducted an observational study of a quality improvement initiative from Jan. 1, 2014, through Dec. 31, 2018, among patients aged 35 years and older presenting for a primary care visit. Primary care clinicians were offered training in melanoma identification through skin examination and were encouraged to offer annual screening to patients.




 The researchers found that 24.3 percent of the 595,799 screen-eligible patients were screened at least once. Screened patients were older (median age, 59 versus 55 years) and were more likely to be female and non-Hispanic White than unscreened patients. Compared with unscreened patients, screened patients were more likely to be diagnosed with in situ or thin invasive melanomas (hazard ratios, 2.6 and 1.8, respectively) after adjustment for age, sex, and race, and were more likely to be diagnosed with in situ or thin invasive interval melanomas (diagnosed at least 60 days after initial screening examination; hazard ratios, 2.1 and 1.3, respectively). The incidence of melanoma thicker than 4 mm did not differ significantly for unscreened and screened patients for all melanomas or interval melanomas.




 "The significant increase in melanoma incidence in the United States, particularly thin melanoma, without a concomitant decrease in melanoma mortality, raises the concern that early detection efforts, such as visual skin screening, may result in overdiagnosis," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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Incidence of melanoma thicker than 4 mm did not differ significantly for screened and unscreened patients

AAD: Skin Videomicroscopy Biomarker May Help Predict Cancer Relapse

Primary Care-Based Screening Ups Thin Melanoma Detection

Diagnosis of new cancer cases declined during the pandemic and has not recovered to expected levels, according to a study published in the March issue of the
 
 Journal of the National Comprehensive Cancer Network
 
 .




 Antoine Eskander, M.D., from the University of Toronto, and colleagues assessed the impact of the pandemic on weekly reported cancer incidence. Analysis included 358,487 adults diagnosed with cancer in Ontario, Canada, from Sept. 25, 2016, to Sept. 26, 2020.




 The researchers found that at the start of the pandemic, there was an immediate 34.3 percent decline in the estimated mean cancer incidence volume (relative rate, 0.66), followed by a 1 percent increase in cancer incidence volume in each subsequent week (relative rate, 1.009). Both screening and nonscreening cancers followed similar trends. Melanoma and cervical, endocrine, and prostate cancers had the largest immediate declines. A weekly decline in incidence during the COVID-19 period continued for hepatobiliary and lung cancers. Early in the pandemic (March 15 to Sept. 26, 2020), 12,601 fewer people were diagnosed with cancer, with an estimated weekly backlog of 450.




 "Our data demonstrates that many cancers have gone undetected due to the disruptions in the health care system in response to the COVID-19 pandemic," Eskander said in a statement. "This is concerning because a delay in diagnosis for cancer is associated with a lower chance of cure."




 Two authors disclosed financial ties to the pharmaceutical industry.




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While weekly detection increased from March 2020 low, incidence rates have not fully recovered

Pandemic Tied to Drop in New Cancer Diagnoses

Overdiagnosis of melanoma seems to be occurring among White men and women, according to a study published online March 16 in
 
 JAMA Dermatology
 
 .




 Adewole S. Adamson, M.D., from Dell Medical School at the University of Texas in Austin, and colleagues quantified melanoma overdiagnosis among White and Black patients in the United States using data from the Surveillance, Epidemiology, and End Results program from 1975 to 2014.




 The researchers found that from 1975 to 2014, there was an approximately fourfold and sixfold increase in melanoma incidence in White women and White men, respectively (incidence rate ratios [IRRs], 4.01 [95 percent confidence interval, 3.65 to 4.41] and 5.97 [5.47 to 6.52], respectively), while much smaller increases were seen in Black women and men (IRRs, 1.21 [0.97 to 1.49] and 1.17 [0.77 to 1.78], respectively). Reductions were seen in mortality due to melanoma among Black women and men (mortality rate ratios [MRRs], 0.76 [0.63 to 0.90] and 0.72 [0.62 to 0.84], respectively), while the rate was stable in White women (MRR, 1.02 [0.96 to 1.09]) and increased for White men (MRR, 1.49 [1.25 to 1.77]). Estimated mortality would have increased 60 percent in White women and more than doubled in White men had medical care not improved. Based on these trends, in 2014, an estimated 59 and 60 percent of White women and men with melanoma, respectively, were overdiagnosed, calculated as the difference between observed incidence and estimated true cancer occurrence.




 "Dermatologists must grapple with the very real prospect that screening is a major source of the increased incidence of melanoma," the authors write.




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About fourfold and sixfold increases in melanoma incidence seen in White women and men from 1975 to 2014, while much smaller increases seen in Blacks

Overdiagnosis of Melanoma Seen in White Men, Women

For solid organ transplant recipients (SOTRs), viruses and ultraviolet radiation exposure are associated with the development of skin cancer, according to a study published online March 9 in
 
 JAMA Dermatology
 
 .




 Michael R. Sargen, M.D., from the National Institutes of Health in Rockville, Maryland, and colleagues conducted a population-based cohort study involving 444,497 SOTRs who underwent a transplant from Jan. 1, 1987, to Dec. 31, 2017, in the United States to characterize the spectrum of disease and risk factors for nonkeratinocyte skin cancers.




 The researchers identified 2,380 nonkeratinocyte skin cancers among the SOTRs. The most common cancer was melanoma, followed by Merkel cell carcinoma, Kaposi sarcoma, sebaceous carcinoma, and cutaneous lymphomas (61.8, 14.0, 7.8, 7.1, and 4.5 percent, respectively). The mostly strongly elevated risks were seen for cancers associated with viruses, including Kaposi sarcoma, Merkel cell carcinoma, and extranodal natural killer/T-cell lymphoma (standardized incidence ratios [SIRs], 20.5, 16.2, and 44.3, respectively). Significantly elevated risks were also seen for sebaceous carcinoma, anaplastic large cell lymphoma, and diffuse large B-cell lymphoma (SIRs, 15.2, 6.82, and 5.17, respectively). Male sex, older age at transplant, factors associated with ultraviolet radiation exposure, and increasing time since transplantation were independently associated with a greater risk for multiple skin cancer types. Reduced melanoma incidence was seen in association with treatment with mammalian target of rapamycin (mTOR) inhibitors (incidence rate ratio, 0.75).




 "These results support modifications to current screening guidelines among SOTRs and suggest that wider use of mTOR inhibitors in high-risk patients could reduce the incidence of melanoma," the authors write.




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Most elevated risks seen for cancers associated with viruses; male sex, older age, UV radiation exposure also linked to increased risk for cancers

What Factors Increase Risk for Nonkeratinocyte Skin Cancers in Transplant Recipients?

For patients with sentinel lymph node (SLN)-positive melanoma, fewer patients are undergoing completion lymph node dissection (CLND) and more are receiving adjuvant systemic therapy, according to study published online Jan. 27 in the
 
 Annals of Surgery
 
 .




 Kristy K. Broman, M.D., M.P.H., from Moffitt Cancer Center in Tampa, Florida, and colleagues examined overall trends and center-level variation in utilization of CLND and adjuvant systemic therapy in an international cohort study at 21 centers involving adults with SLN-positive melanoma and negative distant staging from July 2017 to July 2019.




 The researchers found that performance of CLND decreased from 28 to 8 percent among 1,109 patients, and use of adjuvant systemic therapy increased from 29 to 60 percent. The most influential factors for both CLND and adjuvant systemic therapy were nodal tumor size, stage, and location of treating center. Management of stage IIIA patients varied notably among treating centers, as did use of CLND with adjuvant systemic therapy versus nodal observation alone for similar-risk patients.




 "These changes in practice began prior to the publication of landmark trials of nodal observation and adjuvant immunotherapy and targeted therapy but accelerated dramatically at the included melanoma referral centers over a two-year time period postpublication," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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From 2017 to 2019, increase seen in use of adjuvant systemic therapy, with variation in use among treating centers

Lymph Node Dissection Declining in SLN-Positive Melanoma

The recurrence rate for Merkel cell carcinoma (MCC) is about 40 percent, and most recurrence occurs within the first three years, according to a study published online Feb. 23 in
 
 JAMA Dermatology
 
 .




 Aubriana M. McEvoy, M.D., from the University of Washington in Seattle, and colleagues estimated the risk for stage-specific MCC recurrence and mortality in a prospective study involving 618 patients enrolled between 2003 and 2019; 233 experienced MCC recurrence.




 The researchers found that the five-year recurrence rate was 40 percent. The risk for recurrence was high in the first year (11, 33, 30, 45, and 58 percent for pathologic stage I, IIA/IIB, IIIA, IIIB, and IV, respectively); overall, 95 percent of the recurrences occurred within the first three years. Living patients were followed for a median of 4.3 years. In univariate analyses, factors associated with increased recurrence risk, beyond stage, included immunosuppression, male sex, known primary lesion among patients with clinically detectable nodal disease, and older age. Sixty-five percent of the 187 deaths in the cohort were due to MCC. MCC-specific survival was strongly dependent on stage and was 95 versus 41 percent at five years for patients with pathologic stage I versus IV. Local recurrence did not appreciably reduce survival compared with no recurrence among patients presenting with stage I to II MCC (85 versus 88 percent MCC-specific survival at five years).




 "A multivariate tool combining stage, age, sex, immune suppression, and unknown primary status would offer a more accurate recurrence risk estimate and is in development," the authors write.




 Several authors disclosed financial ties to the pharmaceutical and health care industries; one author disclosed pending patents.




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Five-year recurrence rate about 40 percent; 95 percent of recurrences occurred within first three years

What Is the Recurrence Rate for Merkel Cell Carcinoma?

Acral lentiginous melanoma (ALM) survival varies according to socioeconomic status (SES) and race, with differences in SES contributing to survival disparities for Hispanic Black and White patients, according to a study published in the February issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Bernice Y. Yan, M.D., from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, and colleagues conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results database for 2000 to 2016 to compare disease-specific survival in ALM across SES and race. A total of 2,245 patients were identified with a first ALM diagnosis.




 The researchers found that the five-year disease-specific survival was 77.8 percent. Compared with those in the highest SES quintile, patients in the lowest and second-to-lowest SES quintiles had 1.33 (95 percent confidence interval, 0.90 to 1.96) and 1.42 (95 percent confidence interval, 1.03 to 1.97) times the risk for death, respectively, after adjustment. The risk for death was increased 1.48 (95 percent confidence interval, 1.10 to 1.99) and 1.24 (95 percent confidence interval, 0.88 to 1.79) times for Hispanic White and Black patients, respectively, versus non-Hispanic Whites. After adjustment for SES and American Joint Committee on Cancer stage at diagnosis, the hazard ratios for ALM-specific death were attenuated in Hispanic White and Black patients.




 "Importantly, our study suggests that SES partially contributes to increased ALM mortality in Hispanic White and Black patients," the authors write. "Further investigations into factors accounting for SES and race disparities may improve survival outcomes in ALM."




 One author disclosed ties to the pharmaceutical industry.




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Differences in socioeconomic status contribute to survival disparities for Hispanic Black and White patients

Acral Lentiginous Melanoma Survival Varies by Race, SES

Knowledge of skin cancer risk may influence risky behaviors, including the use of tanning beds, according to a study published in the January issue of
 
 Dermatologic Surgery
 
 .




 Naiara S. Barbosa, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a mailed survey to assess local Minnesota residents' knowledge, attitudes, and behavior regarding skin cancer and tanning bed use and to estimate the prevalence of high risk for melanoma. Surveys were mailed to 886 local residents (549 individuals aged 18 to 39 years; 337 individuals aged 40 years and older).




 The researchers found that 55 percent of the younger group and 37 percent of the older group had used indoor tanning. According to a skin cancer risk calculator, the prevalence of high risk for melanoma was 18 percent in the younger group and 33 percent in the older group. Respondents with high risk scores were more likely to correctly perceive their higher risk for skin cancer. Among participants with high risk scores and those who previously used tanning beds, most reported a low likelihood of future indoor tanning.




 "It was nice to see that having an accurate perception of skin cancer and a perceived high risk of skin cancer development was associated with a less chance of tanning bed use within the next year," a coauthor said in a statement. "More studies would help clarify some of the questions regarding skin cancer risk, perceived risk, and what accurately predicts behavior modification pertaining to skin cancer development."




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Those at high risk of skin cancer accurately assessed risk and reported lower likelihood of future tanning bed use

Knowledge of High Skin Cancer Risk Might Modify Risky Behaviors

For patients with previously untreated, advanced esophageal squamous cell carcinoma, treatment with nivolumab plus chemotherapy or nivolumab plus ipilimumab results in significantly longer overall survival than chemotherapy alone, according to a study published in the Feb. 3 issue of the
 
 New England Journal of Medicine
 
 .




 Yuichiro Doki, M.D., from the Osaka University Graduate School of Medicine in Japan, and colleagues conducted an open-label, phase 3 trial involving 970 adults with previously untreated, unresectable advanced, recurrent, or metastatic esophageal squamous cell carcinoma who were randomly assigned to receive nivolumab plus chemotherapy, nivolumab plus the monoclonal antibody ipilimumab, or chemotherapy alone in a 1:1:1 ratio.




 The researchers found that at a minimum follow-up of 13 months, overall survival was significantly longer with nivolumab plus chemotherapy than chemotherapy alone among patients with tumor-cell programmed death ligand 1 (PD-L1) expression of 1 percent or greater (median 15.4 versus 9.1 months; hazard ratio, 0.54) and in the overall population (median, 13.2 versus 10.7 months; hazard ratio, 0.74). Significantly longer overall survival was also seen with nivolumab plus ipilimumab than with chemotherapy alone among patients with tumor-cell PD-L1 expression of 1 percent or more (median, 13.7 versus 9.1 percent; hazard ratio, 0.64) and in the overall population (median, 12.7 versus 10.7 months; hazard ratio, 0.78). Among patients with tumor-cell PD-L1 expression of 1 percent or greater, nivolumab plus chemotherapy, but not nivolumab plus ipilimumab, was associated with a significant progression-free survival benefit over chemotherapy alone.




 "Overall survival favored the nivolumab-containing regimens across most of the prespecified subgroups," the authors write.




 The study was funded by Bristol Myers Squibb and Ono Pharmaceutical. Bristol Myers Squibb is the manufacturer of nivolumab.




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Overall survival longer in patients receiving first-line treatment with nivolumab plus chemo or nivolumab plus ipilimumab versus chemo alone

Nivolumab Combo Treats Advanced Esophageal Squamous-Cell Carcinoma

Mohs micrographic surgery (MMS) is less expensive and more effective than wide local excision (WLE) for stage T2a cutaneous squamous cell carcinoma (cSCC), according to a study published in the February issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Jeremy Udkoff, M.D., from the University of Pittsburgh Medical Center, and colleagues conducted a cost-effectiveness analysis to determine whether MMS is effective compared to WLE for Brigham and Women's Hospital stage T2a cSCC. A Markov model was created using variables from published data with a five-year time horizon.




 The researchers found that MMS was less expensive than WLE ($4,365.57 versus $4,699.41). Over five years, MMS gained 2.22 weeks of perfect health (3.776 and 3.733 quality-adjusted life years [QALY] for MMS and WLE, respectively). The incremental cost-effectiveness ratio for WLE versus MMS was –$7,822.19 for stage T2a cSCC. The probability of being more cost-effective was 99.9 percent for MMS versus WLE. Choosing MMS over WLE would result in annualized savings of $200 million and more than 25,000 QALY. MMS would remain cost-effective if it cost 3.1 times the current rate.




 "Providing these data to physicians, policy makers, and insurance companies represents an important step in methodologically examining available therapies to help ease the fiscal strains on our health care system while providing better outcomes for patients," the authors write.




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Mohs micrographic surgery is less expensive and results in 2.22 weeks of perfect health gained over five years versus WLE

How Does MMS Compare to Wide Local Excision for cSCC?

Metastases develop in about 2 percent of cutaneous squamous cell carcinomas (cSCCs), according to a study published in the February issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Selin Tokez, from the Erasmus MC Cancer Institute in Rotterdam, Netherlands, and colleagues examined the cumulative incidence and disease-specific survival of patients with metastatic cSCC (mcSCC) in the Dutch population. Data were included for 11,137 patients with first cSCC in 2007 or 2008, with a median follow-up of 9.1 years.




 The researchers found that metastases developed in 1.9 percent of the patients, with a median time to metastasis of 1.5 years. Risk factors for metastases included age (adjusted hazard ratio, 1.03), male sex (adjusted hazard ratio, 1.7), and immunosuppression (adjusted hazard ratios: 5.0 and 2.7 for organ transplant recipient and hematological malignancy, respectively). For patients with mcSCC, the five-year disease-specific survival was 79.1 percent.




 "We showed that the majority of metastases occur within four years and that this risk is higher with male sex, increasing age, and immunosuppression," the authors write. "Individual risk prediction models should include these high-risk patient characteristics to tailor follow-up care to the subgroups of patients with cSCC at increased risk of mcSCC among the large group of predominantly low-risk cSCC patients."




 One author disclosed financial ties to Sanofi Genzyme, which funded the study.




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Risk factors for metastases include age, male sex, and immunosuppression

Metastases Occur in About 2 Percent of Cutaneous SCCs

Electrical impedance spectroscopy (EIS) measured with a noninvasive device (Nevisense) increases diagnostic confidence for students and dermatologists assessing lesions clinically suspicious for melanoma, according to a study published in the January issue of
 
 SKIN
 
 .




 Avani Kolla, from the NYU Grossman School of Medicine in New York City, and colleagues conducted a pilot study to assess the impact of adding EIS measurement scores to clinical and dermoscopic images of lesions clinically suspicious for melanoma. Thirty-four melanocytic lesions suspicious for melanoma were evaluated by three pigmented lesions specialists and three fourth-year medical students via an online survey. Participants provided their diagnosis, biopsy recommendation, and confidence in diagnosis as benign or malignant based on history and clinical and dermoscopic images, before and after receiving an EIS score.




 The researchers found that the mean biopsy sensitivity for melanoma/severely dysplastic nevi was increased from 70 to 84 percent with the addition of EIS scores, and mean diagnostic accuracy was increased from 74 to 86 percent. For all histopathologic categories, mean diagnostic confidence increased for both students and dermatologists.




 "Despite the small sample sizes, we did find statistically significant improvements in diagnostic confidence and accuracy among the students and pigmented lesions specialist dermatologists," the authors write. "Additional larger studies in real-world clinical settings are needed to more fully examine the role of EIS in providing patients with greater reassurance when their clinically atypical nevi are being evaluated, and facilitating clinical decision-making."




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EIS increases diagnostic confidence for students and dermatologists assessing lesions clinically suspicious for melanoma

Is Electrical Impedance Spectroscopy Beneficial for Detecting Melanoma?

For patients with previously untreated metastatic or unresectable melanoma, the combination of relatlimab, a lymphocyte-activation gene 3-blocking antibody, and nivolumab, a programmed death 1-blocking antibody, provides greater benefit in terms of progression-free survival than nivolumab alone, according to a study published in the Jan. 6 issue of the
 
 New England Journal of Medicine
 
 .




 Hussein A. Tawbi, M.D., Ph.D., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues examined relatlimab and nivolumab as a fixed-dose combination compared with nivolumab alone administered intravenously every four weeks to patients with previously untreated metastatic or unresectable melanoma.




 The researchers found that the median progression-free survival was 10.1 and 4.6 months with relatlimab-nivolumab and nivolumab, respectively (hazard ratio for progression or death, 0.75). At 12 months, progression-free survival was 47.7 and 36.0 percent with relatlimab-nivolumab and nivolumab, respectively. Across key subgroups, progression-free survival favored relatlimab-nivolumab over nivolumab. Grade 3 or 4 treatment-related adverse events occurred in 18.9 and 9.7 percent of patients in the relatlimab-nivolumab and nivolumab groups, respectively.




 "These data further support the added benefit of dual checkpoint inhibition over monotherapy, add another immune checkpoint combination to the therapeutic armamentarium, and establish relatlimab-nivolumab as a potential new treatment option for patients with previously untreated metastatic or unresectable melanoma," the authors write.




 The study was funded by Bristol Myers Squibb, the manufacturer of relatlimab.




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Combination provides greater benefit than nivolumab alone for progression-free survival in untreated metastatic or unresectable melanoma

Relatlimab-Nivolumab Ups PFS in Untreated Advanced Melanoma

For patients with advanced
 
 BRAF
 
 V600-mutant metastatic melanoma, overall survival (OS) is superior with a treatment sequence beginning with nivolumab/ipilimumab (N/I), according to a study presented Nov. 16 at the inaugural American Society of Clinical Oncology Virtual Plenary Series.




 Michael B. Atkins, M.D., from the Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C., and colleagues compared the efficacy and toxicity of the sequence of N/I followed by dabrafenib/trametinib (D/T) or the converse sequence for patients with treatment-naive
 
 BRAF
 
 V600-mutant metastatic melanoma. Patients were randomly assigned to receive step 1 with N/I (arm A; 133 patients) or D/T (arm B; 132 patients) and at disease progression were enrolled in step 2 for alternate therapy: D/T (arm C) or N/I (arm D).




 At the fourth interim analysis with 59 percent of patients two years from enrollment, the trial was stopped because the outcomes were definitive enough. The researchers found that at a median follow-up of 27.7 months, 27 and 46 patients had switched to arm C and arm D, respectively. To date, the overall response rates were 46, 43, 48, and 30 percent in arms A, B, C, and D, respectively. Two-year overall survival (OS) was 72 and 52 percent for those starting with arm A and arm B, respectively. Progression-free survival (PFS) showed a trend in favor of arm A. The curves for PFS and OS showed a biphasic pattern, with arm B above arm A until six and 10 months, respectively.




 "The drug combinations tested in this trial all improve survival compared to prior standards of care, but we now know which combination should be administered first to achieve maximum benefit for the vast majority of our patients," Atkins said in a statement. "This trial should provide clearer guidance to clinicians on when to administer particular treatments."




 Several authors disclosed financial ties to biopharmaceutical companies, including Bristol Myers Squibb, the manufacturer of N/I.




 <a class="rm-stats-tracked" href="https://lombardi.georgetown.edu/news-release/trial-stopped-early-giving-immunotherapy-before-targeted-rx-improves-survival-in-advanced-melanoma/" target="_blank">
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Two-year overall survival 72 percent for those starting with N/I, 52 percent for those starting with dabrafenib/trametinib

Giving Nivolumab/Ipilimumab First Ups Overall Survival in Melanoma

Patient-led surveillance is safe and feasible after treatment of localized melanoma, according to a study published online Nov. 24 in
 
 JAMA Dermatology
 
 .




 Deonna M. Ackermann, M.P.H., from the School of Public Health at the University of Sydney, and colleagues conducted a pilot for a randomized clinical trial involving 100 patients who had been treated for localized melanoma, owned a smartphone, had a partner to assist with skin self-examination (SSE), and had been attending scheduled follow-up visits. Participants were randomly assigned to six months of patient-led surveillance or clinician-led surveillance (49 and 51 patients, respectively).




 The researchers found that patient-led surveillance correlated with increased SSE frequency and thoroughness compared with clinician-led surveillance (odds ratios, 3.5 [95 percent confidence interval (CI), 0.9 to 14.0] and 2.2 [95 percent CI, 0.8 to 5.7], respectively), no detectable adverse impact on psychological outcomes (fear of cancer recurrence subscale score: mean difference, –1.3; 95 percent CI, –3.1 to 0.5), and increased clinic visits (risk ratio, 1.5; 95 percent CI, 1.1 to 2.1), skin lesion excisions (risk ratio, 1.1; 95 percent CI, 0.6 to 2.0), and subsequent melanoma diagnoses (risk difference, 10 percent; 95 percent CI, –2 to 23 percent). Eight participants in the intervention group were diagnosed with new primary melanomas and one local recurrence, including five ahead of routinely scheduled visits; in the control group, three were diagnosed, none of which were ahead of routinely scheduled visits.




 "This pilot randomized clinical trial found that patient-led surveillance of melanoma appears to be safe, feasible, and acceptable," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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Patient-led surveillance correlated with increased skin self-examination frequency, had no adverse impact on psychological outcomes

Is Patient-Led Surveillance Feasible After Localized Melanoma?

The disease burden attributable to nonmelanoma skin cancer (NMSC) is considerable and expected to continue increasing, according to a study published online July 30 in
 
 BMC Cancer
 
 .




 Wan Hu, from Anhui Medical University in Hefei, China, and colleagues report on the NMSC-related disease burden globally and the temporal trend of disease burden from 1990 to 2019; using the Bayesian age-period-cohort model integrated nested Laplacian approximation, the authors also predict the disease burden in the coming 25 years .




 The researchers found that in 2019, the disease burden was significantly higher in men than women. Significant differences in disease burden were seen in different sociodemographic index regions, with heavier disease burden for better socioeconomic development. In 2019, the number of new cases and age-standardized incidence rate (ASIR) was higher for basal cell carcinoma than squamous cell carcinoma. However, the opposite was seen for the number of disability-adjusted life-years (DALYs) and age-standardized DALYs. From 1990 to 2019, there was an increase in the ASIR of NMSC from 54.08 to 79.10/100,000, with an estimated annual percentage change of 1.78. The same trend was seen in other indicators, including the number of new cases, number of deaths, number of DALYs, age-standardized mortality rate, and age-standardized DALYs rate. From 2020 to 2044, the number of new cases, deaths, and DALYs attributable to NMSC were predicted to increase by at least 1.5-fold.




 "The study shows that NMSC poses a substantial global disease burden and predicts that the future disease burden of NMSC will remain severe," the authors write. "We call on health policymakers to act and intervene."




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Number of new cases, deaths, and DALYs attributable to NMSC expected to increase at least 1.5-fold by 2044

Global Disease Burden Related to Nonmelanoma Skin Cancer Explored

The global burden of melanoma is considerable and is expected to increase by 2040, according to a study published online March 30 in
 
 JAMA Dermatology
 
 .




 Melina Arnold, Ph.D., from the International Agency for Research on Cancer in Lyon, France, and colleagues examined global patterns of cutaneous melanoma in 2020 and calculated the estimated numbers of cases and deaths for 2040 using data from the GLOBOCAN 2020 database.




 The researchers estimated 325,000 new melanoma cases and 57,000 deaths worldwide for 2020. Across countries and world regions, there were large geographic variations observed, with the highest incidence rates among males and females seen in Australia/New Zealand (42 and 31, respectively, per 100,000 person-years), followed by Western Europe (19 and 19 per 100,000 person-years), North America (18 and 14 per 100,000 person-years), and Northern Europe (17 and 18 per 100,000 person-years). In most African and Asian countries, melanoma continued to be rare, with incidence rates usually less than one per 100,000 person-years. The peak mortality rates were five per 100,000 person-years in New Zealand; geographic variations in mortality rates were less pronounced. Assuming the 2020 rates continue, the burden from melanoma is estimated to increase to 510,000 new cases and 96,000 deaths by 2040 (increases of about 50 and 68 percent, respectively).




 "This epidemiological assessment found a heavy public health and economic burden, and our projections suggest that it will remain so in the coming decades," the authors write.




 One author disclosed receipt of personal fees from Amgen.




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If 2020 rates continue, burden estimated to increase by about 50 percent for incidence, 68 percent for deaths by 2040

Global Burden of Melanoma Considerable, Set to Rise by 2040

In Episode 52 of Derms and Conditions, our host James Q. Del Rosso, DO, sits down with Darrell Rigel, MD, MS, a Clinical Professor of Dermatology at the Mount Sinai Icahn School of Medicine and a world leader in research and patient care for melanoma and other skin cancers. The two discuss the current state of sunscreens and how to address the most common questions that patients have in the office.&nbsp; Patients often wonder if they need to use sunscreen when the UV index is low, if sunscreen is necessary for patients with darker skin tones, what the difference is between organic and inorganic sunscreens, and if sunscreen is safe for the environment. Dr. Del Rosso and Dr. Rigel answer all of these questions and many more, so tune in to this episode to learn how to counsel your patients and improve their sunscreen usage.&nbsp;

In Episode 52 of Derms and Conditions, our host James Q. Del Rosso, DO, sits down with Darrell Rigel, MD, MS, a Clinical Professor of Dermatology at the Mount Sinai Icahn School of Medicine and a world leader in research and patient care for melanoma and other skin cancers. The two discuss the current state of sunscreens and how to address the most common questions that patients have in the office.Patients often wonder if they need to use sunscreen when the UV index is low, if sunscreen is necessary for patients with darker skin tones, what the difference is between organic and inorganic sunscreens, and if sunscreen is safe for the environment. Dr. Del Rosso and Dr. Rigel answer all of these questions and many more, so tune in to this episode to learn how to counsel your patients and improve their sunscreen usage.&nbsp;<div style="border:1px solid rgb(210, 62, 135);margin:15px 0;padding:20px;text-align:left;">Neutrogena is proud to sponsor this episode of Derms and Conditions - listen for the code at the end of the podcast to request a free full-size sunscreen. We also invite you to <a target="_blank" rel="noopener noreferrer" href="https://www.neutrogenamd.com/?action=sign-up&amp;utm_source=Fred&amp;utm_medium=email&amp;utm_campaign=DermsConditionsPodcast&amp;utm_content=sign_up">CLICK HERE</a> to register at <a target="_blank" rel="noopener noreferrer" href="https://www.neutrogenamd.com/?action=sign-up&amp;utm_source=Fred&amp;utm_medium=email&amp;utm_campaign=DermsConditionsPodcast&amp;utm_content=sign_up">NeutrogenaMD.com</a> for patient samples and educational resources.</div>

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