Search

Background Follow-up of patients with nonmelanoma skin cancer (NMSC) is mainly aimed at the early diagnosis of local recurrences and early detection of a subsequent or second NMSC ( sNMSC). However, the frequency and chronology of sNMSC have not been widely studied in the literature. Objectives To assess the frequency and chronology of developing an sNMSC. Methods This was a retrospective longitudinal study of patients with a first NMSC excised and diagnosed at the Hospital Universitario Virgen Macarena (Seville, Spain) between 1 January 1998 and 31 December 2000 and followed up until 31 December 2009. Age, sex, histological type of NMSC (basal cell carcinoma, squamous cell carcinoma), anatomical location, and the diagnosis date of both the first NMSC and the sNMSC were recorded. Main outcomes assessed were the frequency of developing an sNMSC, the annual probability density and the median sNMSC-free survival through the Kaplan-Meier model. Results A total of 926 patients with a first single NMSC were enrolled and followed up for a median time of 81·9 months. Two hundred and nine patients (22·6%) developed an sNMSC in a median time of 28·3 months. Probability density of a sNMSC ranged from 0·003 to 0·004 for the first 5 years of follow-up. Age ≥ 40 years ( P = 0·02), and first NMSC excised from the limbs ( P = 0·03) were predictors of developing an sNMSC. Conclusions The development of an sNMSC is a common event in patients previously diagnosed with an NMSC especially during the first 5 years of follow-up. This finding should be taken into consideration when designing follow-up guidelines for patients with NMSC. [ABSTRACT FROM AUTHOR]

Background During recent years numerous studies have suggested that personal and environmental factors might influence cancer development. Objectives To investigate environmental and personal characteristics associated with skin cancer risk. Methods A multicentre hospital-based case-control study was performed in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain, including 409 patients with squamous cell carcinoma (SCC), 602 with basal cell carcinoma (BCC) and 360 with cutaneous malignant melanoma (CMM) and 1550 control persons. Exposures were assessed by questionnaires that were partly self-administered, partly completed by dermatologists. Unconditional logistic regression modelling was used to assess associations including the influence of certain drugs and food items on skin cancer risk. Results The usual associations were observed for sun exposure and pigmentation characteristics, with chronic sun exposure being most strongly associated with SCC risk, and naevi and atypical naevi with CMM risk. Use of ciprofloxacin was associated with a decreased risk of BCC [odds ratio (OR) 0·33] and use of thiazide diuretics was associated with an increased risk of SCC (OR 1·66). Ciprofloxacin was also associated with SCC (OR 0·34) and thiazines with BCC (OR 2·04), but these associations lost significance after correction for multiple testing. Consumption of pomegranate, rich in antioxidants, was associated with decreased BCC and SCC risk, also after correcting for multiple testing. Recent experience of stressful events was associated with increased risk, particularly of CMM. Conclusions In this large case-control study from across Europe the expected associations were observed for known risk factors. Some new potential protective factors and potential risk factors were identified for consumption of certain food items, medication use and stress, which deserve further investigation in future studies. [ABSTRACT FROM AUTHOR]

Background A wide variety of both surgical and nonsurgical therapies is currently available for patients with skin cancer. Objectives This part of the EPIDERM (European Prevention Initiative for Dermatological Malignancies) project is aimed at the evaluation of the treatment preferences for skin cancer in eight countries of the European Union. Methods A multicentre hospital-based case-control study was carried out at dermatology departments in Finland, Germany, Greece, Italy, Malta, Poland, Scotland and Spain. Patients with skin cancer (basal cell carcinoma, actinic keratosis, squamous cell carcinoma, cutaneous malignant melanoma and Bowen disease) were consecutively enrolled between July 2008 and July 2010. Information on the study variables (sex, age, country, tumour type, anatomical location and treatment) was obtained from questionnaires designed by the EPIDERM project. Results In total, 1708 patients with skin cancer were included. Surgery was the first treatment option in 76·5% of the patients ( P = 0·001). Actinic keratosis was the only tumour type in which nonsurgical treatment was more frequent than surgery (91·4%). Tumours on the head were less likely to be surgically excised than those at other locations (odds ratio 0·25, P = 0·001). Simple excision or curettage was the most common surgical procedure (65·4%), followed by graft and flaps (22·4%). Cryotherapy was the most common nonsurgical option (52·4%), followed by imiquimod (18·0%), photodynamic therapy (PDT; 12·0%), 5-fluorouracil (5-FU; 5·7%), and diclofenac with hyaluronic acid (4·0%). Conclusions Surgery remains the first-choice treatment of skin cancer. Regarding nonsurgical treatments, the conservative treatments available (imiquimod, 5-FU, PDT and diclofenac gel) have not yet exceeded the use of ablative options such as cryotherapy despite their accepted benefit of treating field cancerization. [ABSTRACT FROM AUTHOR]

Background. Skin-cancer screening should rely on simple, low-cost and high-sensitivity diagnostic procedures. Aims. To compare diagnosis and management options after the evaluation of clinical and dermatoscopic teleconsultations with a store-and-forward teledermatology screening system for pigmented lesions. Methods. Kappa values between telediagnoses and the gold standard (histological examination) were assessed. Referral rates, diagnostic confidence level (DCL), sensitivity and specificity were evaluated in both approaches. Picture quality and time and cost investments were also measured. In total, 61 teleconsultations were evaluated. Results. Sensitivity of the clinical and dermatoscopic teleconsultations was 1 for both, whereas specificities were 0.65 and 0.78, respectively ( P < 0.05). DCL was higher for the dermatoscopic teleconsultations (4.75 vs. 4.14, P < 0.05). Agreement between the clinical and dermatoscopic teleconsultation was κ = 0.89 (95% CI 0.81–0.97). Agreement with the gold standard was 0.91 (95% CI 0.82–1.00) for the clinical teleconsultation and 0.94 (95% CI 0.88–1.00) for teledermatoscopy ( P > 0.05). Teledermatoscopy increased the economic investment of a teledermatology facility by 2.4 times. The GP spent 1.5 times longer on dermatoscopic teleconsultations. Conclusions. Teledermatoscopy has improved the DCL, specificity and referral rates of a teledermatology-based screening system for pigmented lesions. A more detailed economic analysis remains to be performed before recommending teledermatoscopy as a routine screening procedure in pigmented-lesion clinics. [ABSTRACT FROM AUTHOR]