Search

The number of melanomas removed from Australians is increasing. Despite this, it has been reported that the incidence of melanoma is decreasing in the young Australian population. However, the denominator for these estimates includes individuals at low risk of melanoma, and the proportion of such individuals has changed over recent decades due to immigration. In this study, the incidence was calculated for the susceptible young population. Data from the Australian Bureau of Statistics were analysed to determine the number of people younger than 30 years at low risk of developing melanoma in 1982 and 2009. Low risk people were defined as those born in Asia, the Pacific Islands, The Middle East, or Sub-Saharan Africa, or had parents born in these regions. There was a significant increase in the number of young Australians at low risk for melanoma. If these people are not included when calculating the crude rate of melanoma, the rate increased from 5.9 per 100,000 in 1982 to 6.3 in 2009. If the estimated number of young Maoris and young Aborigines is excluded from the susceptible population, the crude rate increased from 6.0 per 100,000 in 1982 to 6.8 in 2009. This is the first calculation of the rate of melanoma for the susceptible young Australian population.

We report the cases of two patients who developed eruptive cutaneous squamous cell carcinomas (SCC) soon after commencement of ustekinumab, as treatment of moderate to severe plaque type psoriasis. Ustekinumab is a human monoclonal antibody with a novel mechanism, selectively targeting the shared p40 subunit of interleukin-12 (IL-12) and IL-23. Its efficacy has been well documented in three large phase-III trials (PHOENIX I, PHEONIX 2, ACCEPT). Safety data on this new biological agent continue to grow. To date, no link between ustekinumab and cutaneous carcinogenesis has been demonstrated and, to our knowledge, these cases are the first of their kind. Importantly, both these patients had independent risk factors for developing non-melanoma skin cancers; however, the specific time correlation with the administration of ustekinumab is of note. Our report suggests that ustekinumab may allow the development of cutaneous carcinomata in predisposed individuals., (© 2012 The Authors. Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.)

Background: Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients., Objectives: To investigate the efficacy and safety of PDT using MAL for BCCs defined as 'difficult to treat', i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications., Methods: This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with 'difficult-to-treat' BCC were treated with MAL PDT, using 160 mg g(-1) cream and 75 J cm(-2) red light (570-670 nm), after lesion preparation and 3 h of cream exposure. Results Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years., Conclusions: MAL PDT is an attractive option for 'difficult-to-treat' BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures.

Background and Objective: To determine the incidence of new skin cancer formation in people who have had a nonmelanoma skin cancer (NMSC) removed., Methods: A prospective study of Australian outpatients with histologically confirmed nonmelanoma skin cancer (NMSC)., Results: Four hundred eighty-one patients were entered in the study and 300 were followed for at least 10 years. Another skin cancer developed in 67.8% and multiple skin cancers (three or more) in 51.8%. A logistical regression analysis found that the main risk factors for new skin cancer formation were male sex and if the patient had multiple skin cancers. A squamous cell carcinoma (SCC) developed in 36% during the study and a melanoma in 4.7% of men and 2.1% of women. Men who had a NMSC were 8 times more likely than the general population to develop a melanoma while women with NMSC were 4 times more likely. Three patients died of metastatic SCC and one of metastatic melanoma during the followup period. A multivariate analysis showed that multiple skin cancer formation was the main risk factor for SCC or melanoma formation., Conclusion: Patients with NMSC require careful followup as they have an increased risk of new cancer formation. Those with multiple skin cancer merit particularly careful followup as all develop another NMSC within 10 years and have a significantly increased risk of developing SCC or melanoma.

Background: Retrospective studies have given conflicting results with respect to how many cutaneous squamous cell carcinomas (SCCs) arise in actinic keratoses (AK)., Objective: This study was conducted to determine what percentage of SCCs arise in AKs and to obtain more information about two histological features of SCCs, namely, thickness and ulceration., Methods: A prospective study was done of all SCCs treated by the authors during one calendar year., Results: Two hundred eight patients with SCC were entered into the study. An AK was contiguous with an SCC in 72% of the cases. This was taken as evidence that the SCC arose in the AK. Men presented with thicker and more ulcerated SCCs than women, but these were not statistically significant: p = 0.06 for thickness and p = 0.07 for ulceration. Ulcerated SCCs were more likely to arise on the head and neck (p = 0.02), on patients who had multiple skin cancers (p = 0.005), and on patients who had a family history of skin cancer (p = 0.03)., Conclusion: Actinic keratoses need to be removed before they turn into SCCs. The prognostic significance of ulceration of cutaneous SCCs needs to be determined.

Recent reports have detected a decrease in the incidence of malignant melanoma (MM) in young Australian women, but an increase in older Australians. The incidence rates were calculated for the entire population and no adjustments were made to take into account the change in the racial composition of the Australian population. In the past 25 years there has been an influx of immigrants from Asia, the Pacific Islands, and the Middle East who are at low risk for MM. The migrants are relatively young and there are more Asian women than men. The large increase in the percentage of the population that has a low risk for MM may be an important reason why the incidence has fallen in some population groups.

Background and Objective: In retrospective studies of non-melanoma skin cancers, the recurrence rates were relatively high. This study had as its aim to determine the recurrence rate of nonmelanoma skin cancer (NMSC) and prospectively, risk factors for recurrence in southern Australia., Study Design: This is a prospective study of outpatients with histologically confirmed NMSC. All patients seen by a dermatologist between November 1988 and November 1989 were entered into the study and followed for at least 3 years. Any recurrent NMSCS were removed and recorded., Results: Four hundred and eighty-one patients were entered and 420 followed for at least 3 years. A recurrent NMSC developed in 8% (adjusted for losses). A multivariate analysis determined that the main risk factor for recurrence within the first 3 years of follow-up was the number of NMSC a patient had when entering into the study. Those with 3 to nine NMSC were five times more likely to develop a recurrence than those with less than three NMSC. Those with 10 or more NMSC were 25 times more likely to develop a recurrence. Age, sex, and types of skin cancers removed were not risk factors within the first 3 years of follow-up., Conclusion: Patients who have had multiple skin cancers require careful follow-up because of the risk of developing recurrences.

Background: Investigations of lymphocyte counts in patients with skin cancer have given conflicting results, possibly because homogeneous groups of patients were not studied., Objective: Our purpose was to measure lymphocyte counts in patients with skin cancer to determine whether any abnormalities were associated with the number of cancers removed and to determine whether a lymphocyte count could identify patients at risk of the development of large numbers of cancers., Methods: Apparently otherwise normal patients who had histologically confirmed skin cancers removed were studied. One group consisted of patients who had one skin cancer removed but had not had another within a minimum of 5 years. The other group consisted of patients who had had three or more skin cancers. Standard flow cytometry was used to determine the total lymphocyte count, CD4 (helper cell) count, and CD8 (cytotoxic cell) count., Results: Ninety-six patients with multiple skin cancers, and 24 with one skin cancer were studied. Only basal cell carcinomas (BCCs) were removed from 84 patients and the results from this homogeneous group were as follows: women had a higher CD4 cell count than men (p < 0.05); patients with 20 or more BCCs had a lower lymphocyte count (p < 0.01); and patients with one BCC had a higher CD4/CD8 ratio than those who had multiple BCCs (p < 0.05)., Conclusion: Differences were found between men and women, as well as between subgroups of patients with skin cancer. However, the range of lymphocyte counts was large and it was not possible to determine a threshold below which patients had a worse prognosis. A lymphocyte count is not a reliable way of predicting which patients will have a large number of skin cancers.

The cell-mediated immunity of patients who had basal cell carcinomas (BCCs) removed was studied by measuring cuntaneous delayed hypersensitivity reactions to recall antigens (Multitest CMI, Pasteur-Merieux), and by measuring lymphocyte counts and subsets. One group of patients had multiple BCCs (3 or more) removed and were considered to have a high risk of new BCC formation. The other group consisted of patients who had one BCC and had not developed another within 5 years; these were considered to have a low risk of new BCC formation. The low-risk patients had significantly larger cutaneous reactions to recall antigens (p < 0.05) and significantly fewer were anergic (p < 0.01). There was a correlation between smaller cutaneous reactions and increasing numbers of BCCs (p < 0.05). There was no significant difference between the groups in lymphocyte counts or subsets, but the low-risk patients had a significantly higher CD4:CD8 ratio (p < 0.05) than the high-risk group. The Multitest CMI test can be used to determine which patients are at risk of developing many BCCs.

Background: Investigations of the immune status of patients with skin cancer have had conflicting results, possibly because uniform groups of patients were not studied. Patients who had multiple skin cancers (three or more) were studied to determine whether they had impaired cell-mediated immunity (CMI)., Methods: Thirty-four patients and 34 matched control subjects were studied who were younger than 60 years, were not immunosuppressed, and were free from internal cancer. Cell-mediated immunity was tested by the cutaneous reaction to recall antigens (Multitest CMI, Pasteur Merieux, Lyon, France) and the estimation of lymphocyte levels., Results: Patients had significantly lower Multitest CMI scores (P < 0.0005), lower lymphocyte counts (P < 0.02), and were more likely to have a first-degree relative with skin cancer (P < 0.002). Multitest CMI scores decreased with the number of skin cancers removed (P < 0.0006) and were a significant predictor for CD4 (P < 0.04) and CD8 cell counts (P < 0.02)., Conclusions: Patients who had multiple skin cancers had impaired CMI, and the degree of impairment correlated with the number of skin cancers removed.

Background: Nonmelanoma skin cancer (NMSC) is increasing in incidence and more are developing on the trunk and limbs. The objectives were to determine how many outpatients have more than one NMSC at the time they present for treatment and to determine the anatomical distribution of the cancers., Methods: All outpatients with histologically confirmed NMSC visited by the authors during 1992 received a total body examination and the number and sites of NMSC were recorded., Results: A total of 952 outpatients were seen. A single NMSC was present in 69.4%, two in 16%, three in 6.4%, four in 3.5%, five to nine in 4.2%, and 0.5% had ten or more. Of the 291 patients with more than one NMSC, one anatomical region was involved in 53.4%, two were involved in 38.4%, and 8.2% had three or more regions involved., Conclusion: Patients with NMSC required a total body examination to detect unsuspected skin cancers.

Objective: To determine the incidence of new skin cancer formation in people who have had skin cancer removed., Study Design: A prospective study of Melbourne out-patients with histologically confirmed non-melanoma skin cancer (NMSC). All patients with NMSC seen by one author (D.C.) between November 1988 and November 1989 were entered into the study and reviewed regularly. New skin cancers were removed and recorded., Results: Four hundred and eighty-one patients were entered and 420 followed for at least 3 years. New NMSC developed in 60% (adjusted for losses) by the end of 3 years. A multivariate analysis determined that the main risk factor for new NMSC formation was the number of previous skin cancers that a patient had. Those who had had multiple skin cancers (3 or more) were at significantly greater risk than those with less than 3. Age, sex and type of NMSC were not risk factors for new skin cancer formation., Conclusion: Patients with NMSC require long-term follow-up because of the risk of new skin cancer formation. Those with multiple NMSC need more careful follow-up, and possibly more frequent examinations, because they are at greater risk.

HLA DR frequencies of patients with multiple non-melanoma skin cancers were analysed. There were significant differences in the frequencies of HLA DR1, DR4 and DR7 between patients who only had basal cell carcinomas and patients who had both basal and squamous cell carcinomas. There were significant differences in the frequency of HLA DR53 between the two groups. This antigen is in linkage disequilibrium with HLA DR4 and DR7, and it is not possible to distinguish the primary susceptibility locus.

Background: The frequency with which squamous cell carcinoma (SCC) of the skin metastasizes is a matter of dispute. Studies from private practices have reported much lower rates than hospital-based surveys, and one school of thought is that SCCs which arise in sun-damaged skin have a low risk of metastasis., Methods: A prospective study of out-patients with histologically confirmed SCC was undertaken in southern Australia, a region with a very high incidence of skin cancer., Results: Between November 1988 and November 1989, 481 patients were entered into the study and 420 followed for at least 3 years. An SCC was the initial diagnosis for 73 patients, 3 were immunosuppressed and 2 had an SCC of the lip, leaving 68 immunocompetent patients with SCC of the skin. Metastatic SCC developed in 2 patients (5.8% adjusted for losses) within 3 years. The SCCs were small and arose in sun-damaged skin., Conclusion: Patients with SCC of the skin need a careful follow-up because of the risk of metastasis.

An association between HLA DR4 and the development of multiple basal cell carcinomas (BCC) and malignant melanoma (MM) was detected in southern Australia. There were highly significant differences in HLA DR frequencies between patients with multiple BCCs and MM and matched patients with multiple BCCs only. These findings suggest that hereditary factors associated with the HLA system influence what types of multiple skin cancers people develop.

No association between HLA DR1 and the development of multiple basal cell carcinomas (BCC) was found among patients who had lived at least two-thirds of their lives in the tropics. The percentage of patients with multiple BCCs increased with age; this was different from what has been found in people living in the temperate zone of Australia.

Squamous cell carcinoma (scc) of the skin was studied in two similar populations, one living in the temperate zone of Australia, the other living in the tropics. In the tropics, the patients were significantly younger, the man to woman ratio approached unity, and women had significantly more sccs on the legs. In the temperate zone, men had significantly more on the head and neck, but women had significantly more on the upper and lower limbs.

A survey of patients with histologically confirmed nonmelanoma skin cancer (NMSC) found 12 families in which several members developed skin cancers. The prevalence of NMSC in these families was far greater than in the normal population. The trait appeared to be dominantly inherited, and NMSC developed at an earlier age in succeeding generations, possibly because of a change in sun exposure habits.

A survey of people with skin cancer in tropical Australia detected a change in site of the prevalent cancer. In the post-war generation more basal cell carcinomas are occurring on the back and fewer on the head and neck. A reversal of the sex ratio was also detected, with more women being afflicted.

Background: HLA-DR1 is associated with the development of multiple basal cell carcinomas (BCC). However, the association is weak., Objective: The purpose of our study was to determine whether HLA-DR1 is a marker for susceptibility to the development of many BCCs during a lifetime., Methods: Persons with multiple BCCs were placed into two groups: those with less than 10 and those with 20 or more. In addition, the HLA-DR1 frequencies were analyzed., Results: HLA-DR1 was associated with multiple BCCs in the group with less than 10 BCCs but not with the other group. These patients were significantly younger on average than those with 20 or more BCCs., Conclusion: HLA-DR1 is associated with the development of multiple BCCs at an early age but it is not associated with development of large numbers of BCCs. The amount of UV light a person receives appears to be more important.

The clinical features of patients with basal-cell carcinoma (BCC) living in temperate and tropical Australia were studied. In the temperate zone the patients were considerably older on average, men outnumbered women and there were differences between the sexes in the site of the prevalent BCC. In the tropics the patients were significantly younger on average, the male-to-female ratio approached unity and there were no differences between the sexes with regard to the site of the BCC.

An association between HLA DR7 and the development of multiple non-melanoma skin cancer was detected in immunosuppressed patients in southern Australia. The relative risk was 2.6 which was lower than for immunocompetent patients with the same skin cancers. HLA frequencies of renal transplant recipients with multiple skin cancers were determined. The types HLA B27 and HLA Dr7 were found in significantly higher frequency, and there was no absence of HLA A11.

A survey of patients with basal cell carcinomas (BCCs) revealed that major changes have occurred since the World War II. In the pre-World War II generations, men out-number women and most BCCs occur on the head and neck. Men had more BCCs on the ear and trunk, while women had more on the head and leg. In the post-World War II generation, women outnumbered men and most BCCs occurred on the trunk.

An association between HLA-DR1 and the development of multiple basal cell carcinomas was detected in southern Australia. A reduction in HLA-DR4 was found in patients with basal cell carcinoma compared with a local control group. The relative risk for HLA-DR1 was 2.1, which was lower than that for persons in farther countries from the equator.

Presumed skin cancers were excised from 46 consecutive outpatients without antibiotic cover. A purulent wound developed in ten patients. Similar, but contaminated lesions were excised from 40 patients, but mupirocin ointment was used before surgery. Not one purulent wound developed out of 45 excisions.