A Growing Melanoma Mortality Epidemic Among White Men Ages ≥50: Opportunities For An Education And Early Detection Program

The overall melanoma mortality rate amongst whites (the population overwhelmingly affected by melanoma) has remained deceptively stable during the past 30 years. Population-based screening is one potential strategy for reducing melanoma mortality. We evaluated the need for a primary care (PCP)-based melanoma early detection program targeting those at greatest risk of melanoma death. Using Surveillance, Epidemiology and End Results (SEER) data, we collected detailed U.S. melanoma incidence and mortality rates. We analyzed health care utilization data from the National Ambulatory Care Medical Survey (NAMCS) and Medical Expenditure Panel Survey (MEPS) to explore opportunities to reduce mortality. We reviewed screening studies and mass media healthcare campaigns to identify necessary components for an early detection initiative. From 1983 to 2013, melanoma incidence rates more than tripled and mortality rates increased 57% among white men ≥50. White men diagnosed at age ≥50 made up 56% of all fatal melanoma cases from 2009-2013. The sharpest increase in mortality rates in men occurred around 50 years of age from all tumor thickness categories. Of the 38 million white men in the U.S aged ≥50, approximately 26 million made 76 million visits to a PCP in 2014. Recent skin cancer screening initiatives demonstrate improvements in early detection. This data suggests that there is an urgent need and ample evidence to initiate targeted melanoma screening programs in white men aged 50 and older

Pregnancy and Melanoma: Recommendations for Clinical Scenarios

Managing pregnant patients with a history of melanoma or with a melanoma diagnosis can be daunting and confusing for dermatologists. We present three clinical scenarios that raise questions about the safety of pregnancy in patients with a history of melanoma, skin biopsies during pregnancy, and excisions and sentinel lymph node biopsies during pregnancy. Our recommendations incorporate the most up-to-date clinical data to help guide clinicians when faced with pigmented lesions and melanoma in a pregnant patient

Botulinum toxin for treatment of Raynaud phenomenon in CREST syndrome

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is a form of a rare, clinical subtype of systemic sclerosis, known as limited systemic sclerosis. Limited systemic sclerosis, including CREST syndrome, manifests as fibrotic skin changes restricted to the hands and face, with vascular, musculoskeletal, and visceral involvement. We present a case of a 75-year-old woman with a longstanding history of CREST syndrome complicated by a digital ulceration and persistent pain associated with recalcitrant Raynaud phenomenon. After failing a number of first-line pharmacologic therapies such as diltiazem, sildenafil, and topical nitropaste, the patient was started on a trial of botulinum toxin for the left second digit, with 10 unit injections into both webspaces for a total of 20 units. Following injection, the patient reported no further baseline pain in the affected finger and an over fifty-percent improvement in discomfort with manipulation of the digit at a follow-up time of one week. The ulceration started healing within the following three weeks. This result was maintained at a follow-up time of six weeks

Botulinum toxin for treatment of Raynaud phenomenon in CREST syndrome

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is a form of a rare, clinical subtype of systemic sclerosis, known as limited systemic sclerosis. Limited systemic sclerosis, including CREST syndrome, manifests as fibrotic skin changes restricted to the hands and face, with vascular, musculoskeletal, and visceral involvement. We present a case of a 75-year-old woman with a longstanding history of CREST syndrome complicated by a digital ulceration and persistent pain associated with recalcitrant Raynaud phenomenon. After failing a number of first-line pharmacologic therapies such as diltiazem, sildenafil, and topical nitropaste, the patient was started on a trial of botulinum toxin for the left second digit, with 10 unit injections into both webspaces for a total of 20 units. Following injection, the patient reported no further baseline pain in the affected finger and an over fifty-percent improvement in discomfort with manipulation of the digit at a follow-up time of one week. The ulceration started healing within the following three weeks. This result was maintained at a follow-up time of six weeks