Incidence and Survival for Merkel Cell Carcinoma in Queensland, Australia, 1993-2010

Importance: Merkel cell carcinoma (MCC) is an uncommon but highly invasive form of skin cancer. The mechanisms that cause MCC are yet to be fully determined. Objectives To compare the incidence and survival rates of MCC in Queensland, Australia, known to be a high-risk area, with MCC incidence and survival elsewhere in the world. We also analyzed incidence trends and differences in survival by key demographic and clinical characteristics. Design, Setting, and Participants: Retrospective cohort study of population-based administrative data for MCC collected by the Queensland Cancer Registry and supplemented with detailed histopathologic data. Deidentified records were obtained of all Queensland residents diagnosed as having MCC during the period from 1993 to 2010. A subsample of histopathologic records were reviewed by a senior dermatopathologist to determine the potential for misclassification. A total of 879 eligible cases of MCC were included in the study. Main Outcomes and Measures: Incidence rates were directly age standardized to the 2000 United States Standard Population. Trends were examined using Joinpoint software with results expressed in terms of the annual percentage change. The period method was used to calculate 5-year relative survival, and adjusted hazard ratios were obtained from multivariate Poisson models.Results: There were 340 cases of MCC diagnosed in Queensland between 2006 and 2010, corresponding to an incidence rate of 1.6 per 100 000 population. Men (2.5 per 100 000) had higher incidence than women (0.9 per 100 000), and rates peaked at 20.7 per 100 000 for persons 80 years or older. The overall incidence of MCC increased by an average of 2.6% per year from 1993 onwards. Relative survival was 41% after 5 years, with significantly better survival found for those younger than 70 years at diagnosis (56%-60%), those with tumors on the face or ears (51%), and those with stage I lesions (49%). Conclusions and Relevance: Incidence rates for MCC in Queensland are at least double those of any that have been previously published elsewhere in the world. It is likely that Queensland’s combination of a predominantly white population, outdoor lifestyle, and exposure to sunlight has played a role in this unwanted result. Interventions are required to increase awareness of MCC among clinicians and the public

Personalised electronic messages to improve sun protection in young adults

The incidence of all skin cancers, including melanoma, continues to rise. It is well known that ultraviolet (UV) radiation is the main environmental risk factor for skin cancer, and excessive exposure at a young age increases the risk of developing skin cancer. The aim of this study was to determine the acceptability and feasibility of delivering sun protection messages via electronic media such as short message services (SMS) to people 18-40 years, and explore factors associated with their acceptability. Overall, 80% of participants agreed that they would like to receive some form of sun protection advice; of these, 20% prefer to receive it via SMS and 42% via email. Willingness to receive electronic messages about the UV index was associated with being unsure about whether a suntanned person would look healthy and greater use of sun protection in the past. Careful attention to message framing and timing of message delivery and focus on short-term effects of sun exposure such as sunburn and skin ageing should increase the acceptability of such messages to young people. We conclude that sun protection messages delivered to young adults via electronic media appear feasible and acceptable

Teledermatological monitoring of leg ulcers in cooperation with home care nurses

Objectives: To examine the feasibility and acceptance of teledermatology for wound management for patients with leg ulcers by home care nurses and evaluate the reduction of costs and the acceptance of teledermatology by patients and home care nurses

The use of mobile phones for skin tumor screening

A lot of importance is attributed to mobile telemedicine these days, a topic that encompasses a wide and ever growing range of applications. Small, handheld devices such as camera mobile phones have come into every day use providing technically sophisticated tasks on a user-friendly level and can therefore be easily used in various fields of telemedicine. Dermatology is a perfect candidate for the use of telemedicine tools in general, as well as mobile devices in particular. The unique aspect of mobile teledermatology is that this system represents a filtering, or triage system, allowing a sensitive approach for the management of patients with emergent skin diseases. In order to investigate the feasibility of teleconsultation using a new generation of cellular phones, a clinical study to evaluate the accuracy of online diagnosis of skin tumours was conducted. Teledermoscopy represents a recent development of teledermatology that might add up additional information in the diagnosis of pigmented skin lesions. Teledermatology, mobile as well as stationary, can advance the reliability of diagnosis by expert consultations without expensive and time-consuming relocations. Consequently, the quality of patient's care can be raised and the costs of the health care system can be reduced

Consumer acceptance of patient-performed mobile teledermoscopy for the early detection of melanoma

Background Mobile teledermoscopy allows consumers to send images of skin lesions to a teledermatologist for remote diagnosis. Currently, technology acceptance of mobile teledermoscopy by people at high risk of melanoma is unknown. Objectives We aimed to determine the acceptance of mobile teledermoscopy by consumers based on perceived usefulness, ease of use, compatibility, attitude/intention, subjective norms, facilitators and trust before use. Consumer satisfaction was explored after use

Three roots of melanoma

Segura et al1 describe morphologic features of melanomas with a nodular component using in vivo reflectance-mode confocal microscopy (RCM) and correlate these RCM findings with histopathologic findings. The most striking observation made by the investigators is the remarkable difference in epidermal involvement between nodular melanoma (NM) and superficial spreading melanoma (SSM) with a nodular component. At RCM, SSMs frequently showed epidermal disarrangement and pagetoid infiltration, whereas NMs exhibited a preserved epidermal pattern and few pagetoid cells.1 This new observation provides fertile ground for revisiting the conventional concept of melanoma development. We propose an alternative hypothesis based on recent observations made in stem cell research and demonstrate how this hypothesis can better account for the observed clinical and epidemiologic differences between melanoma subtypes

Pregnancy as driver for melanoma

Whether or not pregnancy favours the occurrence and growth of melanoma is a source of controversy in the literature. Several case reports have shown dramatic courses of diseases in pregnancy. We present a case of a 36-year-old woman with multiple naevi with one melanoma detected in 2009 in the first trimester and a second primary melanoma in 2010 in the third trimester of her pregnancy. Both lesions have been present for at least 5 years and have been interpreted as dysplastic naevi. Because of their growth during pregnancy they were removed. No metastatic disease has been found between 2010 and early 2016. This case shows the difficulty of detecting melanomas in pregnancy, particularly when they mimic dysplastic naevi in women with multiple naevi, who are at higher risk. Therefore, we suggest that pregnant women with numerous naevi should be precautious of any changes of their naevi in size, shape and colour. Every suspicious lesion should be either excised or documented/monitored carefully, e.g. with sequential digital dermoscopy imaging