Examining the pathways linking lower socioeconomic status and advanced melanoma

BACKGROUND. Low socioeconomic status (SES) is associated with more advanced melanoma at diagnosis and decreased survival. Exploring the pathways linking lower SES and thicker melanoma will help guide public and professional strategies to reduce deaths. METHODS. The authors surveyed 566 newly diagnosed patients at Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System, and University of Michigan. SES was assessed by education level (high school/general education degree or less [HS], associate/technical school degree, or ≥college graduate). All data was obtained by self‐report among patients within three months of their diagnosis. RESULTS. HS‐educated individuals were significantly more likely than college graduates to believe that melanoma was not very serious (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.79‐4.71) and were less likely to know the asymmetry, borders (irregular), color (variegated), and diameter (>6 mm) (ABCD) melanoma rule or the difference between melanoma and ordinary skin growths (OR, 0.34 [95% CI, 0.23‐0.52] and 0.26 [95% CI, 0.16‐0.41] respectively). Physicians were less likely to have ever told HS‐educated versus college‐educated individuals they were at risk for skin cancer (OR, 0.46; 95% CI, 0.31‐0.71) or instructed them on how to examine their skin for signs of melanoma (OR, 0.40; 95% CI, 0.25‐0.63). HS‐educated individuals were less likely to have received a physician skin examination within the year before diagnosis (OR, 0.54; 95% CI, 0.37‐0.80). CONCLUSIONS. Decreased melanoma risk perception and knowledge among low‐SES individuals and decreased physician communication regarding skin examinations of these individuals may be key components of the consistently observed socioeconomic gradient in mortality. The current findings suggest the need to raise melanoma awareness among lower‐SES patients and to increase physician awareness of socioeconomic disparities in clinical communication and care. Cancer 2012. © 2011 American Cancer Society. The authors examined several potential pathways that may play a role in the previously described socioeconomic disparity in melanoma stage at diagnosis and survival. Less educated melanoma patients have little awareness of the risks of melanoma and less basic knowledge about melanoma detection, and they receive less physician communication about melanoma risk factors and screening and fewer physician skin examinations than more educated patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92359/1/26706_ftp.pd

Frontiers in Pigment Cell and Melanoma Research

We identify emerging frontiers in clinical and basic research of melanocyte biology and its associated biomedical disciplines. We describe challenges and opportunities in clinical and basic research of normal and diseased melanocytes that impact current approaches to research in melanoma and the dermatological sciences. We focus on four themes: (1) clinical melanoma research, (2) basic melanoma research, (3) clinical dermatology, and (4) basic pigment cell research, with the goal of outlining current highlights, challenges, and frontiers associated with pigmentation and melanocyte biology. Significantly, this document encapsulates important advances in melanocyte and melanoma research including emerging frontiers in melanoma immunotherapy, medical and surgical oncology, dermatology, vitiligo, albinism, genomics and systems biology, epidemiology, pigment biophysics and chemistry, and evolution

Morphometric characteristics of basal cell carcinoma peritumoral stroma varies among basal cell carcinoma subtypes

<p>Abstract</p> <p>Background</p> <p>The role that the peritumoral stroma plays in the growth of tumours is currently poorly understood. In this manuscript the morphometric characteristics of basal cell carcinoma subtypes and their associated peritumoral stromas are presented.</p> <p>Methods</p> <p>Ninety eight digitized basal cell carcinoma histology slides were categorized as infiltrative, nodular, or superficial subtypes, and were analysed using a combination of manual and computer-assisted approaches. The morphometric characteristics of the tumour nests and their associated peritumoral stroma were quantified, and the presence of a marked immune reaction or elastosis was noted.</p> <p>Results</p> <p>The tumour to stroma ratio was different among each tumour subtype. Elastosis was identified in a greater proportion of the infiltrative tumours.</p> <p>Conclusions</p> <p>Quantitative differences exist between the peritumoral stroma of basal cell carcinoma subtypes. Future work exploring the relation between these morphometric differences and biochemical variations in peritumoral stroma may further our understanding of the biology of carcinoma development.</p> <p>Trial Registration</p> <p>Not applicable.</p

Interstitial mycosis fungoides, a variant of mycosis fungoides resembling granuloma annulare and inflammatory morphea *

Interstitial mycosis fungoides (IMF) is a rare variant of mycosis fungoides that resembles the interstitial form of granuloma annulare and inflammatory morphea. IMF has received little attention in the literature. Methods:   Clinical, histological, immunophenotypical, and genotypical findings of five cases of IMF were reviewed. The histological and immunophenotypical findings were compared with those of eight cases of interstitial granuloma annulare and six cases of inflammatory morphea. Results:   Five patients with IMF presented with non-indurated, erythematous macules; ill-defined erythematous plaques with slight scale; and nodules on the trunk and proximal limbs. Two of five patients had a prior diagnosis of mycosis fungoides. Skin biopsies revealed a striking dermal interstitial infiltrate of lymphocytes with rare histiocytes that resembled the interstitial form of granuloma annulare or inflammatory morphea. Epidermotropic lymphocytes were present at least focally in all cases. A band-like lymphocytic infiltrate was observed in two of five cases. In contrast, many plasma cells and histiocytes were observed in cases of inflammatory morphea and interstitial granuloma annulare, respectively. With Movat-pentachrome stains, increased dermal mucin deposition was observed in two of five IMF cases, in all cases of interstitial granuloma annulare, and in one of six cases of inflammatory morphea. There was focal loss of elastic fibers in all cases of inflammatory morphea. Immunohistochemical studies of IMF highlighted a dominant population of T cells (CD3+) in the dermis and epidermis. In contrast, moderate numbers of B cells (CD20+) were admixed with T cells and plasma cells in inflammatory morphea. Almost equal numbers of histiocytes (CD68+) and T cells comprised the infiltrate of interstitial granuloma annulare. In two of five IMF cases, a clonal T-cell population was detected by PCR T-cell gamma gene rearrangement analysis. Conclusion:   Mycosis fungoides occasionally presents as an interstitial lymphocytic infiltrate that mimics granuloma annulare and inflammatory morphea. Hematoxylin & eosin (H&E) findings alone can sometimes distinguish the three disorders. Immunophenotyping and genotyping may be helpful in difficult cases. Su LD, Kim YH, LeBoit PE, Swetter SM, Kohler S. Interstitial mycosis fungoides, a variant of mycosis fungoides resembling granuloma annulare and inflammatory morphea. J Cutan Pathol 2002; 29: 135–141. © Blackwell Munksgaard 2002.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72026/1/j.1600-0560.2002.290302.x.pd

Pediatric melanoma: Analysis of an international registry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101810/1/cncr28289.pd

Increased FDG avidity in lymphoid tissue associated with response to combined immune checkpoint blockade

BACKGROUND: Antibodies against programmed death 1 (PD-1) receptor and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) have transformed the systemic treatment of melanoma and many other cancers. Understanding the spectrum of benign findings and atypical response patterns seen in immune checkpoint blockade is important for accurately assessing treatment response as these immunotherapies become more widely used. CASE PRESENTATION: We report a 63-year-old man with metastatic melanoma successfully treated with combination CTLA-4 and PD-1 blockade (ipilimumab and nivolumab), after non-response to pembrolizumab monotherapy. The initial impression of disease progression, based on cutaneous and PET/CT findings of increased fluoro-2-deoxy-D-glucose (FDG) uptake in benign lymphoid tissue, proved to be erroneous after assiduous review of radiographic imaging and correlative pathology. CONCLUSIONS: These findings indicate that increased FDG uptake in benign lymphoid tissue seen on PET/CT may be a surrogate marker of immune activation and treatment response. Prospective studies will be invaluable in validating immune-related radiographic findings as a prognostic biomarker of response in cancer patients being treated with immune checkpoint blockade

Melanoma incidence and mortality in Scotland 1979–2003

We studied 12 450 cases of invasive melanoma diagnosed in Scotland in 1979–2003, by thickness, pathological type, and body site at ages under 40, 40–59, and 60 years and over. Melanoma incidence trebled in males from 3.57 to 10.93/105 per year, and increased 2.3-fold in females from 5.60 to 12.96/105 per year. The rate of increase fell in each successive 5-year period. The greatest increase was in males aged 60 years and over at diagnosis. Significant incidence increases were seen in melanomas <1 mm in all three age groups, but those >4 mm only increased significantly at ages 60 years and over. All histological types increased significantly at ages 60 years and over, and in this age group the greatest increase was seen on the head and neck. Five-year disease-free survival improved steadily. Survival figures for 1994–1998 ranged from 93.6% for males and 95.8% for females with tumours <1 mm, to 52.4 and 48.3%, respectively, for those with tumours >4 mm. Over the 25 years, melanoma mortality doubled in males from 1.1 to 2.4/105 per year, but was unchanged in females at 1.5/105 per year. Public education on melanoma is required both for primary prevention and earlier diagnosis, particularly for older males

Behavioral determinants of successful early melanoma detection

BACKGROUND. Reduced melanoma mortality should result from an improved understanding of modifiable factors related to early detection. The authors of this report surveyed newly diagnosed patients to identify differences in prediagnosis behavioral and medical care factors associated with thinner versus thicker melanoma. METHODS. In total, 566 adults with invasive melanoma completed questionnaires within 3 months of diagnosis on demographics, health care access, skin self‐examination (SSE), and physician skin examination (PSE) practices in the year before diagnosis. SSE was measured by us e of a melanoma picture aid and routine examination of some/all body sites versus none. Patient‐reported partial or full‐body PSE also was assessed. Melanoma thickness was dichotomized at 1 mm. RESULTS. Patient ranged in age from 18 years to 99 years, and 61% were men. The median tumor thickness was 1.25 mm, and 321 tumors (57%) were >1 mm thick. Thinner tumors (≤1 mm) were associated with age ≤60 years ( P = .0002), women ( P = .0127), higher education level ( P = .0122), and physician discovery ( P ≤ .0001). Patients who used a melanoma picture aid and performed routine SSE were more likely to have thinner tumors than those who did not (odds ratio [OR], 2.66; 95% confidence interval [CI], 1.48‐4.80). Full‐body PSE was associated with thinner tumors (OR, 2.51; 95% CI, 1.62‐3.87), largely because of the effect of PSE in men aged >60 years (OR, 4.09 95% CI, 1.88‐8.89). CONCLUSIONS. SSE and PSE were identified as complementary early detection strategies, particularly in men aged >60 years, in whom both partial and full‐body PSE were associated with thinner tumors. Given the high rates of physician access, PSE may be a more practical approach for successful early detection in this subgroup with highest mortality. Cancer 2012. © 2011 American Cancer Society. Physician skin examination (PSE) in the year before melanoma diagnosis is strongly associated with thinner tumors in men aged >60 years. Improving rates of PSE in this high‐risk group is likely to result in earlier detection of melanoma.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92369/1/26707_ftp.pd