Melanoma

Despite the documented increased use of sunscreen and protective clothing in recent years, up to 66% of young adults are still getting sunburned at least once a year.

The use of tanning beds also continues, according to the May 11 issue of the Morbidity and Mortality Report. A review of the National Health Information Survey found that up to 44% of women in the subgroup analysis reported using the devices in 2010, and that those who tan indoors do so up to 28 times each year. Even people with a family history of skin cancer or with recent sunburns are using the devices, said Anne Hartman, a biostatistician with the National Cancer Institute.

Photo credit: Yuri Arcurs/Fotolia.com

The findings are worrisome on a number of levels, said Dr. Daniel M. Siegel, president of the American Academy of Dermatology.

"It is distressing that the study found tanning bed use is higher in those with a family history of skin cancer and that sunburn prevalence remains high," he said in an interview. "This emphasizes how important it is to educate the public and encourage them to change their behaviors as they do not necessarily understand the dangers of sun exposure and indoor tanning. If they do, the risks may not be discouraging the behavior."

The sun protection study extracted data from 5 years of the National Health Interview Survey (NHIS). The survey includes detailed questions on sun exposure, the use of sunscreens and protective clothing, and other sun-protective behaviors from the 2000-2010 surveys (MMWR Morb. Mortal. Wkly. Rep. 2012;61:317-22).

Overall, 50% of respondents reported at least one sunburn during the past 12 months. This was highest among whites (66% in 2010) and lowest among blacks (11% in 2010). A similar number of men and women reported getting sunburned, and the prevalence of burning did not differ from 2000 to 2010 (about 50% each year).

Women were most likely to report sunscreen use and staying in the shade (37% and 35%, respectively). Sunscreen use increased significantly from 2000 to 2010, as did the use of clothing to the ankles (21% in 2000 and 26% in 2010). There were also significant increases in the practice of seeking shade (29% and 35%, respectively). However, there were no significant increases in the use of wide-brimmed hats or long-sleeved shirts.

White women were more likely to report shade use, with a significant increase each year. Black women were least likely to report using sunscreens each year.

Men most often reported using long clothing and staying in the shade (33% and 26%, respectively). Shade use among men increased from 18% in 2000 to 26% in 2010. Long protective clothing use increased from 28% to 33%, but changes in sunscreen use were not significant over that time, nor were changes in wearing a long-sleeved shirt or wide-brimmed hat.

Clinicians and policy-makers can help improve these behaviors by continuing to stress the importance of sun protection, Ms. Hartman said. "Evidence from a recent review by the U.S. Preventive Services Task Force suggests that behavioral counseling can increase sun protective behaviors, particularly among persons aged 10-24 years. Additionally, environmental and policy changes (for example, the provision of shade and sunscreen in recreational setting) could be promising strategies for creating social and physical environments that routinely promote sun protection for younger adults and persons of all ages" (Ann. Intern. Med. 2012 May 8 [Epub ahead of print]).

The indoor tanning study used NHIS data from 2010 and included information from 25,233 respondents aged 18 years and older.

Overall, 6% of respondents reported indoor tanning in the past 12 months, reported Ms. Hartman. Tanning was most common among young adults, with 12% of those aged 18-25 years and 9% of those aged 26-29 years using it.

A total of 9% of those with a family history of skin cancer reported indoor tanning, as did 8% of those who had a sunburn within the past 12 months. The associations with cancer and sunburn suggest that many people still don’t understand the dangers of indoor tanning, Ms. Hartman said.

Tanning was also related to socioeconomic status; 7% of those with some college or technical school and 7% of those with an income of more than 200% of the federal poverty level reporting indoor tanning.

The highest rates were in white women aged 18-21 years (32%), particularly those from the Midwest (44%). A total of 36% of Southern women aged 22-25 years also reported indoor tanning.

When white women did tan inside, they did so frequently, the report found. Overall, women reported an average of 20 times per year, with 58% reporting that they tanned 10 or more times per year. White women aged 18-21 years had the highest frequency of tanning (28 sessions per year), with 68% reporting a frequency of 10 or more times per year.

The findings from both studies suggest the need for even more education about sun protective behaviors, Dr. Marcus Plescia said in a press statement.

"More public health efforts, including providing shade and sunscreen in recreational settings, are needed to raise awareness of the importance of sun protection and sunburn prevention to reduce the burden of skin cancer," said Dr. Plescia, director of cancer prevention and control at the Centers for Disease Control and Prevention. "We must accelerate our efforts to educate young adults about the dangers of indoor tanning."

Ms. Hartman, Dr. Siegel, and Dr. Plescia have no relevant financial disclosures.

Despite the documented increased use of sunscreen and protective clothing in recent years, up to 66% of young adults are still getting sunburned at least once a year.

The use of tanning beds also continues, according to the May 11 issue of the Morbidity and Mortality Report. A review of the National Health Information Survey found that up to 44% of women in the subgroup analysis reported using the devices in 2010, and that those who tan indoors do so up to 28 times each year. Even people with a family history of skin cancer or with recent sunburns are using the devices, said Anne Hartman, a biostatistician with the National Cancer Institute.

Photo credit: Yuri Arcurs/Fotolia.com

The findings are worrisome on a number of levels, said Dr. Daniel M. Siegel, president of the American Academy of Dermatology.

"It is distressing that the study found tanning bed use is higher in those with a family history of skin cancer and that sunburn prevalence remains high," he said in an interview. "This emphasizes how important it is to educate the public and encourage them to change their behaviors as they do not necessarily understand the dangers of sun exposure and indoor tanning. If they do, the risks may not be discouraging the behavior."

The sun protection study extracted data from 5 years of the National Health Interview Survey (NHIS). The survey includes detailed questions on sun exposure, the use of sunscreens and protective clothing, and other sun-protective behaviors from the 2000-2010 surveys (MMWR Morb. Mortal. Wkly. Rep. 2012;61:317-22).

Overall, 50% of respondents reported at least one sunburn during the past 12 months. This was highest among whites (66% in 2010) and lowest among blacks (11% in 2010). A similar number of men and women reported getting sunburned, and the prevalence of burning did not differ from 2000 to 2010 (about 50% each year).

Women were most likely to report sunscreen use and staying in the shade (37% and 35%, respectively). Sunscreen use increased significantly from 2000 to 2010, as did the use of clothing to the ankles (21% in 2000 and 26% in 2010). There were also significant increases in the practice of seeking shade (29% and 35%, respectively). However, there were no significant increases in the use of wide-brimmed hats or long-sleeved shirts.

White women were more likely to report shade use, with a significant increase each year. Black women were least likely to report using sunscreens each year.

Men most often reported using long clothing and staying in the shade (33% and 26%, respectively). Shade use among men increased from 18% in 2000 to 26% in 2010. Long protective clothing use increased from 28% to 33%, but changes in sunscreen use were not significant over that time, nor were changes in wearing a long-sleeved shirt or wide-brimmed hat.

Clinicians and policy-makers can help improve these behaviors by continuing to stress the importance of sun protection, Ms. Hartman said. "Evidence from a recent review by the U.S. Preventive Services Task Force suggests that behavioral counseling can increase sun protective behaviors, particularly among persons aged 10-24 years. Additionally, environmental and policy changes (for example, the provision of shade and sunscreen in recreational setting) could be promising strategies for creating social and physical environments that routinely promote sun protection for younger adults and persons of all ages" (Ann. Intern. Med. 2012 May 8 [Epub ahead of print]).

The indoor tanning study used NHIS data from 2010 and included information from 25,233 respondents aged 18 years and older.

Overall, 6% of respondents reported indoor tanning in the past 12 months, reported Ms. Hartman. Tanning was most common among young adults, with 12% of those aged 18-25 years and 9% of those aged 26-29 years using it.

A total of 9% of those with a family history of skin cancer reported indoor tanning, as did 8% of those who had a sunburn within the past 12 months. The associations with cancer and sunburn suggest that many people still don’t understand the dangers of indoor tanning, Ms. Hartman said.

Tanning was also related to socioeconomic status; 7% of those with some college or technical school and 7% of those with an income of more than 200% of the federal poverty level reporting indoor tanning.

The highest rates were in white women aged 18-21 years (32%), particularly those from the Midwest (44%). A total of 36% of Southern women aged 22-25 years also reported indoor tanning.

When white women did tan inside, they did so frequently, the report found. Overall, women reported an average of 20 times per year, with 58% reporting that they tanned 10 or more times per year. White women aged 18-21 years had the highest frequency of tanning (28 sessions per year), with 68% reporting a frequency of 10 or more times per year.

The findings from both studies suggest the need for even more education about sun protective behaviors, Dr. Marcus Plescia said in a press statement.

"More public health efforts, including providing shade and sunscreen in recreational settings, are needed to raise awareness of the importance of sun protection and sunburn prevention to reduce the burden of skin cancer," said Dr. Plescia, director of cancer prevention and control at the Centers for Disease Control and Prevention. "We must accelerate our efforts to educate young adults about the dangers of indoor tanning."

Ms. Hartman, Dr. Siegel, and Dr. Plescia have no relevant financial disclosures.

Despite the documented increased use of sunscreen and protective clothing in recent years, up to 66% of young adults are still getting sunburned at least once a year.

The use of tanning beds also continues, according to the May 11 issue of the Morbidity and Mortality Report. A review of the National Health Information Survey found that up to 44% of women in the subgroup analysis reported using the devices in 2010, and that those who tan indoors do so up to 28 times each year. Even people with a family history of skin cancer or with recent sunburns are using the devices, said Anne Hartman, a biostatistician with the National Cancer Institute.

Photo credit: Yuri Arcurs/Fotolia.com

The findings are worrisome on a number of levels, said Dr. Daniel M. Siegel, president of the American Academy of Dermatology.

"It is distressing that the study found tanning bed use is higher in those with a family history of skin cancer and that sunburn prevalence remains high," he said in an interview. "This emphasizes how important it is to educate the public and encourage them to change their behaviors as they do not necessarily understand the dangers of sun exposure and indoor tanning. If they do, the risks may not be discouraging the behavior."

The sun protection study extracted data from 5 years of the National Health Interview Survey (NHIS). The survey includes detailed questions on sun exposure, the use of sunscreens and protective clothing, and other sun-protective behaviors from the 2000-2010 surveys (MMWR Morb. Mortal. Wkly. Rep. 2012;61:317-22).

Overall, 50% of respondents reported at least one sunburn during the past 12 months. This was highest among whites (66% in 2010) and lowest among blacks (11% in 2010). A similar number of men and women reported getting sunburned, and the prevalence of burning did not differ from 2000 to 2010 (about 50% each year).

Women were most likely to report sunscreen use and staying in the shade (37% and 35%, respectively). Sunscreen use increased significantly from 2000 to 2010, as did the use of clothing to the ankles (21% in 2000 and 26% in 2010). There were also significant increases in the practice of seeking shade (29% and 35%, respectively). However, there were no significant increases in the use of wide-brimmed hats or long-sleeved shirts.

White women were more likely to report shade use, with a significant increase each year. Black women were least likely to report using sunscreens each year.

Men most often reported using long clothing and staying in the shade (33% and 26%, respectively). Shade use among men increased from 18% in 2000 to 26% in 2010. Long protective clothing use increased from 28% to 33%, but changes in sunscreen use were not significant over that time, nor were changes in wearing a long-sleeved shirt or wide-brimmed hat.

Clinicians and policy-makers can help improve these behaviors by continuing to stress the importance of sun protection, Ms. Hartman said. "Evidence from a recent review by the U.S. Preventive Services Task Force suggests that behavioral counseling can increase sun protective behaviors, particularly among persons aged 10-24 years. Additionally, environmental and policy changes (for example, the provision of shade and sunscreen in recreational setting) could be promising strategies for creating social and physical environments that routinely promote sun protection for younger adults and persons of all ages" (Ann. Intern. Med. 2012 May 8 [Epub ahead of print]).

The indoor tanning study used NHIS data from 2010 and included information from 25,233 respondents aged 18 years and older.

Overall, 6% of respondents reported indoor tanning in the past 12 months, reported Ms. Hartman. Tanning was most common among young adults, with 12% of those aged 18-25 years and 9% of those aged 26-29 years using it.

A total of 9% of those with a family history of skin cancer reported indoor tanning, as did 8% of those who had a sunburn within the past 12 months. The associations with cancer and sunburn suggest that many people still don’t understand the dangers of indoor tanning, Ms. Hartman said.

Tanning was also related to socioeconomic status; 7% of those with some college or technical school and 7% of those with an income of more than 200% of the federal poverty level reporting indoor tanning.

The highest rates were in white women aged 18-21 years (32%), particularly those from the Midwest (44%). A total of 36% of Southern women aged 22-25 years also reported indoor tanning.

When white women did tan inside, they did so frequently, the report found. Overall, women reported an average of 20 times per year, with 58% reporting that they tanned 10 or more times per year. White women aged 18-21 years had the highest frequency of tanning (28 sessions per year), with 68% reporting a frequency of 10 or more times per year.

The findings from both studies suggest the need for even more education about sun protective behaviors, Dr. Marcus Plescia said in a press statement.

"More public health efforts, including providing shade and sunscreen in recreational settings, are needed to raise awareness of the importance of sun protection and sunburn prevention to reduce the burden of skin cancer," said Dr. Plescia, director of cancer prevention and control at the Centers for Disease Control and Prevention. "We must accelerate our efforts to educate young adults about the dangers of indoor tanning."

Ms. Hartman, Dr. Siegel, and Dr. Plescia have no relevant financial disclosures.

Counsel patients up to age 24 years on the merits of avoiding sun exposure to reduce the risk of skin cancers, the U.S. Preventive Services Task Force recommended May 8. The task force stopped short making the same recommendation for patients older than 24 years, saying that the evidence is not sufficient "to assess the balance of benefits and harms."

The panel noted in its recommendations the prevalence of skin cancer – affecting more than 2 million Americans yearly – and the rising incidence of can melanoma, with 70,000 cases in 2011 and about 8,800 deaths. The USPSTF said there was "convincing" evidence that ultraviolet radiation exposure during childhood and youth is linked to "a moderately increased risk for skin cancer later in life," but that for adults the evidence is only adequate, and, it is associated with just a small increase in risk.

There are potential downsides to counseling – for instance, it might lead kids to be less active – but no studies showed such a decrease, according to the task force’s recommendations. The document also noted that studies need to be done on whether sun exposure avoidance leads to lower vitamin D levels in adults.

The American Academy of Dermatology Association praised the recommendation for children and adolescents. "However, we firmly believe that behavior counseling is essential for all populations, including the adult population," said AADA President Daniel M. Siegel, in a statement. "Given this, we will continue our efforts to educate the public on skin cancer prevention, and encourage our members to conduct additional research in this important area," he said.

Counsel patients up to age 24 years on the merits of avoiding sun exposure to reduce the risk of skin cancers, the U.S. Preventive Services Task Force recommended May 8. The task force stopped short making the same recommendation for patients older than 24 years, saying that the evidence is not sufficient "to assess the balance of benefits and harms."

The panel noted in its recommendations the prevalence of skin cancer – affecting more than 2 million Americans yearly – and the rising incidence of can melanoma, with 70,000 cases in 2011 and about 8,800 deaths. The USPSTF said there was "convincing" evidence that ultraviolet radiation exposure during childhood and youth is linked to "a moderately increased risk for skin cancer later in life," but that for adults the evidence is only adequate, and, it is associated with just a small increase in risk.

There are potential downsides to counseling – for instance, it might lead kids to be less active – but no studies showed such a decrease, according to the task force’s recommendations. The document also noted that studies need to be done on whether sun exposure avoidance leads to lower vitamin D levels in adults.

The American Academy of Dermatology Association praised the recommendation for children and adolescents. "However, we firmly believe that behavior counseling is essential for all populations, including the adult population," said AADA President Daniel M. Siegel, in a statement. "Given this, we will continue our efforts to educate the public on skin cancer prevention, and encourage our members to conduct additional research in this important area," he said.

Counsel patients up to age 24 years on the merits of avoiding sun exposure to reduce the risk of skin cancers, the U.S. Preventive Services Task Force recommended May 8. The task force stopped short making the same recommendation for patients older than 24 years, saying that the evidence is not sufficient "to assess the balance of benefits and harms."

The panel noted in its recommendations the prevalence of skin cancer – affecting more than 2 million Americans yearly – and the rising incidence of can melanoma, with 70,000 cases in 2011 and about 8,800 deaths. The USPSTF said there was "convincing" evidence that ultraviolet radiation exposure during childhood and youth is linked to "a moderately increased risk for skin cancer later in life," but that for adults the evidence is only adequate, and, it is associated with just a small increase in risk.

There are potential downsides to counseling – for instance, it might lead kids to be less active – but no studies showed such a decrease, according to the task force’s recommendations. The document also noted that studies need to be done on whether sun exposure avoidance leads to lower vitamin D levels in adults.

The American Academy of Dermatology Association praised the recommendation for children and adolescents. "However, we firmly believe that behavior counseling is essential for all populations, including the adult population," said AADA President Daniel M. Siegel, in a statement. "Given this, we will continue our efforts to educate the public on skin cancer prevention, and encourage our members to conduct additional research in this important area," he said.

NEW YORK – All patients, regardless of skin color, need to be screened for skin cancer and receive sun protection education, according to Dr. Brooke A. Jackson.

"We have done a pretty good job of relaying the skin cancer awareness/risk message to fair skin types, but we still need to work on the message to darker skin types," noted Dr. Jackson. "This includes offering skin cancer screenings to all of our patients regardless of skin color, having a [high] level of suspicion for nonhealing lesions or changing lesions in darker skin types, and discussing skin cancer risks and sun protection with our patients who have darker skin."

Dr. Jackson and her colleagues surveyed 105 dark-skinned adult patients who presented to her private practice in Chicago for a variety of reasons.

Overall, 91 patients identified themselves as black, 9 as Hispanic, 4 as Asian, and 1 as Middle Eastern, noted Dr. Jackson, clinical assistant professor of dermatology at Northwestern University in Chicago.

Of the 105 patients, 9 had a Fitzpatrick skin type of III, 29 had type IV, 64 had type V, and 3 patients had type VI.

Patients read the descriptions for several types of lesions and were asked to identify whether a particular lesion was a risk factor for skin cancer, including "dark spot with irregular border," "new mole," "nonhealing wound," "bleeding lesion," and "shiny pink bump."

Dr. Jackson found that "regardless of ethnic origin or skin type, ‘dark spot with irregular borders’ followed by ‘new mole’ were the most frequent top two choices" selected as being high risk for skin cancer.

"Shiny pink bump" was the least selected choice for recognition of skin cancer and was not selected by any respondents with skin types III and VI, she reported.

Indeed, "15 respondents, most of whom were of African ethnicity and/or had skin type V, were unaware that skin of color was at risk for developing skin cancer," noted Dr. Jackson and her colleagues.

As for skin protective behaviors, 70 of the 91 black patients reported use of sunblock or sunscreen, and 47 used protective clothing. Twenty-nine black patients practiced sun avoidance. Ten of the black patients reported that they took no precaution at all with regard to sun exposure. Similarly, among the 64 Fitzpatrick skin type V patients, 13 reported practicing no sun protection.

Dr. Jackson stated that neither she nor her colleagues had any disclosures relevant to this presentation.

NEW YORK – All patients, regardless of skin color, need to be screened for skin cancer and receive sun protection education, according to Dr. Brooke A. Jackson.

"We have done a pretty good job of relaying the skin cancer awareness/risk message to fair skin types, but we still need to work on the message to darker skin types," noted Dr. Jackson. "This includes offering skin cancer screenings to all of our patients regardless of skin color, having a [high] level of suspicion for nonhealing lesions or changing lesions in darker skin types, and discussing skin cancer risks and sun protection with our patients who have darker skin."

Dr. Jackson and her colleagues surveyed 105 dark-skinned adult patients who presented to her private practice in Chicago for a variety of reasons.

Overall, 91 patients identified themselves as black, 9 as Hispanic, 4 as Asian, and 1 as Middle Eastern, noted Dr. Jackson, clinical assistant professor of dermatology at Northwestern University in Chicago.

Of the 105 patients, 9 had a Fitzpatrick skin type of III, 29 had type IV, 64 had type V, and 3 patients had type VI.

Patients read the descriptions for several types of lesions and were asked to identify whether a particular lesion was a risk factor for skin cancer, including "dark spot with irregular border," "new mole," "nonhealing wound," "bleeding lesion," and "shiny pink bump."

Dr. Jackson found that "regardless of ethnic origin or skin type, ‘dark spot with irregular borders’ followed by ‘new mole’ were the most frequent top two choices" selected as being high risk for skin cancer.

"Shiny pink bump" was the least selected choice for recognition of skin cancer and was not selected by any respondents with skin types III and VI, she reported.

Indeed, "15 respondents, most of whom were of African ethnicity and/or had skin type V, were unaware that skin of color was at risk for developing skin cancer," noted Dr. Jackson and her colleagues.

As for skin protective behaviors, 70 of the 91 black patients reported use of sunblock or sunscreen, and 47 used protective clothing. Twenty-nine black patients practiced sun avoidance. Ten of the black patients reported that they took no precaution at all with regard to sun exposure. Similarly, among the 64 Fitzpatrick skin type V patients, 13 reported practicing no sun protection.

Dr. Jackson stated that neither she nor her colleagues had any disclosures relevant to this presentation.

NEW YORK – All patients, regardless of skin color, need to be screened for skin cancer and receive sun protection education, according to Dr. Brooke A. Jackson.

"We have done a pretty good job of relaying the skin cancer awareness/risk message to fair skin types, but we still need to work on the message to darker skin types," noted Dr. Jackson. "This includes offering skin cancer screenings to all of our patients regardless of skin color, having a [high] level of suspicion for nonhealing lesions or changing lesions in darker skin types, and discussing skin cancer risks and sun protection with our patients who have darker skin."

Dr. Jackson and her colleagues surveyed 105 dark-skinned adult patients who presented to her private practice in Chicago for a variety of reasons.

Overall, 91 patients identified themselves as black, 9 as Hispanic, 4 as Asian, and 1 as Middle Eastern, noted Dr. Jackson, clinical assistant professor of dermatology at Northwestern University in Chicago.

Of the 105 patients, 9 had a Fitzpatrick skin type of III, 29 had type IV, 64 had type V, and 3 patients had type VI.

Patients read the descriptions for several types of lesions and were asked to identify whether a particular lesion was a risk factor for skin cancer, including "dark spot with irregular border," "new mole," "nonhealing wound," "bleeding lesion," and "shiny pink bump."

Dr. Jackson found that "regardless of ethnic origin or skin type, ‘dark spot with irregular borders’ followed by ‘new mole’ were the most frequent top two choices" selected as being high risk for skin cancer.

"Shiny pink bump" was the least selected choice for recognition of skin cancer and was not selected by any respondents with skin types III and VI, she reported.

Indeed, "15 respondents, most of whom were of African ethnicity and/or had skin type V, were unaware that skin of color was at risk for developing skin cancer," noted Dr. Jackson and her colleagues.

As for skin protective behaviors, 70 of the 91 black patients reported use of sunblock or sunscreen, and 47 used protective clothing. Twenty-nine black patients practiced sun avoidance. Ten of the black patients reported that they took no precaution at all with regard to sun exposure. Similarly, among the 64 Fitzpatrick skin type V patients, 13 reported practicing no sun protection.

Dr. Jackson stated that neither she nor her colleagues had any disclosures relevant to this presentation.

Skin & Allergy News Managing Editor Amy Pfeiffer and Senior Editor Terry Rudd review hot news in dermatology with the experts in this month's Skinny Vodcast.

Highlights include Naseem Miller's interview with Dr. Thomas Rohrer on the launch of the American Academy of Dermatology's SPOT skin cancer program. We also have coverage from the AAD's 2012 volunteer event in San Diego. 

And, Dr. Susan Weinkle explains how a foot pedal-operated device can facilitate high viscosity filler injections and minimize hand fatigue from multiple injections.

Lastly, Dr. Lily Talakoub offers tips on how to answer patient questions about potential makeup toxins.

Skin & Allergy News Managing Editor Amy Pfeiffer and Senior Editor Terry Rudd review hot news in dermatology with the experts in this month's Skinny Vodcast.

Highlights include Naseem Miller's interview with Dr. Thomas Rohrer on the launch of the American Academy of Dermatology's SPOT skin cancer program. We also have coverage from the AAD's 2012 volunteer event in San Diego. 

And, Dr. Susan Weinkle explains how a foot pedal-operated device can facilitate high viscosity filler injections and minimize hand fatigue from multiple injections.

Lastly, Dr. Lily Talakoub offers tips on how to answer patient questions about potential makeup toxins.

Skin & Allergy News Managing Editor Amy Pfeiffer and Senior Editor Terry Rudd review hot news in dermatology with the experts in this month's Skinny Vodcast.

Highlights include Naseem Miller's interview with Dr. Thomas Rohrer on the launch of the American Academy of Dermatology's SPOT skin cancer program. We also have coverage from the AAD's 2012 volunteer event in San Diego. 

And, Dr. Susan Weinkle explains how a foot pedal-operated device can facilitate high viscosity filler injections and minimize hand fatigue from multiple injections.

Lastly, Dr. Lily Talakoub offers tips on how to answer patient questions about potential makeup toxins.

Among patients with stage I or II cutaneous melanoma, women have been found to have a consistent 30% advantage over men in overall survival, disease-specific survival, rate of distant metastasis, rate of lymph node metastasis, and rate of relapse, a study published online April 30 in the Journal of Clinical Oncology has shown.

"The 30% advantage extends to the whole spectrum of melanoma disease behavior," reported Dr. Arjen Joosse of Erasmus University Medical Center, Rotterdam, the Netherlands, and his associates.

Women with melanoma are known to have higher survival rates than men, but the details of the difference had never been thoroughly explored. Some experts have proposed that men have more advanced disease at diagnosis because they are less aware of melanoma, less likely to be screened, and less likely to seek medical care for a suspect lesion. Others contend that biologic differences between the sexes account for survival differences, and point to estrogen as a likely contributor.

Dr. Joosse and his colleagues examined the issue by analyzing the pooled results of four large, randomized phase III clinical trials of localized melanoma performed by the European Organisation for Research and Treatment of Cancer (EORTC). The trials, which investigated different therapies for the disease, involved detailed medical records and "meticulous" follow-up of 2,672 patients (48% men and 52% women).

"Women exhibited an independent, significant, and consistent advantage of approximately 30%" for overall survival, relapse-free survival, disease-specific survival, time to in-transit metastasis, lymph node metastasis, and distant metastasis, the investigators reported (J. Clin. Oncol. 2012 April 30 [doi:10.1200/JCO.2011.38.0584]).

This sex-based difference persisted across numerous prognostic subgroups of patients, regardless of the location of the initial lesion, Breslow thickness, the presence or absence of ulceration, and whether the patient underwent sentinel node biopsy or elective lymph node dissection. If the hypothesis about sex differences in melanoma detection, screening, and diagnostic delays were true, there should be marked differences in the discrepancy between men and women across such subgroups; but no such differences were found.

Moreover, because women showed both a longer delay before relapse and a higher cure rate, compared with men, "it seems that whatever the cause of the female advantage may be, it causes both a delay in progression and a larger subset of melanomas being cured in women, compared with men," the researchers wrote.

To explore the hypothesis that estrogen might be the source of women’s survival advantage, the investigators classified the female patients by age to approximate their menopausal status.

Postmenopausal women (defined as those aged 60 years and older) retained the 30% advantage in overall survival, relapse-free survival, time to lymph node metastasis, and time to distant metastasis, compared with premenopausal women (aged 45 and younger). The advantage for disease-specific survival declined significantly in this analysis, but that may be a chance finding because of the small sample sizes and low event rates in these subgroups.

Thus, estrogen alone cannot account for the sex-based differences in survival. Other factors that may be involved include androgen receptors in melanoma cells; differences in oxidative stress between men and women; differences between the sexes in vitamin D metabolism, because vitamin D levels appear to affect melanoma prognosis; and differences in immune homeostasis, since melanoma is thought to be immunogenic.

Unravelling the underlying cause of the survival difference between men and women could point the way to targeted therapies, the investigators noted.

They added that the 30% survival advantage in their study is consistent with a 30% advantage in 5 of the 7 published studies in the literature that included 10,000 or more patients.

The study investigators reported no relevant financial disclosures.

Among patients with stage I or II cutaneous melanoma, women have been found to have a consistent 30% advantage over men in overall survival, disease-specific survival, rate of distant metastasis, rate of lymph node metastasis, and rate of relapse, a study published online April 30 in the Journal of Clinical Oncology has shown.

"The 30% advantage extends to the whole spectrum of melanoma disease behavior," reported Dr. Arjen Joosse of Erasmus University Medical Center, Rotterdam, the Netherlands, and his associates.

Women with melanoma are known to have higher survival rates than men, but the details of the difference had never been thoroughly explored. Some experts have proposed that men have more advanced disease at diagnosis because they are less aware of melanoma, less likely to be screened, and less likely to seek medical care for a suspect lesion. Others contend that biologic differences between the sexes account for survival differences, and point to estrogen as a likely contributor.

Dr. Joosse and his colleagues examined the issue by analyzing the pooled results of four large, randomized phase III clinical trials of localized melanoma performed by the European Organisation for Research and Treatment of Cancer (EORTC). The trials, which investigated different therapies for the disease, involved detailed medical records and "meticulous" follow-up of 2,672 patients (48% men and 52% women).

"Women exhibited an independent, significant, and consistent advantage of approximately 30%" for overall survival, relapse-free survival, disease-specific survival, time to in-transit metastasis, lymph node metastasis, and distant metastasis, the investigators reported (J. Clin. Oncol. 2012 April 30 [doi:10.1200/JCO.2011.38.0584]).

This sex-based difference persisted across numerous prognostic subgroups of patients, regardless of the location of the initial lesion, Breslow thickness, the presence or absence of ulceration, and whether the patient underwent sentinel node biopsy or elective lymph node dissection. If the hypothesis about sex differences in melanoma detection, screening, and diagnostic delays were true, there should be marked differences in the discrepancy between men and women across such subgroups; but no such differences were found.

Moreover, because women showed both a longer delay before relapse and a higher cure rate, compared with men, "it seems that whatever the cause of the female advantage may be, it causes both a delay in progression and a larger subset of melanomas being cured in women, compared with men," the researchers wrote.

To explore the hypothesis that estrogen might be the source of women’s survival advantage, the investigators classified the female patients by age to approximate their menopausal status.

Postmenopausal women (defined as those aged 60 years and older) retained the 30% advantage in overall survival, relapse-free survival, time to lymph node metastasis, and time to distant metastasis, compared with premenopausal women (aged 45 and younger). The advantage for disease-specific survival declined significantly in this analysis, but that may be a chance finding because of the small sample sizes and low event rates in these subgroups.

Thus, estrogen alone cannot account for the sex-based differences in survival. Other factors that may be involved include androgen receptors in melanoma cells; differences in oxidative stress between men and women; differences between the sexes in vitamin D metabolism, because vitamin D levels appear to affect melanoma prognosis; and differences in immune homeostasis, since melanoma is thought to be immunogenic.

Unravelling the underlying cause of the survival difference between men and women could point the way to targeted therapies, the investigators noted.

They added that the 30% survival advantage in their study is consistent with a 30% advantage in 5 of the 7 published studies in the literature that included 10,000 or more patients.

The study investigators reported no relevant financial disclosures.

Among patients with stage I or II cutaneous melanoma, women have been found to have a consistent 30% advantage over men in overall survival, disease-specific survival, rate of distant metastasis, rate of lymph node metastasis, and rate of relapse, a study published online April 30 in the Journal of Clinical Oncology has shown.

"The 30% advantage extends to the whole spectrum of melanoma disease behavior," reported Dr. Arjen Joosse of Erasmus University Medical Center, Rotterdam, the Netherlands, and his associates.

Women with melanoma are known to have higher survival rates than men, but the details of the difference had never been thoroughly explored. Some experts have proposed that men have more advanced disease at diagnosis because they are less aware of melanoma, less likely to be screened, and less likely to seek medical care for a suspect lesion. Others contend that biologic differences between the sexes account for survival differences, and point to estrogen as a likely contributor.

Dr. Joosse and his colleagues examined the issue by analyzing the pooled results of four large, randomized phase III clinical trials of localized melanoma performed by the European Organisation for Research and Treatment of Cancer (EORTC). The trials, which investigated different therapies for the disease, involved detailed medical records and "meticulous" follow-up of 2,672 patients (48% men and 52% women).

"Women exhibited an independent, significant, and consistent advantage of approximately 30%" for overall survival, relapse-free survival, disease-specific survival, time to in-transit metastasis, lymph node metastasis, and distant metastasis, the investigators reported (J. Clin. Oncol. 2012 April 30 [doi:10.1200/JCO.2011.38.0584]).

This sex-based difference persisted across numerous prognostic subgroups of patients, regardless of the location of the initial lesion, Breslow thickness, the presence or absence of ulceration, and whether the patient underwent sentinel node biopsy or elective lymph node dissection. If the hypothesis about sex differences in melanoma detection, screening, and diagnostic delays were true, there should be marked differences in the discrepancy between men and women across such subgroups; but no such differences were found.

Moreover, because women showed both a longer delay before relapse and a higher cure rate, compared with men, "it seems that whatever the cause of the female advantage may be, it causes both a delay in progression and a larger subset of melanomas being cured in women, compared with men," the researchers wrote.

To explore the hypothesis that estrogen might be the source of women’s survival advantage, the investigators classified the female patients by age to approximate their menopausal status.

Postmenopausal women (defined as those aged 60 years and older) retained the 30% advantage in overall survival, relapse-free survival, time to lymph node metastasis, and time to distant metastasis, compared with premenopausal women (aged 45 and younger). The advantage for disease-specific survival declined significantly in this analysis, but that may be a chance finding because of the small sample sizes and low event rates in these subgroups.

Thus, estrogen alone cannot account for the sex-based differences in survival. Other factors that may be involved include androgen receptors in melanoma cells; differences in oxidative stress between men and women; differences between the sexes in vitamin D metabolism, because vitamin D levels appear to affect melanoma prognosis; and differences in immune homeostasis, since melanoma is thought to be immunogenic.

Unravelling the underlying cause of the survival difference between men and women could point the way to targeted therapies, the investigators noted.

They added that the 30% survival advantage in their study is consistent with a 30% advantage in 5 of the 7 published studies in the literature that included 10,000 or more patients.

The study investigators reported no relevant financial disclosures.