IMPORTANCE UV radiation (UVR) exposure is the primary environmental risk factor for developing cutaneous malignant melanoma (CMM). OBJECTIVE To measure changes in sun behavior from the first until the third summer after the diagnosis of CMM using matched controls as a reference. DESIGN, SETTING, AND PARTICIPANTS Three-year follow-up, observational, case-control study performed from May 7 to September 22, 2009, April 17 to September 15, 2010, and May 6 to July 31, 2011, at a university hospital in Denmark of 21 patients with CMM and 21 controls matched to patients by sex, age, occupation, and constitutive skin type participated in the study. Exposure to UVR was assessed the first and second summers (n=20) and the first and third summers (n=22) after diagnosis. Data from 40 participants were analyzed. MAIN OUTCOMES AND MEASURES Exposure to UVR was assessed by personal electronic UVR dosimeters that measured time-related UVR in standard erythema dose (SED) and corresponding sun diaries (mean, 74 days per participant each participation year). RESULTS Patients' daily UVR dose and UVR dose in connection with various behaviors increased during follow-up (quantified as an increase in daily UVR dose each year; all days: mean, 0.3 SED; 95% CI, 0.05-0.5 SED; days with body exposure: mean, 0.6 SED; 95% CI, 0.07-1.2 SED; holidays: mean, 1.2 SED; 95% CI, 0.3-2.1 SED; days abroad: 1.9 SED; 95% CI, 0.4-3.4 SED; and holidays with body exposure: mean, 2.3 SED; 95% CI, 1.1-3.4 SED). After the second year of follow-up, patients' UVR dose was higher than that of controls, who maintained a stable UVR dose. No difference was found between groups in the number of days with body exposure or the number of days using sunscreen in the second and third years of follow-up. CONCLUSIONS AND RELEVANCE Our findings suggest that patients with CMM do not maintain a cautious sun behavior in connection with an increase in UVR exposure, especially on days with body exposure, when abroad, and on holidays.
BACKGROUND: During the Chernobyl accident in 1986, 237 individuals were identified as having the most severe exposure to ionizing radiation. In the period between 1998 and 2000, 99 long term survivors out of this group were reassessed for radiation-induced cutaneous lesions. OBJECTIVE: To identify sequelae of accidental cutaneous irradiation. METHODS: Detailed dermatologic examinations, including biopsies of suspicious cutaneous lesions for histopathologic examination and 20 MHz sonography, were performed in all patients. RESULTS: Twenty-two of the 99 patients displayed radiation-induced cutaneous lesions. Epidermal atrophy, telangiectases, and pigment alterations were present in all these individuals. Keratotic lesions were found in 14 patients. Cutaneous fibrosis was documented in 8 individuals by the use of 20 MHz sonography, while a radiation ulcer was found in 5. In one patient, two basal cell carcinomas were found. CONCLUSION: The life-long follow-up of irradiated persons is of great importance in order to identify cutaneous neoplasms at an early treatable stage.
The incidence of malignant melanoma has increased markedly in recent years in Norway, and in other countries. Epidemiologic studies show that important risk markers are familial occurrence, skin type, number of regular nevi and presence of dysplastic nevi. The ultraviolet component of sunlight is an important etiologic factor, especially acute intermittent sun-burn experienced during childhood. Some of the melanomas are familial, and genetic markers can perhaps be used in screening. Finally, health education is a very important tool in reducing incidence of melanoma and mortality from this disease. In each single patient, data from cellular and molecular research can assist in making a precise diagnosis and in estimating prognosis.
The naevus profile was examined in 379 randomly selected Swedes (30-50 years) and in 121 melanoma patients in the same age-range selected from the Regional Cancer Register. The total body count of common naevi (CN) greater than or equal to 2 mm in the population was high (mean 67, range 1-300). Even so, the melanoma patients had almost twice as many CN as the controls (mean 113, range 13-347). The prevalence of clinical dysplastic naevi (DN) was 18% in the population and 56% in the patients. The corresponding figures for histologically diagnosed DN were 8% and 40% respectively. Subjects with dysplastic naevi had a significantly larger number of CN than those without DN. Subjects with a sun-sensitive skin, greater than or equal to 150 naevi and presence of DN had a 50 times higher melanoma risk than those without these characteristics. For identifying subjects at risk of developing cutaneous malignant melanoma (CMM), clinically diagnosed DN was as good a discriminator as histologically diagnosed DN. The numbers of naevi in different skin areas were tested for their power in predicting the total body naevus count. The strongest correlations were found between total counts and counts on the anterior surface of the thighs and the lateral aspect of the arms. Counts from either of these areas will provide a practical and satisfactory estimate of the total number of naevi. To study the possible link between sun exposure, naevus formation and melanoma development, the distribution of CN, DN and CMM over the body surface was studied in the 121 melanoma patients and in 310 consecutive controls. The number of naevi was four times as high in a sun-exposed area on the lower back compared with in an adjacent sun-protected area on the buttocks, indicating that sunlight plays a role in naevus development. Both CN and CMM were found to have a general distribution pattern over the body surface consistent with the idea that sun exposure is important for their formation. The number of CN and CMM per unit body surface area was significantly higher in intermittently sun-exposed than in rarely or chronically exposed skin. The distribution pattern of DN was quite different from that of CN, with few DN on the sun-exposed upper chest and face and many DN in protected areas such as the buttocks and lower abdomen, indicating that DN may develop independently of sun exposure.(ABSTRACT TRUNCATED AT 400 WORDS)
BACKGROUND: Neurofibromas represent proliferation of the connective tissue cells of peripheral nerves and deposition of collagenous extracellular matrix. There is evidence that the appearance and growth of neurofibromas may be associated with prior or ongoing mechanical trauma in patients with neurofibromatosis type 1 (NF1). OBJECTIVE: To study the histologic characteristics of apparently healthy skin of patients with NF1. DESIGN: The histologic features of healthy-looking skin of patients with NF1 were analyzed. SETTING: University hospital. PATIENTS: Ten patients who fulfilled the criteria for NF1. INTERVENTIONS: Punch biopsy specimens of healthy-looking skin of the forearm from 9 volunteer patients and of the upper eyelid during cosmetic operation from 1 volunteer patient were obtained. MAIN OUTCOME MEASURES: The main outcomes were not predicted, and the hypothesis was formulated during data collection. RESULTS: Apparently unaffected skin of 5 patients with NF1 was studied by routine histologic testing with respect to expression of S100 protein. Unexpectedly, analysis of the samples revealed the presence of a small neurofibroma tumor in one of the samples. The tumor was located in deep dermis around a hair follicle. In addition, neurofibromatous tissue not large enough to be called a tumor was found on the same anatomical location in another patient. In further studies, 10 punch biopsy specimens of apparently healthy skin from patients with NF1 were similarly sectioned and analyzed. No tumors were found in these additional samples. In 4 patients, however, abundant S100 protein-positive cells were located within collagenous extracellular matrix surrounding hair follicles. CONCLUSIONS: The skin of patients with NF1 might be more widely affected than previously thought and occult neurofibromas are not rare.
To determine which host characteristics are risk factors for cutaneous malignant melanoma in order to aim prevention and early detection programs at people at high risk.
The 583 case subjects were aged 20 to 69 years and had had malignant melanoma newly diagnosed between Oct. 1, 1984, and Sept. 30, 1986. The 608 control subjects were randomly selected from a list of residents in the study area and were stratum matched for age, sex and municipality.
Through in-person interviews the interviewer ascertained exposure to putative external risk factors and assessed skin colour and number of nevi on the arm, and the subject reported his or her natural hair colour at age 20 years, eye colour, skin reaction to repeated sun exposure, and freckle and whole-body nevus densities.
Although all the host factors mentioned were significantly associated with melanoma risk when considered separately, only hair colour, skin reaction to repeated sun exposure, and self-reported freckle and nevus densities remained significant after backward logistic regression analysis. The odds ratio for melanoma was estimated to be 10.7 in people who had many nevi compared with those who had none (95% confidence interval [CI] 6.6 to 17.4), 4.0 in people who had red hair compared with those who had black hair (95% CI 1.9 to 8.2), 1.9 in people who had many freckles compared with those who had none or few (95% CI 1.3 to 2.8) and 1.4 respectively in people who burned and had a subsequent increase in tan and those who burned and had no increase in tan after repeated sun exposure compared with those who did not burn [corrected].
Four risk factors for malignant melanoma have been identified. Prospective evaluation of their predictive value should be done. In the meantime, however, these factors should be used to identify people apparently at high risk for malignant melanoma, who can then be targeted for early detection and prevention programs.
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