Skin Malignancy in the Military: A Number Needed to Biopsy Analysis

ABSTRACT Introduction Skin malignancy has increased in prevalence over the last 15 years and effective diagnosis is required for adequate treatment. Retrospective data analysis of skin biopsy data has shown correlation between various independent variables, but no studies have been shown to directly assess skin malignancy risks for military personnel. Assessing correlation could lead to more effective, targeted screening programs that could lead to decreased mortality from skin malignancies. We present a 1-year analysis of the number needed to biopsy (NNB) to detect skin cancer and analysis of military-specific risk factors in a military dermatology training program. The present study aims to (1) compare skin biopsy yields to civilian institutions and patient populations and (2) determine significance of exposure variables including age, gender, military beneficiary status, branch of service, and military rank. Materials and Methods We performed a retrospective observational study over 1 year by identifying all skin biopsies performed in the Walter Reed National Military Medical Center dermatology clinic from August 2015 to July 2016. Utilizing the pathology reports, we manually excluded biopsies performed for the purpose of ruling out inflammatory/immunologic conditions or cosmeses and focused only on encounters performed to rule out basal cell carcinoma, squamous cell carcinoma, or melanoma. We decided to exclude malignant diagnoses that were exceedingly rare or could mimic inflammatory conditions, such as cutaneous T-cell lymphoma. For uncertain diagnoses with vague context per pathology report, previous office clinic notes and pre-biopsy differential were referenced and included only if melanoma or non-melanoma skin cancer (NMSC) diagnosis was the intended indication. Results A total of 3,098 biopsies were included in the study, diagnostic for 1,084 total skin malignancy and 54 melanoma diagnoses. Melanoma comprised 4.98% of all skin malignancy diagnosed. The NNB for all skin malignancy was 2.86 (95% CI 2.76-2.96) and NNB for melanoma and NMSC was 20.93 (95% CI 19.70-22.15) and 1.91 (95% CI 1.83-2.00), respectively. Patient age, gender, and military rank significantly impacted NNB values (P < .001). Conclusions The proportion of melanoma skin cancers is notably increased in our population compared to published population statistics with comparable total biopsy yields. Skin biopsy for purpose of screening for malignancy should be performed in the military population and consideration should be made for gender, age, and rank. Our findings can further expand on military risk factors for skin cancer and aid in further multivariant modeling.

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Mohs Surgery versus Standard Local Excision for Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Skin Cancer

Facial Plastic Surgery ◽

10.1055/s-0040-1709142 ◽

2020 ◽

Vol 36 (02) ◽

pp. 133-140

Author(s):

Timothy M. Johnson ◽

Noah R. Smith

Keyword(s):

Risk Factors ◽

Squamous Cell Carcinoma ◽

Skin Cancer ◽

Cell Carcinoma ◽

Local Excision ◽

Mohs Surgery ◽

Skin Cancers ◽

The Face ◽

Carcinoma Squamous Cell ◽

Melanoma Skin

AbstractBasal cell carcinoma, squamous cell carcinoma, and melanoma represent the three most common skin cancers that occur on the face. The most common surgical treatments for facial skin cancers are Mohs surgery and standard local excision. The effective utilization of either of these techniques is based on tumor and patient risk stratification incorporating known risk factors for occult invasion and local recurrence, combined with patient comorbidities, expectations, and desires. Best available evidence highlights multiple and consistent risk factors for each specific skin cancer type, and dictate local control rates reported in the literature. Recognizing gaps in the literature, we compare and review surgical treatment guidelines and data for standard local excision versus Mohs surgery for cutaneous nonmelanoma and melanoma skin cancer. This article serves as a resource for optimal therapeutic decision making for surgical management of skin cancer on the face.

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P260 An analysis of non-melanoma skin cancer rates in the tofacitinib Ulcerative Colitis clinical programme

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.386 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S294-S296

Author(s):

B E Sands ◽

R D Cohen ◽

C Ha ◽

W Reinisch ◽

L Salese ◽

...

Keyword(s):

Risk Factors ◽

Ulcerative Colitis ◽

Risk Factor ◽

Skin Cancer ◽

Cell Carcinoma ◽

Significant Risk ◽

Time Interval ◽

Non Melanoma Skin Cancer ◽

Maintenance Study ◽

Melanoma Skin

Abstract Background Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). We present an updated analysis of non-melanoma skin cancer (NMSC) events in the tofacitinib UC clinical programme, including final data from the open-label, long-term extension (OLE) study (as of 24 Aug 2020). Methods NMSC events were evaluated from 3 randomised, placebo (PBO)-controlled studies (2 Phase [P]3 induction studies [NCT01465763; NCT01458951]; 1 P3 maintenance study [NCT01458574]) and an OLE study (NCT01470612), as 3 cohorts: Induction (P3 induction studies [patients (pts) receiving tofacitinib 10 mg twice daily (BID) or PBO]); Maintenance (P3 maintenance study [pts receiving tofacitinib 5 or 10 mg BID or PBO]); Overall (pts receiving tofacitinib 5 or 10 mg BID in P3 or OLE studies). Analysis was by predominant dose (PD) 5 or 10 mg BID, based on average daily dose <15 or ≥15 mg, respectively (82% of pts received PD 10 mg BID). An independent adjudication committee reviewed potential NMSC. Proportions and incidence rates (IRs; unique pts with events per 100 pt-years of exposure) were evaluated for NMSC. A Cox proportional hazards model was used for risk factor analysis. Results 1124 pts were evaluated for NMSC (2809.4 pt-years of tofacitinib exposure; up to 7.8 years of treatment; median duration 685.5 days). NMSC events in Induction and Maintenance were previously reported (Table 1).1 In Overall, NMSC occurred in 21 pts (IR 0.73 [95% confidence interval (CI) 0.45, 1.12]): PD tofacitinib 5 mg BID n=5, IR 0.63 (0.21, 1.48); PD tofacitinib 10 mg BID n=16, IR 0.77 (0.44, 1.25) (Table 1); 2 new cases since May 2019.1 Eleven pts had squamous cell carcinoma and 15 pts had basal cell carcinoma; 5 pts had both. No NMSC was metastatic or led to discontinuation. IRs by time interval and subgroup are reported (Table 2). Prior NMSC (hazard ratio [HR] 12.08 [95% CI 4.20, 34.76]) and age (per 10-year increase, HR 2.01 [1.38, 2.93]) were significant risk factors for NMSC in the multivariable analysis. Prior immunosuppressant use was not a significant risk factor in either the multivariable or univariate analyses. Conclusion In this analysis, NMSC IRs for tofacitinib were similar to those in pts with UC treated with biologics2 and those previously reported in the tofacitinib UC clinical programme.1 NMSC events were more likely to occur in pts with recognised NMSC risk factors: prior NMSC and increasing age.3 Dose dependency of NMSC IR could not be concluded here, as dose changes were permitted. NMSC IRs remained stable over time, up to 7.8 years of exposure. References

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Erratum: Mohs Surgery versus Standard Local Excision for Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma Skin Cancer

Facial Plastic Surgery ◽

10.1055/s-0040-1721103 ◽

2020 ◽

Author(s):

Timothy M. Johnson ◽

Noah R. Smith

Keyword(s):

Squamous Cell Carcinoma ◽

Skin Cancer ◽

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Local Excision ◽

Squamous Cell ◽

Basal Cell ◽

Mohs Surgery ◽

Carcinoma Squamous Cell ◽

Melanoma Skin

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Variation in Skin Cancer Pattern in the Southwestern Region of Pakistan

10.53350/pjmhs2115123402 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3402-3404

Author(s):

Hina , Manzoor ◽

Najeeb Ahmad ◽

Zafar H Tanveer ◽

Khush Naseed Ahmed ◽

Munir , Ahmed ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Skin Cancer ◽

Cell Carcinoma ◽

Squamous Cell ◽

Published Data ◽

Non Melanoma Skin Cancer ◽

Broad Term ◽

The Difference ◽

Field Workers ◽

Melanoma Skin

Background: Skin cancer is a broad term that refers to a variety of different types of cancer. It is usually recognized as non-melanoma and melanoma skin cancer. In many parts of the world, the prevalence is high, with significant ecological and ethical variation. Objectives: Objective was to determine demographic and histological features of skin cancer in Southwest region of Pakistan. Methodology: This retrospective study was carried out on skin cancer 1169 cases of Centre for Nuclear Medicine and Radiotherapy (CENAR) in Quetta. The data from January 2000 to December 2009 (10Years) was retrieved from record. The aim was to determine the importance of skin cancer in this area, its gender wise distribution and its pathological types. Results: Record of total 9308 cancer patients was retrieved from patients presenting to CENAR Quetta. From 9308 case, 1169(12.5%) patients were of skin cancer which was second most prevalent category of cancer in this area. Prevalence was higher in males with 713(61%) cases as compared to females. Pathologically with 634(54%) cases, the most prevalent category was Squamous cell carcinoma (SCC). Conclusion: Skin cancer is wide-spread type of cancer in patients of south-west region of Pakistan. The findings of this study are not aligned with published data. The difference is because of high altitude of the study area, dry climate and long skin exposure particularly in low socio-economic field workers. Keywords: Skin cancer, gender, Melanoma skin cancer (MSC), Squamous cell carcinoma (SCC), Non-melanoma skin cancer (NMSC), Basal cell carcinoma (BCC),

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Surgical Management of Melanoma and Other Skin Cancers

10.2310/surg.2038 ◽

2015 ◽

Author(s):

Jennifer A. Wargo ◽

Kenneth Tenabe

Keyword(s):

Lymph Node ◽

Surgical Treatment ◽

Skin Cancer ◽

Cell Carcinoma ◽

Stage Iv ◽

Stage Iii ◽

Non Melanoma Skin Cancer ◽

Skin Cancers ◽

Stage Iv Melanoma ◽

Melanoma Skin

The prevalence of malignant skin cancers has increased significantly over the past several years. Approximately 1.2 million cases of non-melanoma skin cancer are diagnosed per year. More alarming, up to 80,000 cases of melanoma are diagnosed per year, an incidence that has been steadily increasing, with a lifetime risk of 1 in 50 for the development of melanoma. The disturbing increase in the incidence of both non-melanoma skin cancer and melanoma can largely be attributed to the social attitude toward sun exposure. The clinical assessment and management of skin lesions can be challenging. This review describes the assessment process, including thorough history and examination; the need for possible biopsy; and excision criteria. Specific types of skin cancer are distinguished and include basal cell carcinoma; squamous cell carcinoma; and melanoma; and for each type the incidence; epidemiology; histologic subtypes; diagnosis; and both surgical and non-surgical treatments are provided. Stages I-IV of melanoma are detailed, with prognostic factors described. Surgical treatment for stages I and II include description of the margins of excision and sentinel lymph node biopsy. The surgical treatment of Stage III melanoma further includes therapeutic lymph node dissection and isolated limb perfusion. Adjuvant therapies are also presented and include radiotherapy and chemotherapy. The additional treatment of metastasectomy for Stage IV melanoma is described. For both Stage III and IV melanoma, the study of vaccines to host immune cells is reported. For Stage IV melanoma, the text also describes immunotherapy treatment. Operative procedures specific to superficial and deep groin dissections are outlined. This review contains 9 figures, 3 tables, and 96 references.

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Current and Future Trends in Molecular Biomarkers for Diagnostic, Prognostic, and Predictive Purposes in Non-Melanoma Skin Cancer

Journal of Clinical Medicine ◽

10.3390/jcm9092868 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2868 ◽

Cited By ~ 1

Author(s):

Taxiarchis Konstantinos Nikolouzakis ◽

Luca Falzone ◽

Konstantinos Lasithiotakis ◽

Sabine Krüger-Krasagakis ◽

Alexandra Kalogeraki ◽

...

Keyword(s):

Skin Cancer ◽

Cell Carcinoma ◽

Cpg Island ◽

Distant Metastases ◽

Telomerase Activity ◽

Molecular Biomarkers ◽

Non Melanoma Skin Cancer ◽

Cpg Island Methylation ◽

Bowen Disease ◽

Melanoma Skin

Skin cancer represents the most common type of cancer among Caucasians and presents in two main forms: melanoma and non-melanoma skin cancer (NMSC). NMSC is an umbrella term, under which basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Merkel cell carcinoma (MCC) are found along with the pre-neoplastic lesions, Bowen disease (BD) and actinic keratosis (AK). Due to the mild nature of the majority of NMSC cases, research regarding their biology has attracted much less attention. Nonetheless, NMSC can bear unfavorable characteristics for the patient, such as invasiveness, local recurrence and distant metastases. In addition, late diagnosis is relatively common for a number of cases of NMSC due to the inability to recognize such cases. Recognizing the need for clinically and economically efficient modes of diagnosis, staging, and prognosis, the present review discusses the main etiological and pathological features of NMSC as well as the new and promising molecular biomarkers available including telomere length (TL), telomerase activity (TA), CpG island methylation (CIM), histone methylation and acetylation, microRNAs (miRNAs), and micronuclei frequency (MNf). The evaluation of all these aspects is important for the correct management of NMSC; therefore, the current review aims to assist future studies interested in exploring the diagnostic and prognostic potential of molecular biomarkers for these entities.

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