Melanoma Incidence Rates Research Articles

The incidence of skin melanoma in Gran Canaria (Canary Islands, Spain) is lower than expected in Southern Europe despite high-risk environmental conditions: an island-wide cross-sectional study

The Canary Islands are a leading European touristic destination. The ultraviolet index (UVI) in the region is the highest in Spain, and similar to indexes registered in Australia and New Zealand, which hold the highest incidence of skin melanoma worldwide. Yet according to cancer registry data, the incidence in the Canary Islands in the late 1990s was the lowest in Spain (among the lowest in Europe) and about six times lower than in New Zealand. To analyze the incidence rates of skin melanoma in Gran Canaria island between 2007 and 2018. The study was based in the two centres of the Canary Islands' Healthcare Service centralizing melanoma care in Gran Canaria. We analyzed crude and age-standardized (ASR) incidence rates of invasive cutaneous melanoma for the period 2007-2018 following the inclusion criteria of the International Agency for Research on Cancer (IARC). Clinical and histological characteristics of melanoma patients were assessed. A total of 1058 patients were included. The incidence rates obtained matched the latest available Canary Islands' cancer registry data, confirming its reliability (ASR, Segi-Doll world standard population: 6.4 cases per 100,000 habitants for 2008-2012). The incidence was also below the latest IARC predictions for Southern Europe (GLOBOCAN 2018). Histological characteristics of patients were similar to other Southern European series. The incidence of skin melanoma in Gran Canaria is unexpectedly low for a Southern European population exposed to such a high UVI. Further research in the Canary Islands could provide insight into a better understanding of melanoma pathogenesis.

Carfilzomib in Combination with Bortezomib Enhances Apoptotic Cell Death in B16-F1 Melanoma Cells.

Simple SummaryThe incidence rate of metastatic melanoma has been rapidly increasing worldwide and its 5-year survival rate is very low. Due to partial responses, various side effects, and resistance to any known cancer therapeutics, more potent and safer therapeutics are needed to increase the survival rate of patients with melanoma. Since proteasome inhibitors, such as bortezomib and carfilzomib, have been suggested as treatments for various cancers, we investigated their potential for the treatment of melanoma by studying their molecular mechanisms of action in B16-F1 melanoma cells. In this study, we found that both bortezomib and carfilzomib lead to apoptosis via ER stress as well as ROS accumulation and MMP loss in melanoma cells. Bortezomib and carfilzomib synergistically reduced B16-F1 tumor growth in vitro and in a C57BL/6 xenograft mouse model. Therefore, a combination therapy with carfilzomib and bortezomib at submaximal concentrations may reduce their side effects and be beneficial for melanoma treatment.Proteasome inhibitors, such as bortezomib (BZ) and carfilzomib (CFZ), have been suggested as treatments for various cancers. To utilize BZ and/or CFZ as effective therapeutics for treating melanoma, we studied their molecular mechanisms using B16-F1 melanoma cells. Flow cytometry of Annexin V-fluorescein isothiocyanate-labeled cells indicated apoptosis induction by treatment with BZ and CFZ. Apoptosis was evidenced by the activation of various caspases, including caspase 3, 8, 9, and 12. Treatment with BZ and CFZ induced endoplasmic reticulum (ER) stress, as indicated by an increase in eIF2α phosphorylation and the expression of ER stress-associated proteins, including GRP78, ATF6α, ATF4, XBP1, and CCAAT/enhancer-binding protein homologous protein. The effects of CFZ on ER stress and apoptosis were lower than that of BZ. Nevertheless, CFZ and BZ synergistically induced ER stress and apoptosis in B16-F1 cells. Furthermore, the combinational pharmacological interactions of BZ and CFZ against the growth of B16-F1 melanoma cells were assessed by calculating the combination index and dose-reduction index with the CompuSyn software. We found that the combination of CFZ and BZ at submaximal concentrations could obtain dose reduction by exerting synergistic inhibitory effects on cell growth. Moreover, this drug combination reduced tumor growth in C57BL/6 syngeneic mice. Taken together, these results suggest that CFZ in combination with BZ may be a beneficial and potential strategy for melanoma treatment.

The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review.

Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow’s index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of n = 12082 (range 100–4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow’s thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains “flow and timing” and “reference standard”. The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma.

Burden of malignant melanoma in Ukraine in 2002-2013: incidence, mortality and survival.

The malignant melanoma (MM) incidence rates were increasing and later stabilizing in many regions of the world, while in South-Eastern Europe incidence rates are uniformly increasing and mortality rates are higher. To describe burden of MM in Ukraine in terms of incidence, mortality and survival by sex, age and stage for the period 2002-2013and compare with European countries. Database of the National Cancer Registry of Ukraine was used to extract MM incidence cases; number of MM deaths was obtained from the official mortality statistics. Age-standardised and age-specific incidence and mortality rates were calculated by sex, age groups (15-39, 40-59and 60+); estimated annual percent of change was used to describe trends. Proportions of new cases by stage of disease and calendar period (2002-2007vs 2008-2013) were compared as well as net survival estimates. In Ukraine, MM was more common in females (age-standardised 5.3per 100,000in 2013; annual percent of change 3.5%) than in males (5.1per 100,000; 4.1%); around 50% of them diagnosed in the age group 60+. The observed increase in proportion of new cases with early stage (I-II) was due to stage II cases. The slight increase in mortality rates in males or stability in females were not accompanied with increase of survival. Net MM survival was consistently lower comparing to European countries. More resources should be targeted to increase the capacity of healthcare in diagnostics and treatment of malignant melanoma, but also in promoting healthcare and education in Ukraine.

15675 Melanoma awareness in a predominantly Hispanic population: A cross-sectional survey

Melanoma incidence rate in 1996 was 15.7 (11.22-18.58) new cases per 100,000 compared with 17.45 (14.31-25.18) in 2017. Despite representing <5% of all cutaneous malignancies, melanoma remains the most lethal skin cancer, yet when diagnosed at early stages, melanoma has a more favorable prognosis. The study objective was to better understand public awareness of melanoma, and evaluate if there was any change over the last 23 years. A survey was conducted from May to November 2017, including 285 participants, aged 18 years or older.

Observation of a 27 Days Periodicity in Melanoma Diagnosis

Streams from the dark universe may affect biologic processes on Earth including occurrence of cancer. Here, we have recovered complete daily melanoma incidence rates 1982–2014 in Australia. If there is no other external cause for melanoma, its seasonal rate should be steady with a broad maximum during local summertime due to increased solar UV exposure. The reported melanoma cases show instead: (A) a modulation repeating every [Formula: see text] weeks; (B) a time-dependence which relates also with Moon’s geocentric orbital position, while it does not fit concurrently measured solar activity; and (C) a modulation periodicity strikingly coinciding with the Moon’s sidereal periodicity of 27.3 days, which is fixed to remote stars and not to the Sun. These findings show that the associated cause must be of exo-solar origin, and not only due steady solar UV exposure. A possible interpretation of the finding is the underlying working hypothesis itself, namely the flux of slow speed streaming DM is temporally enhanced due to gravitational (self-)focusing by the solar system. Interestingly, the gravitational focusing effect by the Moon itself towards the Earth covers speeds up to [Formula: see text][Formula: see text]km/s, fitting within the widely assumed velocity distribution of DM constituents at [Formula: see text][Formula: see text]km/s. The derived observations for melanoma diagnosis are a novel model-independent finding with potential public health implications and possible relevance for other diseases. The results of this work also serve as accumulating and independent signatures strengthening previous physics claims being at work at the Sun and Earth’s upper atmosphere, inspiring a novel cross-disciplinary approach for the dark matter (DM) paradigm. In future, the 27.3 days periodicity does not necessarily require long-term physical and medical measurements to search for a direct cause-effect relationship. Potential candidates from the dark sector are the highly ionizing anti-quark nuggets, magnetic monopoles, but also particles like dark photons; other as yet unpredicted DM constituents with sufficient impact on the highly sensitive living matter could be at work.

Climatic Exposure Risk Associated With Skin Cancer

Skin cancer is a public health concern due to high incidence and prevalence rates. In contrast to many other types of cancer, melanoma incidence rates have increased significantly since the 1960s. As the most common form of cancer, melanoma is a significant yet highly preventable health concern. The purpose of the present study was to explore ssociations between melanoma incidence rates and climate change. A review of data available from the Surveillance, Epidemiology, and End Results Program (SEER) and the National Oceanic and Atmospheric Administrations (NOAA) revealed significant changes in melanoma incidences rates and essential meteorological variables. Spending more time outdoors primary to increases in average temperatures may result in greater risk of DNA mutations in skin cells especially as ultraviolet indices have increased alongside ozone diminution. Public health interventions should situate melanoma risk within the context of climate change by encouraging both sun protective and pro-environmental behavior.

Publicly available UV irradiance data in the contiguous United States and its applications

Background: Skin cancer is the most common type of cancer in the United States. The majority of skin cancer is caused by overexposure to ultraviolet (UV) light. National Environmental Public Health Tracking Program at CDC has collaborated with partners to develop and disseminate county-level daily UV irradiance (2005 to 2015) data for the contiguous United States.Methods: UV dataset was derived based on measurements from the Ozone Monitoring Instrument (OMI) during 2005-2015. UV irradiance data were first calculated at the census tract level; then daily population-weighted UV irradiance were calculated at the county level. We analyzed the spatial distributions and long-term trends of UV irradiance, and ratio of UV irradiance to solar irradiance. We also have used the newly developed dataset in a few applications to improve characterization of UV exposure.Results: The UV dataset is currently the only publicly-available, spatially-resolved, and long-term UV radiation dataset covering the contiguous United States. The national averages across all years available is 2,700 J/m2 for erythemally weighted daily dose of UV irradiance (EDD). UV irradiance increased toward the South and the West. The ratio of UV to solar irradiance mainly increased toward the South and in some areas with high altitude. This spatial variation suggests that using solar irradiance as indicator of UV irradiance in studies covering large geographic regions may bias the true pattern of UV exposure. National annual average daily UV irradiance increased significantly over the years by about 0.5% per year. In addition, we identified hotspots of skin cancer vulnerability, which took into consideration demographic, social risk factors and UV exposure intensity. We also examined state laws allowing sunscreen use in schools in the context of state average UV irradiance. Finally, we are currently studying the association between UV irradiance and cutaneous melanoma incidence rates among white US residents.

Epidemiologic Burden of Skin Cancer in the US and Worldwide

Skin cancer is one of the leading causes of skin disease burden worldwide. This systematic review provides an overview of the United States (US) and global melanoma and non-melanoma skin cancer (NMSC) epidemiologic studies published in the last 5 years. The incidence of melanoma and NMSC continues to rise both in the US and worldwide. The highest global age-standardized incidence rates (ASIRs) for melanoma were Australasia, North America, Eastern Europe, Western Europe, and Central Europe. Various results were reported for the mortality of skin cancer; however, overall, the mortality was higher in men than women and remained relatively stable. Notably, NMSC caused more deaths globally than melanoma, albeit at a slower rate. Epidemiologic studies on skin cancer provide the vital information needed to implement effective preventive efforts. Increased global skin cancer burden necessitates continued surveillance and production of accurate, high-quality NMSC and melanoma epidemiologic studies.

Association between menopausal hormone therapy and melanoma: a systematic review and meta-analysis

Abstract Background Age-specific incidence rates of cutaneous Malignant Melanoma (MM) are higher in women during their reproductive years, while the rate of increase slows after menopause, supporting the speculation that hormones might influence the risk of developing cutaneous MM. The aim of our systematic review and meta-analysis is to summarize the evidence on the association between Menopausal Hormone Therapy (MHT) and the risk of MM. Methods Medline and Web of Science were systematically searched for eligible publications until December 2019. Our review and meta-analysis follow the PRISMA guidelines. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using a random effect model. Results The pooled analysis of all 19 studies (9 cohort and 10 case-control) showed a significant positive association of MHT with risk of MM (OR 1.19; 95% CI 1.13-1.26; I2=41.93%, p = 0.029). Excluding Uveal and intraocular MM (3 studies), MHT increased the risk of cutaneous MM (OR 1.19; 95% CI 1.13-1.26; I2=35.73%, p = 0.077). No significant publication bias could be detected. Stratifying by study design, MHT significantly increased the risk of cutaneous MM (OR 1.19; 95% CI 1.12-1.27; I2=42.52%, p = 0.107) in the cohort studies; no significant association was found in case-control studies. Conclusions This meta-analysis of available literature resulted in an increased risk of MM in women used MHT. Further investigations are necessary to increase the reliability of the results and estimate the relationship of other characteristics of MHT, such as type (opposed and unopposed estrogens) and route of administration, with MM. Key messages Menopausal Hormone Therapy (MHT) significantly increases the risk of Malignant Melanoma (MM). Further awareness of clinical practitioners should be raised on the potential association of MHT with MM.

Mid-term trends and recent birth-cohort-dependent changes in incidence rates of cutaneous malignant melanoma in Italy.

In Oceania, North America and north-western Europe, after decades of increase, cutaneous malignant melanoma (CMM) rates began to stabilise or decline before 2000. Anecdotal evidence suggests that the reversal of the incidence trend is extending to southern Europe. To obtain a formal confirmation, this nationwide study from Italy investigated the incidence trends by birth cohort. Twenty-one local cancer registries covering a population of 15 814 455 provided incidence data for primary CMM registered between 1994 and 2013. Trends in age-standardised rates were analysed using joinpoint regression models and age-period-cohort models. Age-standardised incidence showed a consistent increase throughout the period (estimated annual percent change, 3.6 [95% confidence interval, 3.2-4.0] among men and 2.5 [2.0-3.1] among women). This pattern was confirmed by a sensitivity analysis with removal of low-risk populations of southern Italy. The rates, however, showed a stabilisation or a decrease in men and women aged below 35. Using the cohort of 1949-the median cohort with respect to the number of cases for both genders-as a reference, the incidence rate ratio increased for successive cohorts born until 1973 (women) and 1975 (men), and subsequently tended to decline. For the most recent cohorts in both genders, the risk of disease returned to the level of the cohort of 1949. The changes observed in the latest generations can be interpreted as the earliest manifestations of a birth-cohort-dependent incidence decrease. Our study adds to previous data indicating that the reversal of the long-term upward incidence trend of CMM is extending to southern Europe.

Association between halo nevi and melanoma in adults: A multicenter retrospective case series

To the Editor: The halo nevus is thought to be of little concern in children. In adults, however, a new-onset halo nevus has been suggested to be a harbinger of melanoma either within the halo nevus or at distant cutaneous or noncutaneous sites, according to case reports and small case series.1Epstein W.L. Sagebeil R. Spitler L. Wybran J. Reed W.B. Blois M.S. Halo nevi and melanoma.JAMA. 1973; 225: 373-377Crossref PubMed Scopus (62) Google Scholar,2Pellegrini J.R. Wagner Jr., R.F. Nathanson L. Halo nevi and melanoma.Am Fam Physician. 1984; 30: 157-159PubMed Google Scholar Multiple widely used dermatologic reference texts3Bolognia J. Schaffer J.V. Cerroni L. Dermatology: 2-Volume Set. Elsevier, Philadelphia, PA2017Google Scholar,4James W.D. Berger T.G. Elston D.M. Andrews' Diseases of the Skin. Saunders/Elsevier, London, England2011Google Scholar and online references (eg, UpToDate.com, DermNetNZ.org) advocate extensive melanoma screening in adults with new-onset halo nevus, including full cutaneous, oral, ophthalmic, and vaginal examinations, despite limited evidence supporting an association between halo nevus and melanoma. We aimed to further investigate the association between new-onset halo nevus and melanoma in adults by evaluating the incidence of melanoma in the year after a new halo nevus diagnosis. A multicenter retrospective chart review of clinical and histopathologic records at 8 university hospitals identified 879 patients in whom 888 halo nevi were diagnosed at aged 18 years or older (Brigham and Women's Hospital [n = 80], Massachusetts General Hospital [n = 166], New York University [n = 7], Northwestern University [n = 36], Oregon Health & Science University [n = 103], University of Pennsylvania [n = 27], Huntsman Cancer Institute and the University of Utah [n = 364], and Yale University [n = 96]). Ethical approval was obtained from each university's institutional review board. Patients being treated with immunotherapy for melanoma were excluded. Mean age at halo nevus diagnosis was 36.3 years (standard deviation 13.2 years) (Table I). Clinical records review identified 95 occurrences of melanoma in these 879 patients. Only 9 halo nevi were diagnosed within 1 year before melanoma diagnosis, representing a melanoma incidence rate of 0.01 (95% confidence interval 0.004-0.017) per person per year. All 9 of these melanomas represented primary cutaneous melanoma; there were no occurrences of primary noncutaneous melanoma, metastatic melanoma, or melanoma within the incident halo nevus. None of these 9 patients presented with multiple halo nevi. The remaining 86 melanoma diagnoses occurred either before the halo nevus diagnosis (n = 78) or greater than 1 year after (n = 8) (mean 5.75 years [standard deviation 4.30 years]). Personal history of vitiligo was not significantly associated with odds of melanoma development within the year after an incident halo nevus (odds ratio 3.97; 95% confidence interval 0.65-24.2; P = .13).Table IPatient demographicsCharacteristicAll patients with HN, n = 879Patients with melanoma diagnosed in the year after a new HN, n = 9Patients without melanoma diagnoses, n = 784Mean age at HN diagnosis ± SD, y36.3 ± 13.239.1 ± 11.935.3 ± 12.7 18–39580 (66)5 (55.6)540 (68.9) 40–59212 (24.1)4 (44.4)174 (22.2) 60–7968 (7.7)051 (6.5) ≥801 (0.1)01 (0.1) Unknown18 (2.0)018 (2.3)Mean age at melanoma diagnosis ± SD, y39.4 ± 14.740.4 ± 11.8NASex Men348 (39.6)5 (55.6)307 (39.3) Women529 (60.2)4 (44.4)475 (60.6) Unknown2 (0.2)02 (0.3)Race White799 (90.9)9 (100)711 (90.7) Nonwhite18 (2.0)017 (2.2) Unknown62 (7.1)056 (7.2)Halo nevus biopsied Yes396 (45.1)6 (66.7)345 (44.0) No474 (53.9)3 (33.3)431 (55.0) Unknown9 (1.0)08 (1.0)Vitiligo Yes78 (8.9)2 (22.2)70 (8.9) No450 (51.2)3 (33.3)391 (49.9) Unknown351 (39.9)4 (44.4)323 (41.2)Values are provided as No. (%) unless otherwise indicated.HN, Halo nevus; NA, not applicable; SD, standard deviation. Open table in a new tab Values are provided as No. (%) unless otherwise indicated. HN, Halo nevus; NA, not applicable; SD, standard deviation. Limitations of the study include the retrospective design and heterogeneity by which each site identified halo nevus cases. Halo nevus and melanoma were identified by documentation and coding that may not accurately reflect the true date of onset or incidence. In conclusion, this study found that adult-onset halo nevi were associated with a 1% risk of primary cutaneous melanoma development in the year after halo nevus diagnosis, with no cases of primary noncutaneous or metastatic melanoma. This melanoma risk is comparable to that of individuals with a history of atypical nevi or personal or family history of melanoma.5Varedi A. Bishop M.D. Boucher K.M. Kim C.C. Grossman D. Powering a prospective melanoma chemoprevention trial in high-risk cohorts.Int J Dermatol. 2019; 58: e232-e234Crossref PubMed Scopus (3) Google Scholar Given these findings, we recommend annual total body skin examinations in adults with a new diagnosis of halo nevus and without additional risk factors, and we do not advocate reflexive screening for primary noncutaneous or metastatic melanoma.

Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities.

Melanoma claims annually more than 20,000 lives in Europe and is an important public health burden through its continuously increasing incidence and with its high mortality, costs, and complexity of care in advanced stages. Epidemiological surveillance is indispensable for the research into its causes, new prognostic markers, and innovative therapies, as well as for the building of efficient cancer control plans. However, important differences in the sources and availability of accurate epidemiological data exist among European countries and regions, contributing to a heterogeneous picture with 20-fold differences in the reported national melanoma incidence rates, divergent mortality trends, and solid disparities in survival across the Continent. Countries in the eastern half of Europe report the lowest incidence rates, but high case fatality, persisting and increasing mortality, a higher proportion of thicker tumors and late diagnosis, and lower survival rates. They are the least well equipped with quality cancer registration and reporting, and they lag behind in efficient cancer control plans implementation. This review highlights the main differences in melanoma epidemiology across Europe, together with an insight into their underlying causes in the areas of melanoma registration, early diagnosis, and prevention. These differences should be acknowledged and understood by physicians, researchers, and all stakeholders involved in improving melanoma care and outcomes, as no one-size-fits-all solution can tackle the melanoma problem in Europe. Instead, there is a need for nuanced strategies, adapted to the heterogeneous national and regional contexts, that would build on European diversity to eliminate the outcome disparities.

Abstract IA18: The unnecessary epidemic: Skin cancer in Hispanics and what we need to do about it

Abstract Melanoma is a highly complex disease with multifaceted etiology, whose incidence is on the rise, over and above the impact of screening. Hispanics represent an underserved and understudied population when it comes to melanoma occurrence and outcome. Hispanics are diagnosed with melanoma at later stages than their non-Hispanic white (NHW) counterparts, leading to increased likelihood of metastasis and worse survival. Hispanics are the largest ethnic group in the United States and have rising rates of melanoma, and in particular, increases in tumors with the worst prognosis. While histologic type of melanoma varies by ethnicity (Hispanics tend to get more acral lentiginous melanomas, which tend to present at a later stage), histology does not explain the poorer experience of Hispanics: they are diagnosed with later-stage disease regardless of histology. In our recent analysis, while the risk of presenting with a late-stage melanoma was higher for Hispanics (OR:1.65 [95% CI:1.52-1.79]) than NHW, the overall risk of death from melanoma after accounting for stage at diagnosis was similar for Hispanics and NHW (HR: 0.99 [95% CI: 0.94-1.04]), implying that the overall poorer prognosis for Hispanics is due almost entirely to their later stage of disease at diagnosis, rather than response to treatment or other factors (e.g., ability to access treatment) once they are diagnosed. However, the key question remaining to be answered is why Hispanics are diagnosed at a later stage: without answering that question, we cannot begin to design, test, and implement effective interventions to reduce the melanoma burden in Hispanics. A later stage of diagnosis among Hispanics (compared to NHWs) could be due to a multitude of factors, all of which are modifiable: a lack of access to appropriate screening, lack of adherence to screening recommendations, lack of understanding of appropriate screening approaches in the primary care setting (among both patients and physicians), or a combination of these factors. Addressing the epidemic of melanoma among Hispanics is not limited to investigation of factors resulting in delayed diagnosis: we also lack an understanding of the primary drivers of Hispanics’ lower overall incidence of melanoma (roughly 7 times lower than non-Hispanic whites). Melanoma risk factors either have similar frequency in Hispanics and NHWs (e.g., many large nevi) or are less frequent in Hispanics but do not explain a high proportion of disease variation (e.g., red hair). Considering current knowledge of risk factor prevalence, melanoma incidence rates should actually be similar in Hispanics and non-Hispanic whites. Understanding the factors leading to the lower overall rate of melanoma in Hispanics could help inform prevention strategies for non-Hispanic whites—or determine new genetic pathways as yet undiscovered. While it is possible that Hispanics’ rates of melanoma are lower because they practice better sun-exposure behaviors, we have recently shown that Hispanic children, while frequently engaging in some sun-protective behaviors, also had a high rate of sunburn (59%). U.S.-acculturated Hispanic children reported less shade-seeking at school (P = .001). The surprisingly high rate of sunburn in Hispanic children suggests that the way in which they are practicing sun protection is not preventing sunburns and is an alarming early warning sign for future increases in melanoma rates among Hispanics. Sun safety interventions should be targeted toward Hispanic youth to provide them with practical methods of effective sun protection, in addition to education on the risks of high sun exposure. The contrast in melanoma experience between Hispanics and NHW implies that we already know how to reduce the occurrence of late-stage melanoma in Hispanics, and a better understanding of the differing rates of melanoma among Hispanics and NHW might actually provide insight into enhanced melanoma primary prevention in both groups. Citation Format: Myles Cockburn, Jennifer Unger, Kimberly Miller. The unnecessary epidemic: Skin cancer in Hispanics and what we need to do about it [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA18.

Impact of Sun Exposure and Tanning Patterns on Next-Generation Sequencing Mutations in Melanoma

BackgroundFor the past 30 y, the incidence rate of malignant melanoma has risen steadily. Ultraviolet radiation exposure has been identified as the most prevalent modifiable risk factor for melanoma. Here, next-generation sequencing was used to analyze the relationship between multiple sun exposure factors and select cancer-related genes to determine the relationship of sun exposure on the molecular profiles of melanomas. MethodsThe collection and analysis of study samples were approved by the institutional review board. The patient cohort consisted of 173 patients whose melanoma tissue samples underwent next-generation sequencing analysis for somatic mutations of 50 cancer-related genes. Univariate and multivariate analyses were conducted. ResultsPatients with a history of blistering sunburn had an absolute mutation incidence of 1.67 mutations per patient, compared with patients without a history of blistering sunburn, who had an absolute mutation incidence of 1.16 mutations per patient (P = 0.028). A BRAF mutation was found in more tumors of patients who reported visiting a tanning salon (57.14%), compared with those who had not (18.75%; P = 0.0463). Patients with a previous history of skin cancer were more likely to have a CDKN2A mutation (20.83%), compared with those without a previous history of skin cancer (7.76%; P = 0.0292). ConclusionsThe trends seen in the molecular profiles of melanomas with respect to various sun exposure factors suggest that sun exposure impacts genetic makeup. Considering the increase in absolute mutation incidence in patients with a history of blistering sunburn suggests that additional genes may contribute to the pathology of malignancy. Future studies will use the unique molecular profiles of melanomas to personalize patient treatments.

Melanoma incidence and survival in patients with myelodysplastic syndrome: A matched cohort population-based study

To the Editor: Worse outcomes have been reported in patients with chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL) patients who develop melanoma.1 However, limited data exist regarding the influence of other hematologic malignancies on melanoma incidence and survival rates. We sought to describe melanoma outcomes in patients with pre-existing myelodysplastic syndrome (MDS), a designation that encompasses a variety of hematopoietic stem cell malignancies of leukocyte, red blood cell, or platelet origin.

Time trends and age-period-cohort analysis of cutaneous malignant melanoma incidence rates in the Romagna Region (northern Italy), 1986-2014.

After a long-term increase, the incidence of cutaneous malignant melanoma has stabilized recently or even decreased in several populations of North-western Europe, USA, Canada, Australia and New Zealand, but not in southern Europe. The incidence trends of primary invasive cutaneous malignant melanoma (International Classification of Diseases, 10th revision, codes C43.0-C43.9) in the Romagna Region (northern Italy, 1.2 million inhabitants) for the period 1986-2014 were analysed with an age-period-cohort modelling approach. The series included 2466 men and 2481 women, a total of 4947 patients. Using the method of model building, the best-fitting models were found to be an age-drift model for men and an age-period model for women. Among men, the age-specific incidence rates increased in each successive cohort born between 1916 and 1981 with an attenuation of the trend for younger ones in the last cohorts. Among younger women, a slight decrease occurred for the cohorts born after 1961. For men, the quasi-parallel appearance of incidence curves by age group and cohort on a log scale suggested that the observed change was explained by a linear cohort effect. For women, the curves tended to overlap, suggesting an interaction between age and cohort that could be explained as a nonlinear period effect. In conclusion, the long-term upward incidence trend in the study area is stabilizing among women and an attenuation of the increasing trend is occurring among younger men in the most recent cohorts. These observations need to be confirmed with longer-term studies.

Pharmacodynamic Modeling of Sunscreens: Efficacy Evaluation, Melanoma Incidences and Very Low to Very High Sun Protection Factor

Pharmacodynamic modeling of sunscreens was performed using a new concept of Skin UV Index (SUI) on the exposed skin as a parameter to evaluate the potential effectiveness of sunscreens against sun damage. The SUI predicts the UV heat intensity on the skin surface in terms of the solar UV Index at the time of the study and is calculated by solar UV Index/sunscreen’s SPF. SUI numbers for sunscreen with SPF ranging from 2 to 100 under a solar UV Index of 10 was used for illustration. Based on guidelines from WHO, Australia and New Zealand, sunscreens yielding SUI &lt; 3 are assumed to be effective against sun damage such as sunburn and melanoma. Based on the above assumption, sunscreens with SPF &gt; 4 were found to be effective when sunscreens were evenly applied at 2 mg/cm2. Review of numerous studies suggests that missing applications may represent a major, seemingly unavoidable, SPF-independent factor causing unintended sunburns for sunbathers in the US and other countrieswith a temperate climate. This might in turn become a major factor for causing exponential increase in melanoma incidence rates observed in the last few decades. For example, in an SPF 30 sunscreen study all 25 participants suffered unintendedsunburns after one week of sunbathing. Also, a mean missing application of 20% of the total exposed area and a mean missing of about 50% of the time were reported in two separate studies. Simulations were also performed with under-applications of 50% and 75%. The present simulations may provide a rationale of why routine use of a low SPF 8 sunscreen was reported to be effective against melanoma in a 2018 Australian study. Based on model simulations it is proposed that in the US, SPF 8 sunscreen and SPF 2 to 6 sunscreen may be adequate for routine, unintentional use for sun-sensitive populations and non-sun-sensitive populations, respectively.

Trends in socioeconomic inequalities in the incidence of cutaneous melanoma in Canada from 1992 to 2010

The incidence rates of cutaneous melanoma have been increasing in Canada over the past decades. This study aimed to quantify and assess trends in education- and income-related inequalities in the incidence of cutaneous melanoma in Canada (excluding territories) from 1992 to 2010. Data for the analyses were obtained from the Canadian Cancer Registry (CCR), the Canadian Census of Population (CCP), and the National Household Survey (NHS). The concentration index (C) approach was used to quantify income- and education-related inequalities in the incidence rates of cutaneous melanoma. Trend analyses were performed to evaluate changes in inequalities over the study period. Incidence rates of cutaneous melanoma increased across Canada from 1992 to 2010. The age-adjusted value of C showed a greater concentration of cutaneous melanoma amongst Canadians with higher incomes. Although the age-adjusted value of C did not suggest a significant education-related inequality in the incidence rates, the trend analyses indicate that, with time, incidence rates are becoming more concentrated amongst both males and females with lower levels of education. Incidence rates of melanoma are rising across Canada and are higher amongst individuals with higher income. Our analyses suggest that incidence rates of melanoma are becoming more concentrated amongst Canadians with lower levels of education. Consequently, campaigns and public policies related to the prevention of melanoma in Canada should focus on Canadians with higher income and lower levels of education.

Sun-Protective Behaviors: An Educational Intervention With Hospital Staff Aimed at Skin Cancer Prevention in Children.

Melanoma incidence and mortality rates are predicted to steadily increase. Sun protection is important during early development because of the potential for overexposure to ultraviolet radiation while outdoors. The purpose of this project was to design, implement, and evaluate an educational intervention provided to healthcare professionals (HCPs) with the intention of influencing the behaviors of child populations served. The project evaluated HCPs' baseline knowledge about sun-protective behaviors, their level of knowledge regarding sun-protective behaviors postintervention, their intent to change behavior, and the feasibility of implementing behavior change within the organization. Pre- to post-test knowledge significantly increased. All participants reported that they would encourage children's sunscreen usage, and 98% reported that they would support the behavior change; however, 35% indicated likeliness that they would personally use sunscreen or sun-protection methods.