Light-skinned Populations Research Articles

Treatment of malignant melanoma - a review of the literature

Melanoma is caused by genetic mutations in melanocytes, pigment-producing cells found in the skin, eye, inner ear, and soft meninges. Sun exposure, atypical nevi, previous history of melanoma, and the presence of multiple (≥40) common nevi were found to be associated with an increased risk of melanoma detection (OR: 1. 3; 95% CI: 1. 1-1. 6). Its prevalence is highest among light-skinned populations and in regions of lower latitudes. Significance of family history of melanoma and presence of congenital nevi were excluded. For localized primary melanoma, the dominant prognostic factors for survival are lesion thickness, ulceration, and lymph node involvement Understanding the pathogenesis of melanoma has been crucial in developing new therapeutic approaches. The characterization of oncogenic signaling pathways and interactions has made it possible to identify new targets for clinically effective therapies, such as pathway inhibitors and antibodies to immune checkpoints or the use of phototherapy. In this article we describe the main signaling pathways which are deregulated in melanoma. We also mention how it has become a viable and crucial strategy for melanoma therapy and then thoroughly review the safety, clinical efficacy and progress regarding PDT- promising alternative therapy and the immunotherapies of melanoma in especially advanced metastatic stage basing on published clinical data and registered clinical trials, most of which are in phase III.

Phenolic-rich apple extracts have photoprotective and anti-cancer effect in dermal cells

BackgroundSkin cancer is the most common type of malignancy in light-skinned populations and phenolics are promising anticarcinogenic agents. PurposeTo characterise and evaluate the protective potential of apple extracts against the DNA damage caused by UV-radiation in culture of human fibroblasts as well as to verify the anticarcinogenic effect of these extracts in murine and human melanoma cells. MethodsAcetone-ethanol extracts of apple were purified and fractionated by solid phase extraction. Four phenolic fractions (PF-I, PF-II, PF-III, PF-IV) and one Unfractionated Phenolics (UFP) were obtained. The presence of amygdalin, hydroxycinnamic acid, flavonols, flavanols and dihydrochalcones was confirmed by High-Performance Liquid Chromatography–Mass Spectrometry. ResultsFollowing 48 h exposure to UV-radiation, UFP, PF-III and PF-IV protected (14–34 %) fibroblast DNA against UV-radiation; the UFP and PF-IV, both at 31.25 μg.mL−1, showed high antiproliferative effect in murine melanoma cells (B16F10); UFP and PF-IV, both at 125 μg.mL−1, and PF-II, at 250 μg.mL−1, were effective against human melanoma cells (SK-Mel-103). ConclusionsThe results indicate that phenolic extracts from apple (Malus domestica Borkh cv. Gala) have potential for use in the formulation of cosmetic products and/or medicines for the protection of cellular DNA against UV radiation and for the treatment of melanoma.

Environmental factors’ contribution in skin cancer etiology

Skin cancers are the most frequent types of malignant tumors worldwide, being mostly found in light-skinned populations, with a ratio of 30%. Approximately 3 million non-melanoma skin cancers and 132000 melanoma cases are diagnosed globally each year. The most frequent skin cancers are the basal cell carcinoma, squamous cell carcinoma and malignant melanoma. The incidence, morbidity and mortality of skin cancers are on the rise and have become a major public health concern. We aim to review the most important environmental factors involved in the development of skin cancers, along with the incidence rates and preventive behaviors or strategies (including personal behavioral changes and public educational initiatives). Ultraviolet radiation (UVR) is a well-known physical hazard, responsible for photoaging, photoallergy and phototoxic reactions, being heavily involved in carcinogenesis, including melanoma development. Overexposure to natural and artificial UVR is a public health problem. Sunburns, especially in childhood, are an important risk factor for melanoma development. Excessive exposure causes cumulative damage which determines immune suppression and skin cancer initiation. Transplant patients and AIDS patients have an increased incidence of skin cancer. Some treatment methods, including radiotherapy, phototherapy and psoralen and ultraviolet A (PUVA) therapy can lead to skin cancer development. Viral infections such as those with human papilloma virus can trigger the initiation of squamous cell carcinoma. Patients with familial genetic syndromes are highly sensitive to certain types of skin cancers. Ionising radiation, environmental pollutants, chemical carcinogenic agents and work exposure have been associated with skin cancer. Artificial UV radiation exposure (tanning beds and lamps), aging, skin color, personal diet and smoking are important risk factors. Ultraviolet radiation is the main etiological agent in skin cancer development. A better understanding of the causative factors is an essential step in skin cancer prevention.

A Violent Guatemala

Among ethnic disasters of the past few decades, few can match in intensity or have been reported in the media more extensively than those of the Indigenous in Guatemala. The social structure of the nation—its hierarchy, driven by a light-skinned population, most of whom are ethnically mestizo but who do not identify with the purely Indigenous—its history, and its small size make it an important site for the documentation and reporting of ethnic disputes and differences.

Ultraviolet radiation and cutaneous melanoma: a historical perspective.

In this article, we summarize the research that eventually led to the classification of the full ultraviolet (UV) radiation spectrum as carcinogenic to humans. We recall the pioneering works that led to the formulation of novel hypotheses on the reasons underlying the increasing burden of melanoma in light-skinned populations. It took long before having compelling evidence on the association between UV and melanoma, in particular, the importance of UV exposure during childhood for both the occurrence of melanoma and death. The role of UVA was established only after 2005. If molecular lesions caused by UV radiation are better known, the precise mechanism by which UV exposure drives melanoma occurrence and progression still needs to be elucidated. More research on the UV-melanoma relationships has led to more evidence-based sun-protection recommendations, especially for children, and to effective control of the artificial UV tanning fashion. Since around 1985-1995, the mortality because of melanoma has started to decrease in younger age groups in most light-skinned populations. If sun protection among children remain on top of public health agendas, there is a fairly great chance that melanoma mortality will stabilize and steadily decrease in all light-skinned populations. The introduction of effective therapies against metastatic disease will improve this reversal in mortality trends.

Maximum UV Index Records (2010–2014) in Quito (Ecuador) and Its Trend Inferred from Remote Sensing Data (1979–2018)

To prevent adverse health effects, the World Health Organization promotes the diffusion of the ultraviolet radiation index (UVI), with messages promoting precautionary behaviors, through a scale that considers extreme UVI values to be larger than 11.0. This scale came from a proposal from Canada, a country with a mostly light-skinned population, which experiences maximum UVI values up to 10.0. A modified scale was proposed, adapted to the skin types and the UVI levels in South America, which considers extreme values larger than 16.0. The records from 2010 to 2014 indicated that UVI is frequently larger than 11.0 (40.0–76.1% of the days per month) in Quito (Ecuador). The number of days per month with levels larger than 16.0 varied between 0.7% and 32.0%. We found that the maximum UV index levels do not occur necessarily around the local solar noontime. As the basis for a self-warning system in Quito and based on their skin type and UVI levels, people should know the exposure time before damage can take place. The Tropospheric Emission Monitoring Internet Service (TEMIS) computed the UVI at local solar noontime and under clear-sky conditions. The records from 2010 to 2014 were congruent with the corresponding TEMIS values. We did not identify any trend of the daily TEMIS UVI values during 1979 to 2018, which, used as a proxy, suggested the real UVI levels in Quito during 2010 to 2018 varied in a range similar to 1979–2009.

Systematic Review and Meta-Analysis of the Accuracy of Confocal Microscopy in the Diagnosis of Skin Cancer

Background: Nonmelanoma skin cancer (Basal Cell Cancer (BCC) and Squamous Cell Cancer (SCC)) are the most prevalent cancer in the light-skinned population. The incidence of melanoma has been increasing steadily throughout the world. Early recognition of skin cancer without doing biopsy remains challenging. The development of noninvasive diagnostic technologies is highly relevant and desired. Confocal Laser Scanning Microscopy (CLSM) enables in vivo and ex vivo imaging of human skin at a quasi-histologic resolution. Methods and Materials: Several databases like Medline, Embase, all EBM reviews (ACP Journal Club, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects) and Journals@Ovid were used to perform a literature search on CLSM in the diagnosis of melanoma and non melanoma skin cancers. Standards for Reporting of Diagnosis Accuracy (STARD) initiative checklist and National Institute for Health and Clinical Excellence (NICE) guidelines on methodology were used to assess the quality of the studies found. Eight studies fulfilling relevant criteria inclusive of assessment of diagnostic accuracy of CSLM and histopathology were selected. Heterogeneity among the studies was assessed and the data was pooled for meta- analysis. Results: The eight included studies did not have considerable heterogeneity between them. The pooled sensitivity for melanoma diagnosis was 91.4% and for BCC diagnosis was 90.1%. Pooled specificities were 79.9% and 92.6% for malignant melanoma and BCC respectively. Diagnostic odds ratios for melanoma and BCC were 80.1 and 358.1 respectively. Conclusions: From the limited good quality available literature we found that CLSM has the potential to be an additional noninvasive diagnostic test to dermoscopy for the diagnosis of BCC and melanoma.

Nichtmelanozytärer Hautkrebs

Non-melanoma skin cancer (NMSC) is the most common malignancy of the light-skinned population with an enormous socioeconomic impact. Historically known as incurable under the term noli me tangere (transl. do not touch me), today various non-melanocytic cutaneous neoplasms are grouped as NMSC. The most common of these, basal cell carcinoma, squamous cell carcinoma and actinic keratoses as carcinomas in situ, are increasingly called keratinocyte carcinoma. Today, the pathogenesis and risk factors of NMSC are relatively well understood, which has led to multiple treatment options, the recognition of NMSC as an occupational disease in Germany and a variety of prevention approaches. Although there is largely general consensus in the dermatological world, knowledge of affected high-risk groups in NMSC and prevention is still very low. The development of target group-oriented awareness and prevention campaigns are therefore urgently needed.

Continued Increase in Melanoma Incidence across all Socioeconomic Status Groups in California, 1998–2012

Melanoma incidence has been increasing in light-skinned populations worldwide, but the reasons for the increase have been controversial. Our prior assessment in California non-Hispanic whites showed substantial increases in invasive melanoma incidence for tumors of all thicknesses in all neighborhoods categorized by socioeconomic status (SES) between 1988-1992 and 1998-2002. To understand whether these trends continued, we updated our assessment to include the diagnosis period 2008-2012 and more accurate pathologic stage at diagnosis. We used the California Cancer Registry to calculate age-adjusted incidence rates for over 58,000 newly diagnosed melanomas. Incidence rates not only continued to rise over the 10-year period from 1998-2002 and 2008-2012 but also showed significant increases in almost all groups defined jointly by tumor thickness or stage at diagnosis and a small area (census tract) SES measure. The largest relative rate increases were seen for regional, distant, and ulcerated disease, especially among males living in the lowest SES neighborhoods. Considering tumor thickness and stage as proxies for time to screening detection and neighborhood SES as a proxy for health care access, we interpret this pattern to indicate continued, true increases in melanoma occurrence as opposed to a thin tumor phenomenon simply driven by improved access to care.

The forthcoming inexorable decline of cutaneous melanoma mortality in light-skinned populations

BackgroundReasons underlying time changes in cutaneous melanoma mortality in light-skinned populations are not well understood. An analysis of long-term time trends in melanoma mortality was carried out after regrouping countries in homogeneous regions. MethodsUsing the World Health Organisation (WHO) mortality database, age–period–cohort models were fitted for seven regions where the majority of population is light-skinned. Cohort effects are denoted as changes in rates occurring at different times in steadily older age groups. Period effects are denoted as changes in rates occurring simultaneously in several age groups. ResultsCohort effects better explained changes in melanoma mortality over time than period effects. Lifetime risk to die from melanoma increased in successive generations from 1875 until a peak year. Peak years were for subjects born in 1936–1940 in Oceania, 1937–1943 in North America, 1941–1942 in Northern Europe, 1945–1953 in the United Kingdom (UK) and Ireland, 1948 in Western Europe and 1957 in Central Europe. After peak years, lifetime risk of melanoma death gradually decreased in successive generations and risks of subjects born in 1990–1995 were back to risk levels observed for subjects born before 1900–1905. In Southern Europe, birth years with highest lifetime risk of melanoma death have not yet been attained. As time passes, melanoma deaths will steadily rarefy in younger age groups and concentrate in older age groups, for ultimately fade away after 2040–2050. ConclusionIndependently from screening or treatment, over next decades, death from melanoma is likely to become an increasingly rare event. The temporary epidemic of fatal melanoma was most probably due to excessive UV-exposure of children that prevailed in 1900–1960, and mortality decreases would be due to progressive reductions in UV-exposure of children over the last decades.

Why complex cognitive ability increases with absolute latitude

Evolutionary psychologists attribute the superior IQs of light-skinned populations to genetic imprints left by millenary processes promoted by cold. But a novel theory that explains IQ gains observed across recent generations ascribes them to a latitude→UVB radiation→vitamin D3→parents' sexual hormones→family size→child's intellectual environment→IQ chain of effects. Analyses of 506,347 Peruvian children's math and reading scores from a national census confirmed that complex cognitive ability increases with absolute latitude even under tropical megathermal climates and decreases with high altitude above sea level, birth rate and social development mediate most of the effects, and reading is more strongly influenced than math. The findings weaken the evolutionary cold hypothesis and strengthen the view that contraception has the potential to reduce latitudinal IQ gaps.

The German SCREEN project--design and evaluation of the communication strategy.

Skin cancer is the most common cancer in light-skinned populations worldwide. Primary and secondary preventive activities such as skin cancer screening are intended to reduce skin cancer burden. In 2003, a population-based skin cancer screening project [SCREEN (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany)] was conducted in Northern Germany with more than 360,000 people screened. SCREEN was supported by a communication intervention that was aimed at informing the population about skin cancer, its risk factors and the screening intervention as well as preparing the health professionals for the project. Within SCREEN both physicians and practice nurses were educated in counselling. The aim of the present article is to describe and evaluate the communication strategy accompanying SCREEN. Two computer-assisted telephone interview surveys were performed in April/May 2003 and May 2004. Participants had to be members of the statutory health insurance and be aged 20 years. They were asked about knowledge of skin cancer, perception of physicians' performance and skin cancer screening in general. Data are mainly presented in a descriptive manner. For statistical analyses, Mann-Whitney U test and Pearson's chi-square test were used. Knowledge about sunburn in childhood and high ultraviolet exposure as skin cancer risk factors increased during SCREEN. Simultaneously, the awareness for early detection of skin cancer increased significantly from 41.3 to 74.0% (P < 0.001). A total of 21.5% of the interviewees participated in the skin cancer screening project, similar to the population-based participation rate reached. A comprehensive communication strategy accompanying a screening intervention improves the knowledge of potential screenees and may additionally increase the participation rate.

Country of origin, age at migration and risk of cutaneous melanoma: A migrant cohort study of 1,100,000 Israeli men

Cutaneous melanoma (CM) is a common cancer with increasing incidence in many parts of the world where light-skinned populations live. We conducted a large-scale nationally representative migrant cohort study to assess country of origin and age at migration as predictors of CM, controlling for possible confounders. Data on 1,086,569 Israeli Jewish males, who underwent a general health examination before compulsory military service at ages 16-19 between the years 1967-2005, were linked to Israel National Cancer Registry to obtain incident CM up to 2006. Cox proportional hazards was used to model time to event. Overall, 1562 incident cases were detected during 19.3 million person-years of follow-up. Origin was a strong independent predictor of CM. Incidence was higher for European (hazard ratio [HR] = 4.08, 95% confidence interval [CI]: 3.55-4.67) and Israeli origin (HR = 2.92, 95% CI: 2.25-3.79) compared to N. African/Asian origin, adjusted for year of birth, years of education, residential socio-economic position, rural residence and body surface area (or height). Among those of European origin, the adjusted risk was significantly lower for those who immigrated after the age of 10 years (HR = 0.58, 95% CI: 0.45-0.73) but not for younger ages (HR = 1.02, 95% CI 0.84-1.23) compared to Israeli born. The high rates of CM among men of European origin and the almost twofold lower risk among those immigrating after age 10 provide solid support for the deleterious role of childhood sun exposure as a risk factor for melanoma. These findings will serve in directing public health and research efforts.

The Relationship Between Occupational Sun Exposure and Non-Melanoma Skin Cancer

The cumulative effect of solar ultraviolet (UV) radiation is responsible for the worldwide increase in non-melanoma skin cancer, a category that includes squamous cell carcinoma and its precursors (the actinic keratoses) as well as basal-cell carcinoma. Non-melanoma skin cancer is the most common type of cancer in areas of the world with a light-skinned population. The occupational exposure to UV radiation is high in many outdoor occupations; recent studies suggest that persons working in such occupations are more likely to develop non-melanoma skin cancer. On the basis of a selective review of the literature, we present the current state of knowledge about occupational and non-occupational UV exposure and the findings of meta-analyses on the association of outdoor activity with non-melanoma skin cancer. We also give an overview of the current recommendations for prevention and for medicolegal assessment. Recent meta-analyses have consistently documented a significantly higher risk of squamous cell carcinoma of the skin among persons who work outdoors (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.40-2.22, p<0.001). There is also evidence for an elevated risk of basal-cell carcinoma (OR 1.43, 95% CI 1.23-1.66, p = 0.0001), but the effect is of lesser magnitude and the study findings are not as uniform. The association of occupational exposure to solar UV radiation with squamous cell carcinoma, including actinic keratosis, has been conclusively demonstrated. It follows that, in Germany, suspected non-melanoma skin cancer in persons with high occupational exposure to UV radiation should be reported as an occupational disease under § 9, paragraph 2 of the Seventh Book of the German Social Code (Sozialgesetzbuch, SGB VII). Preventive measures are urgently needed for persons with high occupational exposure to UV radiation.

Mutagen-specific mutation signature determines global microRNA binding.

Micro-RNAs (miRNAs) are small non-coding RNAs that regulate gene products at the post-transcriptional level. It is thought that loss of cell regulation by miRNAs supports cancer development. Based on whole genome sequencing of a melanoma tumor, we predict, using three different computational algorithms, that the melanoma somatic mutations globally reduce binding of miRNAs to the mutated 3′UTRs. This phenomenon reflects the nature of the characteristic UV-induced mutation, C-to-T. Furthermore, we show that seed regions are enriched with Guanine, thus rendering miRNAs prone to reduced binding to UV-mutated 3′UTRs. Accordingly, mutation patterns in non UV-induced malignancies e.g. lung cancer and leukemia do not yield similar predictions. It is suggested that UV-induced disruption of miRNA-mediated gene regulation plays a carcinogenic role. Remarkably, dark-skinned populations have significantly higher GC content in 3′UTR SNPs than light-skinned populations, which implies on evolutionary pressure to preserve regulation by trans-acting oligonucleotides under conditions with excess UV radiation.

Recommended summer sunlight exposure amounts fail to produce sufficient vitamin D status in UK adults of South Asian origin

The cutaneous synthesis of vitamin D is dependent on UVB from sunlight, but melanin reduces the penetration of UVB and thus contributes to vitamin D insufficiency in individuals with darker skin. The national guidance provided on amounts of sunlight exposure in the United Kingdom is for the light-skinned population, and in the absence of dedicated information, darker-skinned people may attempt to follow this guidance. We determined the relative effect of a simulation of UK recommendations of summer sunlight exposure on the vitamin D status of individuals of South Asian ethnicity compared with that of whites. In a prospective cohort study, simulated summer sunlight exposures were provided under rigorous dosimetric conditions to 15 adults (aged 20-60 y) of South Asian ethnicity, and serum 25-hydroxyvitamin D [25(OH)D] was measured weekly. Dietary vitamin D intake was estimated. Outcomes were compared with those of 109 whites (aged 20-60 y) treated with the identical UV-radiation exposure protocol. At baseline (winter trough), all South Asians were vitamin D-insufficient [25(OH)D concentrations <20 ng/mL], and 27% of South Asians were vitamin D-deficient [25(OH)D concentrations <5 ng/mL]; although 25(OH)D concentrations increased postcourse (P < 0.0001), all South Asians remained vitamin D-insufficient. The mean increase in 25(OH)D was 4.3 compared with 10.5 ng/mL in the South Asian and white groups, respectively (P < 0.0001), and 90% of the white group reached vitamin D sufficiency postcourse. The median dietary vitamin D intake was very low in both groups. Sunlight-exposure recommendations are inappropriate for individuals of South Asian ethnicity who live at the UK latitude. More guidance is required to meet the vitamin D requirements of this sector of the population. This study was registered at www.isrctn.org as ISRCTN 07565297.

Targeted Therapy in Nonmelanoma Skin Cancers

Nonmelanoma skin cancer (NMSC) is the most prevalent cancer in light-skinned populations, and includes mainly Basal Cell Carcinomas (BCC), representing around 75% of NMSC and Squamous Cell Carcinomas (SCC). The incidence of these tumors is continuously growing. It was found that the overall number of procedures for NMSC in US rose by 76%, from 1,158,298 in 1992 to 2,048,517 in 2006. Although mortality from NMSC tends to be very low, clearly the morbidity related to these skin cancers is very high. Treatment options for NMSC include both surgical and nonsurgical interventions. Surgery was considered the gold standard therapy, however, advancements in the knowledge of pathogenic mechanisms of NMSCs led to the identification of key targets for drug intervention and to the consequent development of several targeted therapies. These represent the future in treatment of these common forms of cancer ensuring a high cure rate, preservation of the maximal amount of normal surrounding tissue and optimal cosmetic outcome. Here, we will review recent advancements in NMSC targeted therapies focusing on BCC and SCC.

Seasonality of cutaneous melanoma diagnosis in Northern Ireland with a review

In light-skinned populations, the incidence of cutaneous melanoma is highest in summer and lowest in winter. We analyzed the seasonal variation of melanoma incidence in Northern Ireland from 1984 to 2006 according to the Breslow thickness and body site. We also reviewed earlier studies on seasonal variation in the diagnosis of melanoma. Two-thirds of melanomas in women (2028 cases) and one-third of melanomas in men (1230 cases) were diagnosed on the limbs. In both sexes, pronounced seasonal variations were observed in the incidence of invasive melanomas less than 2 mm arising on the limbs. These seasonal variations were mainly noticeable in women of all ages, to a lesser degree in men aged below 50 years, and not in men aged above 50 years. No seasonal variation was observed for melanomas less than 2 mm arising on the trunk or the head and neck nor for melanomas 2 mm thickness or more, irrespective of the age, sex, and body site. Seasonal variations of thin melanomas were less noticeable in men because of the axial predominance of melanoma occurrence in this sex. The review of 15 earlier studies found by a systematic search of Medline supported the likelihood of our findings. This analysis suggests that ultraviolet radiation has a short-term promotional effect on melanocytes or nevocytes of the limbs, and is not associated with progression from thin to thick melanoma.

Epidemiological evidence that UVA radiation is involved in the genesis of cutaneous melanoma

Epidemiological data have contributed to the classification in 2009 of the full ultraviolet (UV) radiation spectrum as carcinogenic to humans. We reviewed the epidemiological evidence that UVA could be involved in the genesis of cutaneous melanoma. Use of artificial UV tanning devices (sunbeds) consists mainly of repeated exposure to high UVA doses. Epidemiological studies published over the last years confirmed the association between sunbed use and melanoma. Sunbed use is the most probable cause of an epidemic of melanoma that took place in Iceland from 1990 to 2006. The four-fold increase in melanoma incidence was not followed by an increase in melanoma mortality. Sunscreens were primarily devised for the prevention of sunburn, and UVB is the wavelength causing most sunburns. All observational studies and randomized trials show that sunscreen use may extend sun exposure intended for getting a tan, while it does not necessarily decrease sunburn occurrence. Sunscreen use for tan acquisition would thus lead to similar exposure to UVB and greater exposure to UVA, which could explain the slightly higher melanoma risk often found among sunscreen users. UVA could be involved in the occurrence of nonlife-threatening melanoma. The increasing use of sunbeds and of sunscreens may partly explain why melanoma incidence increases in most light-skinned populations without concomitant increase in mortality.

Comparison of the diagnostic accuracy of whole-body MRI and whole-body CT in stage III/IV malignant melanoma

Malignant melanoma (MM) is dramatically increasing in light-skinned populations worldwide. Staging and regular follow-up examinations are essential. The purpose of this study was to compare the diagnostic accuracy of whole-body MRI with the standard diagnostic algorithm (whole-body CT and brain MRI) in patients with stage III/IV MM. A group of 50 consecutively admitted patients with stage III/IV MM were included in the study. Whole-body CT and brain MRI scans were performed. Additionally, all patients underwent a whole-body MRI (1.5 Tesla Magnetom Avanto, Siemens Healthcare Sector, Erlangen). The findings were compared on a lesion-by-lesion basis as part of clinical routine follow-up. 33 patients received a follow-up CT and were evaluated. Overall, 824 lesions were detected. The sensitivity of whole-body MRI was observer-dependent. MRI was slightly less sensitive than CT according to the findings of the two most experienced observers (73.4 % vs. 78.2 %, p = 0.0744). CT was significantly more sensitive in the detection of small (1-5 mm) pulmonary nodules (2.9 % vs. 66.9 %, p < 0.0001). Yet overall, MRI was significantly more specific than CT (83.4 % vs. 50.4 %, p < 0.0001). Whole-body MRI in compliance with standard requirements for the observers (high level of experience) should be considered as an appropriate alternative to CT without ionizing radiation, particularly for young patients with advanced MM.