Increasing incidence of lentigo maligna melanoma subtypes: Northern California and national trends 1990-2000

Stanford University, Palo Alto, California, United States
Journal of Investigative Dermatology (Impact Factor: 6.37). 10/2005; 125(4):685-91. DOI: 10.1111/j.0022-202X.2005.23852.x
Source: PubMed

ABSTRACT Worldwide, lentigo maligna melanoma (LMM) comprises 4%-15% of cutaneous melanoma and occurs less commonly than superficial spreading or nodular subtypes. We assessed the incidence of melanoma subtypes in regional and national Surveillance, Epidemiology, and End Results (SEER) cancer registry data from 1990 to 2000. Because 30%-50% of SEER data were not classified by histogenetic type, we compared the observed SEER trends with an age-matched population of 1024 cases from Stanford University Medical Center (SUMC) (1995-2000). SEER data revealed lentigo maligna (LM) as the most prevalent in situ subtype (79%-83%), and that LMM has been increasing at a higher rate compared with other subtypes and to all invasive melanoma combined for patients aged 45-64 and > or =65 y. The SUMC data demonstrated LM and LMM as the only subtypes increasing in incidence over the study period. In both groups, LM comprised > or =75% of in situ melanoma and LMM > or =27% of invasive melanoma in men 65 y and older. Regional and national SEER data suggest an increasing incidence of LM and LMM, particularly in men > or =age 65. An increased incidence of LM subtypes should direct melanoma screening to heavily sun-exposed sites, where these subtypes predominate.

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    ABSTRACT: Epidemiology of rare cutaneous malignancies in the general population is poorly documented. This descriptive study aimed to estimate the incidence and trends of all skin malignancies between 1989 and 2005. Data on skin tumors were extracted from the Netherlands Cancer registry (except for basal cell carcinoma (BCC) data-only available from Comprehensive Cancer Centre South) and categorized according to the International Classification of Diseases for Oncology, third edition, codes. Age-standardized incidence rates (European standardized population rate, ESR) per 100,000 person-years were calculated per year and for the period between 2001 and 2005. Estimated annual percentage changes (EAPCs) were estimated by Poisson regression models. A total of 356,620 skin tumors were diagnosed between 1989 and 2005. Excluding BCC, squamous cell carcinoma (SCC), and melanoma, the remaining skin tumors constituted about 2% of all skin malignancies. The incidence of melanoma showed the steepest increase (EAPC, 4.0%), and ESR was close to that observed for SCC (EAPC, 2.3%) between 2001 and 2005 (17.1 versus 19.6). Hematolymphoid tumors (ESR=0.74) were mainly cutaneous T-cell lymphomas (60.8%). No significant increases in incidence were observed for lymphomas, and appendageal, fibromatous, and myomatous carcinomas during 1989-2005. In addition to keratinocytic cancers and melanoma, there is a wide variety of skin tumors that constitute <2% of all skin malignancies. The incidence of UV-related skin tumors increased significantly and more steeply than did those of other skin malignancies.
    Journal of Investigative Dermatology 03/2010; 130(7):1807-12. DOI:10.1038/jid.2010.58 · 6.37 Impact Factor
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    ABSTRACT: Skin cancer has been shown to present asymmetrically, prevalent on the left side of the body, more so in subtypes of cutaneous melanoma such as lentigo maligna. Biases have been linked to cumulative UV light exposure and automobile driving patterns. Though left-right ratios have previously correlated with the side men or women tend to position themselves or countries drive on, more recent trends indicate a consistent left-sided bias. To clarify reasons for changing trends, a review of the evidence base and LM’s laterality in a UK cohort (99 cases 2000-2011) was conducted for the first time. The strong correlation of left-sided excess, found in both genders (ratios 1.381-1.5, 0.841), is congruent with more recent findings. Though evidence indicates that driving position is no longer a risk factor for LM, due most likely to improved car window UV protection, it remains the most commonly attributed cause. Understanding phenomena such as UV lights “scatter effect” or that cumulative exposure may not be a significant risk factor helps rationalize older conclusions that would otherwise appear contradictory. The reasons for left-sided excess remain unclear but may be due to factors requiring further research such as the body’s anatomical/embryological asymmetry.
    Dermatology Research and Practice 01/2015; 2015:1-6. DOI:10.1155/2015/310270
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    ABSTRACT: Background Malignant melanoma is a form of skin cancer associated with significant mortality once it has spread beyond the skin. Melanoma in situ (MIS) is the earliest histologically recognisable stage of malignant melanoma and represents a precursor of invasive melanoma. Lentigo maligna (LM) represents a subtype of pre-invasive intraepidermal melanoma associated specifically with chronic exposure to ultraviolet (UV) radiation. Over the past two decades, the incidence of MIS has increased significantly, even more than the invasive counterpart. There are several treatment options for MIS, but no consensus exists on the best therapeutic management of this condition. Objectives To assess the effects of all available interventions, surgical and non-surgical, for the treatment of melanoma in situ, including LM. Search methods We searched the following databases up to November 2014: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2014, Issue 10), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), African Index Medicus (from inception), IndeMED of India (from inception), and Index Medicus for the South-East Asia Region (IMSEAR) (from inception). We scanned the references of included and excluded studies for further references to relevant trials and searched five trials registries. We checked the abstracts of major dermatology and oncology conference proceedings, and we shared our lists of included and excluded studies with industry contacts and other experts in the field of melanoma to try to identify further relevant trials. Selection criteria We included randomised controlled trials (RCT) on the management of MIS, including LM, that compared any intervention to placebo or active treatment. We included individuals, irrespective of age and sex, diagnosed with MIS, including LM, based on histological examination. Data collection and analysis Two authors independently evaluated possible studies for inclusion; extracted data from the included study using a standard data extraction form modified for our review; assessed risk of bias; and analysed data on efficacy, safety, and tolerability. They resolved any disagreements by discussion with a third author. We collected adverse effects information from included studies. Main results Our search identified only 1 study eligible for inclusion (and 1 ongoing study in active recruitment stage), which was a single centre, open label, parallel group, 2-arm RCT with 90 participants, who had 91 histologically proven LM lesions. Forty-four participants, with 44 LM lesions, were treated with imiquimod 5% cream 5 days per week plus tazarotene 0.1% gel 2 days/ week for 3 months, and 46 participants, with 47 LM lesions, were treated with imiquimod 5% cream 5 days per week for 3 months. Two months after cessation of topical treatment, the initial tumour footprint was excised using 2 mm margins via a staged excision. This study was open label, and analysis was not intention-to-treat, leading to a high risk of incomplete outcome data. Our primary outcome 'Histological or clinical complete response' was measured at 5 months in 29/44 participants (66%) treated with imiquimod plus tazarotene (combination therapy) and 27/46 participants (59%) treated with imiquimod (monotherapy). The difference was not statistically significant (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.81 to 1.55, P value = 0.48). With regard to our secondary outcomes on recurrence and inflammation, after amean follow up of 42 months, no local recurrences were observed among complete responders. Difference in overall inflammation score between the 2 groups was significant (mean difference (MD) 0.6, 95% CI 0.2 to 1, P value = 0.004), with the mean overall inflammation score being significantly higher in the combination group. The study authors did not clearly report on side-effects. Because of adverse effects, there was a dropout rate of 6/44 participants (13.7%) in the combination group compared with 1/46 (2.2%) in the imiquimod monotherapy group (due to excessive inflammation) before the cessation of topical treatment (first 3 months), but this was not statistically significant (RR 6.27, 95% CI 0.79 to 50.02, P value = 0.08). Authors' conclusions There is a lack of high-quality evidence for the treatment of MIS and LM. For the treatment of MIS, we found no RCTs of surgical interventions aiming to optimise margin control (square method, perimeter technique, 'slowMohs', staged radial sections, staged "mapped" excisions, or Mohs micrographic surgery), which are the mostwidely used interventions recommended as first-line therapy. The use of non-surgical interventions in selected cases (patients with contraindications to surgical interventions) may be effective and may be considered preferable for experienced providers and under close and adequate follow up. For the treatment of LM, we found no RCTs of surgical interventions, which remain the most widely used and recommended available treatment. The use of non-surgical interventions, such as imiquimod, as monotherapy may be effective and may be considered in selected cases where surgical procedures are contraindicated and used preferentially by experienced providers under close and adequate follow up. The use of topical therapies, such as 5-fluorouracil and imiquimod, as neoadjuvant therapies warrants further investigation. There is insufficient evidence to support or refute the addition of tazarotene to imiquimod as adjuvant therapy; the current evidence suggests that it can increase topical inflammatory response and withdrawal of participants because of treatment-related side-effects.
    Cochrane database of systematic reviews (Online) 12/2014; 12(12):CD010308. DOI:10.1002/14651858.CD010308.pub2 · 5.70 Impact Factor

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