Cancer Research: Skin cancer diagnoses rise by 45% in a decade

Cancer Research UK| July 2019 | Skin cancer rates rocket by 45% in 10 years 

Figures analysed by Cancer Research UK (CRUK) demonstrate that in the 10 years since 2004 skin cancer rates rose by  more than a third (35%) for women and by almost three-fifths (55%) for men.

The figures have been released to mark the launch of the charity’s Own Your Tone campaign which encourages people to embrace their natural skin tone and protect their skin from too much sun.

Image source: cancerresearchuk.org

Melanoma skin cancer is the fifth most common cancer in the UK and the second most common cancer in people aged 25-49, but almost 90% of melanoma cases could be prevented if people took better care of their skin in the sun both at home and abroad. Getting sunburnt, just once every two years, can triple the risk of melanoma skin cancer.

Karis Betts, health information manager at Cancer Research UK, said: “Sun safety is not just for when you’re going abroad, the sun can be strong enough to burn in the UK from the start of April to the end of September, so it’s important that people are protecting themselves properly both at home and further afield when the sun is strong. We want to encourage people to embrace their natural look and protect their skin from UV damage by seeking shade, covering up and regularly applying sunscreen with at least SPF 15 and 4 or 5 stars.” (Source: Cancer Research UK)

Read the full press release from Cancer Research UK 

In the news:

Independent Cheap flights blamed as skin cancer rates soar by 45 per cent in a decade

BBC News Skin cancer risk ‘not just from holiday sun’

Improving outcomes for people with skin tumours including melanoma

NICE | 2019| 2019 surveillance of melanoma: assessment and management (NICE guideline NG14) and improving outcomes for people with skin tumours including melanoma (NICE guideline CSG8)

NICE will update the following guidelines:

• Melanoma: assessment and management (NICE guideline NG14)
• Improving outcomes for people with skin tumours including melanoma (NICE guideline CSG8)

Full details are available from NICE 

Leeds research: Smoking may limit body’s ability to fight skin cancer

University of Leeds | February 2019 | Leeds research: Smoking may limit body’s ability to fight skin cancer

A study of more than 700 melanoma patients, mainly from the north of England, provides evidence to suggest that smoking may blight the immune response against melanoma and reduce survival.

The study led by experts at the University of Leeds found that people diagnosed with melanoma who also smoked/ had history of smoking are 40 per cent less likely to survive their melanoma than non-smokers within a decade of diagnosis.

In a subset of 156 patients who had the most genetic indicators for immune cells, smokers were around four and a half times less likely to survive from the cancer than people who had never smoked.

Lead author Julia Newton-Bishop, Professor of Dermatology at the University of Leeds, said: “The immune system is like an orchestra, with multiple pieces. This research suggests that smoking might disrupt how it works together in tune, allowing the musicians to continue playing but possibly in a more disorganised way.

“The result is that smokers could still mount an immune response to try and destroy the melanoma, but it appears to have been less effective than in never-smokers, and smokers were less likely to survive their cancer.

“Based on these findings, stopping smoking should be strongly recommended for people diagnosed with melanoma.” (Source: University of Leeds)

Read the press release from the University of Leeds 

This study was funded by Cancer Research UK and has been published in the journal Cancer Research

Pozniak, J. et al.| 2019| Genetic and environmental determinants of immune response to cutaneous melanoma| Cancer Research| DOI: 10.1158/0008-5472.CAN-18-2864

Skin cancer rates in England far higher than previously thought

Data from a newly established UK skin cancer database, the largest database of its kind in the world, has revealed that there are over 45,000 cutaneous squamous cell carcinomas (cSCC) every year in England, 350 per cent more than previous estimates suggested | JAMA Dermatology | via ScienceDaily

Developed by experts at Queen Mary University of London and Public Health England (PHE), and funded by the British Association of Dermatologists, the database fills in gaps in the recording of skin cancer, ensuring that accurate numbers for the three most common types of skin cancer: melanoma, basal cell carcinoma (BCC), and cSCC, are available for the whole of the UK.

These data are important as they enable researchers and policy makers to evaluate the effectiveness of prevention initiatives, screening, staging (the process of grading a cancer in terms of size, depth and whether it has spread to other parts of the body), and treatments for what is a very common cancer. The study has been published in JAMA Dermatology.

Full story at ScienceDaily

Journal reference: Venables, Z. et al. |  Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England |  JAMA Dermatology | 2018

Can artificial UV radiation cause malignant melanoma in humans?

A new study published in the Anticancer Research journal, refutes reports from the World Health Organization (WHO) and the EU.

The international team of researchers has conducted a thorough search of the scientific databases MEDLINE and ISI Web of Science for relevant studies and subjected the results to a systematic meta-analysis.

 

Although the team found an association of a slightly increased melanoma risk when comparing ‘ever’ versus ‘never’ sunbed users, they identified significant shortcomings in the scientific studies they included in their meta-analysis. Many of the earlier published results were based on observational studies with poor quality data that fail to support causation.

Full story at  Science Daily 

 

Full reference: Burgard et al. Solarium Use and Risk for Malignant Melanoma: Meta-analysis and Evidence-based Medicine Systematic Review | Anticancer Research| 2018 DOI: 10.21873/anticanres.12339

 

A related publication  critically appraises reports recently published by the WHO and the EU regarding sun bed use.  The authors are  deeply concerned that these assessments appear to be based on an incomplete, unbalanced and non-critical evaluation of the literature.

Professor Reichrath, one of the researchers,  cautions that “the current state of scientific knowledge in the field does not allow one to conclude that moderate solarium use results in an increased risk of malignant melanoma.”

Full reference: Reichrath et al. A Critical Appraisal of the Recent Reports on Sunbeds from the European Commission’s Scientific Committee on Health, Environmental and Emerging Risks and from the Word Health Organization. Anticancer Research, 2018 DOI: 10.21873/anticanres.12330

 

Skin Cancer in England

Skin Cancer in England: A look at melanoma skin cancer over 20 years. 

Office for National Statistics have published cancer statistics which helps to measure cancer in England.

 

Patient self-checks are critical for picking up melanoma recurrence

Recurrences of early stage (stage II) melanoma are more often detected by patients and their physicians checking the skin than by routine imaging tests, a study published online by the Journal of the American College of Surgeons has found | OnMedica

Melanoma has a 95% cure rate if caught and treated early, and studies suggest the recurrence rate for melanoma is as high as 50%.

For this study researchers at Thomas Jefferson University and the University of North Carolina analysed data on 581 patients with stage II melanoma and at least one year of follow-up. Of those, 171 patients with early stage melanoma developed a recurrence (29.4%). Male sex, ulceration, and stage were significant predictors of recurrence.

A total of 40% of recurrences were picked up by patients – either they noticed a suspicious change on their skin or experienced a symptom such as coughing blood or seizures. A further, 30% of recurrent melanomas were identified by scheduled physician examination and 26% by surveillance imaging.

Regional nodes were the most common site of recurrence (30%), followed by lung (27%), and in-transit metastases (18%).

Read the overview here

Read the original research abstract here

Sun protection for preventing basal cell and squamous cell skin cancers

Sanchez, G. et al. Cochrane Skin Group. Published online:  25 September 2016

Keratinocyte cancer (BCC and cSCC of the skin) is the most commonly identified type of skin cancer. The main risk is exposure to ultraviolet radiation, which is a component of sunlight. Prevention has become an important way to manage this cancer, so it is important to assess the effectiveness of methods used to prevent keratinocyte cancer in the general population. In this review, we assessed the effects of using topical sunscreen and physical barrier methods (such as sun-protective clothing, hats, sunglasses, and the active search for shade when outdoors) compared with no specific precautionary interventions aimed at preventing the development of BCC and cSCC in adults and children.

We searched the medical literature up to May 2016 for randomised controlled trials that evaluated preventive strategies. We found only one study suitable for inclusion. This study compared the daily application of sunscreen (with or without beta-carotene, which is a precursor of vitamin A) compared with the occasional use of sunscreen (with or without beta-carotene) in the general population, without restriction by gender or age. The study was undertaken in Australia, where 1621 participants, 55% of them with fair skin, were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology (which is a method used to detect cancerous cells under the microscope).

We found no difference between the number of people who developed BCC or cSCC in the two groups over the time period of the trial. So, there did not seem to be a difference in applying sunscreen daily compared with using it occasionally.

Read the full review here

Drinking filter coffee could reduce the risk of malignant melanoma – results from the (NOWAC) Study.

Lukic, M. et al. BMC Cancer. 2016 16:562

Background: Coffee contains biologically-active substances that suppress carcinogenesis in vivo, and coffee consumption has been associated with a lower risk of malignant melanoma. We studied the impact of total coffee consumption and of different brewing methods on the incidence of malignant melanoma in a prospective cohort of Norwegian women.

Methods: We had baseline information on total coffee consumption and consumption of filtered, instant, and boiled coffee from self-administered questionnaires for 104,080 women in the Norwegian Women and Cancer (NOWAC) Study. We also had follow-up information collected 6–8 years after baseline. Multiple imputation was used to deal with missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for malignant melanoma by consumption category of total, filtered, instant, and boiled coffee.

Results: During 1.7 million person-years of follow-up, 762 cases of malignant melanoma were diagnosed. Compared to light consumers of filtered coffee (≤1 cup/day), we found a statistically significant inverse association with low-moderate consumption (>1–3 cups/day, HR = 0.80; 95 % confidence interval [CI] 0.66–0.98) and high-moderate consumption of filtered coffee (>3–5 cups/day, HR = 0.77; 95 % CI 0.61–0.97) and melanoma risk (p trend = 0.02). We did not find a statistically significant association between total, instant, or boiled coffee consumption and the risk of malignant melanoma in any of the consumption categories.

Conclusions: The data from the NOWAC Study indicate that a moderate intake of filtered coffee could reduce the risk of malignant melanoma.

Read the full article here

Early Detection of New Melanomas by Patients With Melanoma and Their Partners Using a Structured Skin Self-examination Skills Training Intervention

Robinson, J.K. JAMA Dermatology. Published online: 29 June 2016

Image source: Wellcome Library // CC BY-NC-ND 4.0

Importance:  More than 1 million patients with melanoma in the United States are at risk to develop a second primary melanoma. Early detection of melanoma improves survival. Patients with melanoma may be able to self-manage care with their skin-check partners (“partners”) and alert the physician when a concerning lesion is identified, thus providing an important adjunct to yearly skin examinations by a physician.

Objective:  To evaluate the effect of a structured skin self-examination (SSE) intervention for patients with melanoma and their partners (“dyads”) on SSE performance and the detection of new melanomas by the dyad or the physician.

Design, Setting, and Participants:  Randomized clinical trial with 24-month follow-up assessments. Patients with stage 0 to IIB melanoma and their skin-check partners participated from June 6, 2011, to April 24, 2015.

Interventions:  Dyads of patients and their partners were randomly assigned to receive the skills training intervention or customary care (control group).

Main Outcomes and Measures:  The main outcome was frequency of SSE performance. The secondary outcome was detection of a new or recurrent melanoma by the dyad or physician. The tertiary outcome was the number of unscheduled physician appointments for concerning lesions.

Results:  The study cohort comprised 494 participants. The patient population was 51.2% (253 of 494) female and had a mean (SD) age of 55 (10) years. Patients in the intervention arms had significantly increased SSEs with their partners at 4, 12, and 24 months (P < .001 for all) compared with the control group (mean differences, 1.57 [95% CI, 1.29-1.85], 0.72 [95% CI, 0.39-1.06], and 0.94 [95% CI, 0.58-1.30], respectively). Patients in the intervention arms identified new melanomas more than those in the control group (χ²₁ = 28.77, P < .01 [n = 51 melanomas in situ] and χ²₁ = 6.43, P < .05 [n = 18 invasive melanomas]) and did not increase physician visits.

Conclusions and Relevance:  Patients with melanoma and their partners reliably performed SSE after participating in a structured skills training program lasting approximately 30 minutes, with reinforcement every 4 months by the study dermatologist. Accurate SSE by those at risk to develop melanoma may enhance early detection and relieve some of the burden on health services to provide continuing follow-up to a growing population of eligible patients.

Read the full article here