Results of the 'Euromelanoma Day' screening campaign in Sweden 2008

Background  The 'Euromelanoma Day' skin cancer screening campaign is organized annually in several European countries since the year 2000. The national results have not been analysed in a Scandinavian country.
Objective  Our objective was to analyse the demographic characteristics and risk factors of the screened population during the 'Euromelanoma Day' in Sweden 2008. We also aimed to describe the clinical diagnoses found, the melanomas confirmed histopathologically and the treatments performed.
Methods  A public health education campaign to promote awareness of skin cancer risk factors and warning signs was carried out. Patients with suspicious lesions were advised to attend the screening. Questionnaires were used to collect relevant demographic, epidemiological and clinical data.
Results  In total, 2659 patients were screened. Women accounted for 62.3% of all patients; the median age was 57 years (range: 5–100 years); and 91.2% had skin phototypes II–III. Previous skin cancer was reported by 18.4% of all patients and 14.8% had a family history of melanoma. In total, 456 patients were diagnosed clinically with non-melanoma skin cancer. Twenty-four patients had histopathologically confirmed melanomas. Ten were in situ and 8 of the 14 invasive melanomas had a Breslow thickness that was less than 1 mm. Treatment or future medical care was carried out in 45.4% of all patients.
Conclusion  The 'Euromelanoma Day' campaign attracted many individuals at risk for skin cancer. The detection rate of non-melanoma skin cancer and melanoma was relatively high compared to similar campaigns in other European countries. Most melanomas found had a favourable prognosis.     

Euromelanoma: a dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma. Past, present and future

Euromelanoma is a dermatologist-led skin cancer prevention programme conducting an annual screening and public education campaign in over 20 European countries. Within its 10-year history, Euromelanoma has screened over 260,000 individuals across Europe, detecting a significant number of cutaneous melanomas and nonmelanoma skin cancers, identifying high-risk individuals for further surveillance and promoting awareness on the suspicious features of melanoma and the hazardous effects of ultraviolet exposure. In this review article, we summarize the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. Euromelanoma has had a significant impact on melanoma prevention and early diagnosis in participating countries and, despite many challenges, has positively influenced public health attitudes towards regular mole examination and the implementation of preventive measures against skin cancer.     

Skin cancer day in Italy: method of referral to open access clinics and tumor prevalence in the examined population

Education campaigns to encourage self-examination coupled with rapid access to specialized dermatological clinics is considered the key strategy in the realization of early detection of cutaneous melanoma and non-melanoma skin cancer (NMSC). An alternative to an initial visit to the family doctor is open access to a skin cancer clinic at the decision of the individual. This approach has been followed mainly in countries with high melanoma incidence where the majority of the population is of northern European origin. However, the efficacy of this system has not been well established because there are few studies involving systematic follow up of individuals with positive screening through pathological confirmation of the diagnosis. We report the follow up data focussed on melanoma and NMSC detection rates in more than 1,000 subjects examined at numerous 1-day, open access clinics on the occasion of the Italian nation-wide "Skin Cancer Day" campaign promoted by the Federation of Italian Dermatological Societies. Total body skin examination was performed on all subjects, and surgical excision of a lesion was recommended in 41 of the 1042 subjects (3.9 %). Histologic diagnosis, available for 39/41 lesions, evidenced 3 superficial spreading melanomas (1 in situ, one "thin" lesion, ie. 0.30 mm in thickness, and one "thick" lesion, with a thickness of 4.53 mm) and 6 NMSC (5 BCC and 1 SCC). Thus, the prevalence of skin cancer (melanoma and NMSC) in this group was 0.8 % (9/1042), and the prevalence of melanoma was 3/1042, 0.2 %, rather similar to that found in populations of northern European origin. Open access to skin cancer clinics may represent an alternative approach to melanoma prevention also in southern European populations. Increased public awareness regarding skin cancer probably represents the main effect of this type of campaign.     

Evaluation of public education campaigns in cutaneous melanoma: the King''s College Hospital experience

The effects of a public education campaign directed at earlier self-recognition of malignant melanoma were assessed at King's College Hospital by reviewing the pathology of all melanomas seen between 1970 and 1987. During the campaign years (1986 and 1987) the number of patients with melanomas nearly doubled, and there was an increase in the proportion of thin, good prognosis lesions, and a fall in the proportion and absolute number of thick lesions. Data from the earlier years showed that median melanoma thickness had been decreasing throughout the series, well before the introduction of the campaign. A greater proportion of tumours of the superficial spreading variety was seen and also an increase in patients below the age of 40. These findings suggest that the biological characteristics of melanomas might be changing in addition to increased public and professional awareness.     

The Euromelanoma skin cancer prevention campaign in Europe: characteristics and results of 2009 and 2010

Background Euromelanoma is a skin cancer education and prevention campaign that started in 1999 in Belgium as ‘Melanoma day’. Since 2000, it is active in a large and growing number of European countries under the name Euromelanoma. Objective To evaluate results of Euromelanoma in 2009 and 2010 in 20 countries, describing characteristics of screenees, rates of clinically suspicious lesions for skin cancer and detection rates of melanomas. Methods Euromelanoma questionnaires were used by 20 countries providing their data in a standardized database (Belgium, Croatia, Cyprus, Czech Republic, FYRO Macedonia, Germany, Greece, Hungary, Italy, Lithuania, Luxembourg, Malta, Moldavia, Portugal, Serbia, Slovenia, Spain, Sweden, Switzerland and Ukraine). Results In total, 59 858 subjects were screened in 20 countries. Most screenees were female (64%), median ages were 43 (female) and 46 (male) and 33% had phototype I or II. The suspicion rates ranged from 1.1% to 19.4% for melanoma (average 2.8%), from 0.0% to 10.7% for basal cell carcinoma (average 3.1%) and from 0.0% to 1.8% for squamous cell carcinoma (average 0.4%). The overall positive predictive value of countries where (estimation of) positive predictive value could be determined was 13.0%, melanoma detection rates varied from 0.1% to 1.9%. Dermoscopy was used in 78% of examinations with clinically suspected melanoma; full body skin examination was performed in 72% of the screenees. Conclusion Although the population screened during Euromelanoma was relatively young, high rates of clinically suspected melanoma were found. The efficacy of Euromelanoma could be improved by targeting high‐risk populations and by better use of dermoscopy and full body skin examination.     

Prevention and early diagnosis of melanoma: a regional experience in Italy

Background Over the 1980s several education campaigns for prevention and early diagnosis of cutaneous melanoma have been reported from various parts of the world. Aim To improve incidence and prognosis of cutaneous melanoma in 1985 we started, in our area, an information and health education campaign aimed at identifying precursors of melanoma (congenital melanocytic nevi), suspicious lesions (changing moles) and subjects with increased risk of melanoma. Method Precursors and suspicious lesions were promptly removed, and high-risk persons entered the follow-up program. Result As a general effect of these activities the percentage of thin melanomas diagnosed in our division after 1985 increased from 25 to 37. Conclusion We believe that education campaigns and screening of a targeted population, particularly of subjects presenting increased risk of melanoma, may be helpful in the early diagnosis of melanoma.     

Trends in the presentation of cutaneous malignant melanoma over three decades at King's College Hospital, London

The aim of this study was to examine trends in the presentation of cutaneous malignant melanoma at King's College Hospital (KCH) over the last three decades (1970-2000). KCH was one of seven centres that participated in the 1987 Cancer Research Campaign (CRC) publicity campaign aimed at promoting earlier self-recognition of melanoma. Data included patient age at presentation, sex, tumour site, Breslow thickness and histological subtype. The late 1980s saw a threefold increase in the annual number of melanomas and an eightfold increase in thin melanomas compared to the 1970s. The increase occurred in both sexes and was particularly marked after the CRC campaign but numbers had already begun to increase prior to this. The increase has predominantly been thin (Breslow < 1.5 mm) tumours of the superficial spreading variety with a resultant fall in mean Breslow thickness. There has been a decline in the annual number of melanomas since the peak in 1992 which is not explained by increased proportion of in situ tumours. The CRC campaign may have contributed to the documented increase in thin tumours but this trend had begun prior to 1987 suggesting factors other than public awareness and earlier presentation are important. It is encouraging that the number of melanomas has declined over the last 5 years at KCH but it is yet to be seen whether this reflects a real decrease in the incidence of melanoma.     

Optical transfer diagnosis differentiating benign and malignant pigmented lesions in a simulated primary care practice

The incidence of the type of skin cancer called melanoma is on the rise. The detection of melanoma can be difficult, particularly for clinicians who have limited training (compared to dermatologists who specialize in skin) in telling the difference between normal moles (nevi) and melanomas. The noninvasive optical transfer diagnosis (OTD) method is a technology designed to assist in the screening of lesions (e.g. moles) that might be melanomas. In this study, from the U.S.A., U.K. and Norway, the authors took images using OTD and then analysed 712 pigmented lesions (which could be moles or melanomas). Of them, 415 were harmless, or ‘benign’, and 297 were suspicious when examined by specialists using a magnifier called a dermatoscope. After image capture, all of the suspicious moles were biopsied and the tissue samples were examined under the miscroscope. Of the suspicious lesions, 80 proved to be cancer on biopsy (64 melanomas, and 16 other types of skin cancer). OTD misdiagnosed 1 of the 80 cancerous lesions as benign. If verified in further studies, particularly in actual primary care settings, it is likely that the use of OTD technology could help doctors reduce the number of referrals to dermatologists, excision (surgical removal of the lesion), or biopsy, and reduce costs. Further studies are planned for screening patients in the primary care (e.g. GP) setting, with comparisons of OTD results to the gold standards of pathology or dermoscopy.     

Melanoma screening: results of the first one-day campaign in Belgium (''Melanoma Monday'')

BACKGROUND: Although the incidence of melanoma is increasing and many informative campaigns have been organized. The general population is still little informed about this tumour. AIMS: To organize a media campaign, with more relevant information and the opportunity for free skin inspections. METHODS: A 'Task Force' organized a media campaign in April 1999 and convinced 65% of the Belgian dermatologists to give up 4 h of their time to do free skin examinations for skin cancer on Monday 26 April 1999; it was called 'Melanoma Monday'. RESULTS: A total 2767 patients were screened. We found 25 melanomas and suspected 59 basal cell carcinomas. In the following 4 weeks another 141 melanomas were found. These 166 melanomas found in one month represent 15-20% of the total number of melanomas per year in Belgium. SUMMARY: A media campaign with relevant information combined with screening opportunities can lead to the early detection of melanomas in a large number of patients and can continue to alert people at risk in the following weeks.     

Total skin examination during screening for malignant melanoma does not increase the detection rate

Summary Total skin examination during public screening for malignant melanoma is often advocated, but the benefit of this approach has not been established properly. We assessed the yield of examination of the entire skin, in addition to examination of intentionally shown skin lesions, in people attending melanoma screening clinics in southern Limburg, the Netherlands, in 1993. Of the 4146 attenders, 2910 (70%) showed a specific skin spot. Additional examination of the entire skin was offered to 1385 people. There were 1221 evaluable cases. Fourteen presumptive diagnoses of malignancies were encountered: seven malignant melanomas, all with low clinical suspicion, and seven basal cell carcinomas. Histology revealed three basal cell carcinomas. No malignant melanomas were confirmed by histology. It is concluded that additional total skin examination during screening for malignant melanoma is not worthwhile, except perhaps for persons presenting lesions that are suspicious of melanoma or dysplastic naevi.     

Melanomas detected with the aid of total cutaneous photography

BACKGROUND: Early detection of melanoma results in excision of thinner melanomas, which are associated with better prognosis. Total cutaneous photography provides a temporal comparison of lesions, which allows clinicians and patients to recognize new and subtly changing lesions. OBJECTIVES: We examined the utility of total cutaneous photography in detecting melanoma, identified the reason for biopsy of suspicious lesions and determined who detected new melanomas, the physician on follow-up examination or the patient on self-examination. PATIENTS/METHODS: The charts of the 576 patients in the total cutaneous photography database were reviewed. Twelve patients were identified who had melanoma diagnosed with photographic assistance. Baseline and prebiopsy photographs, dermatology clinic notes (115 patient visits) and pathology reports for each biopsied lesion were reviewed. Histological diagnosis, cause for biopsy, and whether the lesion was detected by the patient or physician, was recorded for each of the biopsied lesions. Also noted were all the lesions that concerned patients, the cause for concern, and whether these lesions were biopsied. RESULTS: A total of 93 lesions were biopsied in these patients. Twenty-seven (35%) of 77 melanocytic lesions were histologically diagnosed as melanoma. The thickest melanoma found measured 1.1 mm, indicating a favourable prognosis in our patients. Seventy-four per cent of the melanomas were biopsied due to changes from baseline and 19% were biopsied because they were new lesions. The changes noted were subtle and the lesions that proved to be melanoma did not satisfy the classical clinical criteria for melanoma. Eight (30%) of the melanomas were identified by patients on skin self-examination. Twenty-six per cent of the lesions that concerned patients were not biopsied after evaluation by a physician. CONCLUSIONS: We found that photographically assisted follow-up helped detect new and subtly changing melanomas, which did not satisfy the classical clinical features of melanoma. In addition, photographically assisted follow-up helped detect nonmelanoma skin cancers. Patient skin self-examination proved to be valuable, in that it complemented physician follow-up examination in detecting melanomas. Photographic follow-up was also valuable in avoiding unnecessary biopsy in suspicious, but stable lesions. Total cutaneous photography therefore may be an effective way to increase the sensitivity and specificity for detecting melanoma.     

Cutaneous melanomas associated with nevi

OBJECTIVE: To determine the frequency of and the histologic and clinical factors associated with melanoma existing in histologic contiguity with a nevus. DESIGN: Pathology reports from melanomas collected from January 1, 1993, to December 31, 1997, were retrospectively reviewed. SETTING: Independent, community-based dermatopathology laboratory. PATIENTS: A total of 1606 patients with a histologic diagnosis of melanoma. INTERVENTION: None. MAIN OUTCOME MEASURES: Differences in histologic (subtype, Breslow thickness, and Clark level) and clinical (age, sex, and anatomic location) features between melanomas that are associated and unassociated with a nevus. RESULTS: Twenty-six percent of the melanomas reviewed were histologically associated with nevi (dysplastic nevi, 43.0%; and other nevi, 57.0%). Factors that were significantly associated with an increased likelihood of a melanoma being histologically contiguous with a nevus included younger age, superficial spreading subtype, truncal location, Breslow thickness, and Clark level. However, after multivariate analysis, only younger age (odds ratio, 1.27; 95% confidence interval, 1.19-1.37), superficial spreading subtype (odds ratio, 2.96; 95% confidence interval, 2.17-4.02), and truncal location (odds ratio, 3.26; 95% confidence interval, 2.55-4.19) remained significant. CONCLUSIONS: Most melanomas were not histologically contiguous with a nevus. Younger age, superficial spreading subtype, and truncal location are independent significant predicators of a melanoma being histologically associated with a nevus.     

Screening for skin cancer in The Netherlands.

In the summer of 1989 a screening campaign for skin cancer was organized along part of the beach in the western region of The Netherlands, using a mobile trailer. On 4 consecutive Saturdays, 3,069 individuals were examined. A total of 65 individuals with a suspected lesion were found and referred to their general practitioner. The compliance with referral was 80%. Histological reports, obtained from 46 suspected lesions, showed: 6 melanomas (all with a thickness less than 1 mm), 2 squamous cell carcinomas, 23 basal cell carcinomas, 5 dysplastic naevi and 10 benign skin lesions. The positive predictive value of the visual examination appeared to be 83%. The campaign attracted much publicity. The effects of this publicity were measured by a questionnaire sent to all general practitioners and dermatologists in the region. It appeared that during the campaign and in the ensuing 2 months there had been an increase in the number of diagnoses of benign skin lesions and a moderate increase in the diagnoses of malignant lesions.     

Epidemiología del melanoma en una población multicultural mediterránea

Background

The Hospital Costa del Sol, with a catchment population of 380,000 registered inhabitants, logged an average of 48 new melanoma cases per year, of which 30% occurred in foreigners.

Objective

To analyze the clinical and epidemiological features of melanoma in the Hospital Costa del Sol and the trend in the diagnosis of melanoma in the last 10 years.

Material and methods

We performed a retrospective analysis of malignant melanomas diagnosed at the Hospital Costa del Sol from 2002 to 2011.

Results

We reviewed 411 patients (481 melanomas); 50.6% were women. The mean age was 57.33 years. There was a predominance of phototypes ii and iii (57.6%, 26.1%) and recreational sun exposure (73.1%). A total of 69.2% of the patients were Spanish and 30.8% were foreigners. The most commonly affected location was the trunk followed by the head and neck in men and the lower extremities in women. The most frequent histopathological type was superficial spreading melanoma. Twenty-six patients (6.3%) developed multiple melanomas and 22.3% had an associated non-melanoma skin cancer. The hospital incidence rate was 17.5 cases/100,000 population/year. Analysis of the trend showed an increase in the number of in situ and thin (less than 1 mm) melanomas.

Conclusion

The incidence of melanoma is increasing in our area, mainly due to thin melanomas. Our patients also had a high risk of developing a second melanoma or other types of non-melanoma skin cancer.     

Pathology of melanoma

The biologic behavior of several common clinicopathologic types of melanoma is generally predictable by the depth of tumor invasion. However, some individuals have tumors that do no behave as predicted. These include what some authors have called borderline melanoma and minimal deviation melanoma as well as desmoplastic melanoma, thin superficial spreading melanoma with marked regression, and melanomas arising within some nevi. The reasons for the erratic behavior of these melanomas remains enigmatic.     

DO ALL MELANOMAS COME FROM “MOLES”? A STUDY OF THE HISTOLOGICAL ASSOCIATION BETWEEN MELANOCYTIC NAEVI AND MELANOMA

Histological examination of 1101 melanomas (990 superficial spreading and 111 nodular melanomas) from 1098 people revealed that 23.3% showed an associated melanocytic naevus. Of these, 56.5% were classified histologically as common acquired, 37.7% as dysplastic and 5.8% as congenital. Of the superficial spreading melanomas, 25.7% showed an associated naevus. By contrast, only 2.7% of nodular melanomas showed histological evidence of a coexisting naevus. When the superficial spreading melanomas were analysed by level, the presence of a naevus varied from 31.3% of level I melanomas to 21.3% of level IV melanomas. When thickness was measured, an associated naevus was found in 27.0% of superficial spreading melanomas less than 1.0 mm thick, and 14.8% of melanomas with a thickness of 1.0 mm or greater. These data suggest that most melanomas do not arise in pre-existing naevi, and accordingly public educational programs for the early detection of melanoma should focus on looking for changes in previously normal skin as well as in pre-existing moles.     

Phenotypic and histologic characteristics of cutaneous melanoma in patients with melanocortin-1 receptor polymorphisms

BackgroundThe melanocortin-1 receptor (MC1R) is an important risk factor for melanoma due to its role in the production of melanin in response to sun exposure.ObjectivesTo analyze the phenotypic and histologic characteristics of cutaneous melanoma in patients carrying mutations in MC1R and assess the influence of sun exposure on the occurrence of melanoma.Material and methodsA total of 224 patients with a diagnosis of melanoma seen in the Department of Dermatology at Hospital General Universitario Gregorio Marañón in Madrid, Spain between September 2004 and December 2009 were included in the study. The genomic sequence of MC1R was analyzed by polymerase chain reaction.ResultsAt least one of the following MC1R variants was present in 58% of the patients: V60L, V92 M, I155T, R160W, D294H, and R163Q. Carriers of those variants had a history of sunburn (P = .018) and melanomas located on areas with intermittent sun exposure (P = .019), and the majority had a diagnosis of superficial spreading melanoma. These associations were especially significant in patients with the R160W and D294H variants. Carriers of R160W also had melanomas associated with melanocytic nevi (P = .028).ConclusionsThe results of our study suggest that there may be a relationship between the expression of certain MC1R variants and sun exposure, history of sunburn, and skin type. They also indicate a higher frequency of superficial spreading melanomas and melanomas associated with melanocytic nevi in patients carrying certain mutations in MC1R.     

The importance of self-examination in the earliest diagnosis of multiple primary cutaneous melanomas: a report of 47 cases

BACKGROUND: Development of more than one primary melanoma in a patient is a relatively uncommon but well-recognized phenomenon. Its frequency has ranged from 1.2% to 8.2% in several series. This subgroup of patients with multiple primary lesions has not been characterized sufficiently. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. METHOD: Study subjects were drawn from 1240 patients with histologically confirmed melanoma, including melanoma in situ. From this group, multiple melanomas developed in 47 patients (3.79%). Every one of our patients has been taught to perform self-examination of the skin to detect suspicious pigmented lesions. RESULTS: Of the 47 patients described in this study, 38 had two primary melanomas, 7 had three melanomas and 2 had 5 and 10 melanomas, respectively. Mean age at first diagnosis was 46.2 years. The majority of subsequent melanomas (74.5%) were removed within 5 years of the initial operation. Synchronous lesions were found in 10 patients. In male patients, the lesion appeared most frequently on the trunk; in female patients, melanoma appeared mostly on the lower extremities. The second primary melanomas developed in the same anatomic region from the first in 53.2% of our patients. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Regarding invasive melanomas, the mean thickness of the first melanomas was 1.31 mm compared with 0.66 mm for the second ones. Dividing patients into two groups, of more and less than 50, it is highlighted that in older patients synchronous lesions appear more frequently (36.4% vs. 8.0%); the median time interval between sequential melanomas is longer (84 vs. 63.7 months); and the ratio between the primary and secondary melanoma mean thickness is lower (1.21 : 1.08 vs. 1.43 : 0.63 mm). CONCLUSIONS: The study confirms that second primary melanoma is usually thinner than the first lesion, and it is more common in the same region of the body as the initial melanoma. The highest risk for a second melanoma is during the first 5 years, but a much longer time interval of 28 years is possible. Continued medical follow-up with complete skin examinations seems prudent, but it is very important to promote self-skin evaluation in patients to detect not only metastases but also subsequent primary melanomas in their earliest phases.     

Electrical impedance spectroscopy and the diagnostic accuracy for malignant melanoma

Abstract: Background: The accuracy of diagnosis of skin cancer and especially of early malignant melanoma is most important to reduce its morbidity and mortality. Previous pilot studies using electrical impedance measurements indicate statistically significant accuracies for the detection of skin cancer. Objectives: The aim of this study is to investigate the accuracy of electrical impedance spectra to distinguish between malignant melanoma and benign skin lesions using an automated classification algorithm. Patients/Methods: Electrical impedance spectra were measured in a multi‐centre study at 12 clinics around Europe. Data from 285 histologically analysed lesions were used to train an algorithm to sort out lesions for automatic detection of melanoma. Another data cohort of 210 blinded lesions (148 various benign lesions and 62 malignant melanomas where 38 being from Breslow thickness ≤1 mm) from 183 patients was thereafter used to estimate the accuracy of the technique. Results: Observed sensitivity to malignant melanoma is 95% (59/62) and observed specificity 49% (72/148). Conclusions: The results suggest that electrical impedance spectra can distinguish between malignant melanoma and benign skin lesions. Although it is indicated that the accuracy of the device is clinically promising, the overall performance, and the sensitivity to thin malignant melanomas, must be improved and thoroughly validated before the instrument can be used as a routine stand‐alone diagnostic decision support tool. The technique is under revision to further improve the reproducibility, specificity and sensitivity.