New treatments for melanoma.
Explore the source record for details and available documents.
Cancer Vaccines↗
Biomedical subjects
Marie-France Demierre
Publications and source records attributed to Marie-France Demierre.
Characteristics associated with use or intention to use indoor tanning among adolescents.
BACKGROUND: Indoor tanning is a popular behavior that may increase skin cancer risk. OBJECTIVE: To examine characteristics associated with use or intention to use indoor tanning among adolescents. METHODS: A telephone interview was conducted with 1273 adolescents, aged 14 to 17 years, in the Minneapolis-St Paul, Minn, and Boston, Mass, metropolitan areas. Questions included demographic and phenotypic characteristics, knowledge, attitudes, social factors, use of indoor tanning, and intention to tan indoors. RESULTS: Twelve percent of boys and 42% of girls had tanned indoors. Among nontanners, 22.4% planned to start, and 77.2% of tanners planned to continue tanning indoors. Nontanners and tanners at risk for future indoor tanning use were each significantly more likely to be female, less likely to use sun protection, less knowledgeable about skin cancer risks, more likely to agree that tans were attractive, and more strongly influenced by social factors compared with their low-risk counterparts. CONCLUSIONS: Our data suggest that intention to tan indoors may identify a group of adolescents at risk for adopting the behavior; prospective studies are needed for confirmation.
Adolescent↗
Chemoprevention of melanoma.
The United States is experiencing a surge in the incidence of cutaneous malignant melanoma. Because melanoma is typically refractory to available anticancer therapy, exploration of preventive strategies has become a priority. In this review, the rationale for chemoprevention, a new and potentially powerful approach to controlling melanoma, is discussed. Chemoprevention success is based on the principles that ultraviolet-induced melanoma is a multistep process, and that molecular events and pathways associated with these steps can be targeted. Early studies using genetically engineered mice have begun to identify a number of relevant molecular pathways in melanoma. For example, Ras signaling pathways comprise all melanoma-related alterations in N-Ras, B-RAF, MAPK/ERK, and Rho proteins, and thus provide a host of potential molecular targets for melanoma chemoprevention. Among the available prospects, the statins, which inhibit Ras and Rho, have shown much promise as chemoprevention agents. However, thorough evaluation of chemoprevention candidates will require the identification of surrogate biomarkers for risk and molecular targets for intervention, as well as high-risk groups in which to focus clinical studies. We anticipate that melanoma chemoprevention research will progress in step with advances in genomics, proteomics, and preclinical mouse modeling, and ultimately provide us with powerful weapons in our struggle to control this escalating, often fatal disease.
Animals↗
Maternal/female caregiver influences on adolescent indoor tanning.
PURPOSE: To identify aspects of maternal/female caregiver (MFC) influences on adolescents' indoor tanning, including modeling, cognitions (MFC knowledge and attitudes about indoor tanning), and gatekeeping/monitoring (MFC permissiveness and concern) of indoor tanning. METHODS: A telephone survey of adolescents aged 14-17 years and their female parent/caregiver in Minnesota and Massachusetts was conducted in 2000-2001 (n = 1284 matched pairs). Logistic regression was used to obtain odds ratios for relationships between measures of MFC influence and teens' indoor tanning practices, adjusting for demographic and sun sensitivity differences. RESULTS: Separately, each of the five MFC influence variables was significantly associated with adolescents' indoor tanning practices. In a multivariate model, significant independent contributors were parents' behavior, parents' concern about their children's indoor tanning practices, and MFC permissiveness of teen indoor tanning. Using a combined summed scale of the 5 influence factors, there was a monotonically increasing likelihood of tanning with each incremental scale increase: (in comparison to none, 1 factor aOR = 4.1, 95% CI: 1.3, 12.8; any 2 factors aOR = 8.3, 95% CI: 2.8, 24.6; any 3 factors aOR = 14.3, 95% CI = 4.9, 41.8; any 4 factors aOR = 30.5, 95% CI: 10.3, 90.3; all 5 factors aOR = 66.0, 95% CI: 20.0, 217.6). CONCLUSIONS: Mothers/female caregivers may be a powerful influence on their teenagers' indoor tanning use, and are an important target for future health promotion efforts to discourage youth indoor tanning.
Adolescent↗
Frontiers in cancer prevention research.
Explore the source record for details and available documents.
Chemoprevention↗
Chemoprevention of melanoma: an unexplored strategy.
The incidence and mortality of melanoma has continued to increase steeply-faster than most other preventable cancers in the United States. Current sun protection strategies have yet to reduce this increased incidence and mortality. Chemoprevention, defined as the use of natural or synthetic agents to delay, reverse, suppress, or prevent premalignant molecular or histologic lesions from progressing to invasive cancer, has become an important area in cancer research. Melanoma, with its associated risk factors and its known precursors or premalignant lesions, should lend itself well to chemoprevention. Prerequisites for this research should include determination of the molecular mechanisms of ultraviolet (UV) melanomagenesis; use of animal models to test candidate prevention agents; use of molecular and histologic markers as surrogate end point markers; collection of epidemiological, basic science, or in vitro data on potential chemoprevention candidate drugs; and selection of a high-risk patient population in which to carry out clinical chemoprevention trials. Preliminary data available in all these areas are reviewed. Possible mechanisms and molecular targets for the chemoprevention of UV-induced melanoma are discussed. This recent information should stimulate research in the chemoprevention of melanoma.
Animals↗
Time for the national legislation of indoor tanning to protect minors.
Explore the source record for details and available documents.
Adolescent↗
Phase 1/2 pilot study of methotrexate-laurocapram topical gel for the treatment of patients with early-stage mycosis fungoides.
OBJECTIVES: To assess the safety and tolerability of a topical gel formulation combining methotrexate and laurocapram and to obtain preliminary information on the therapeutic potential of methotrexate-laurocapram in patients with early-stage mycosis fungoides (stage IA or IB). DESIGN: An open-label, phase 1/2 pilot study. SETTING: Two academic referral centers. PATIENTS: Ten patients 18 years or older with histologically confirmed stage IA or IB mycosis fungoides. Intervention The gel formulation of methotrexate-laurocapram was applied to the total body surface, excluding genital, perianal areas, nipples, face, and skin under the breasts, on an every-other-day basis for 24 consecutive weeks. MAIN OUTCOME MEASURES: The safety of methotrexate-laurocapram was assessed in this study by reviewing adverse events and laboratory data. Efficacy outcomes included changes in lesion condition and severity assessments, reduction in area of sample lesions, and the investigator's global evaluation. RESULTS: Adverse events consisted of skin reactions of mild severity. No clinically significant laboratory abnormalities were observed. Based on the investigator's global evaluation at the end of the treatment phase (week 24), 7 (78%) of 9 patients demonstrated a slight-to-moderate response to treatment with methotrexate-laurocapram. Statistical significance (P =.049) was reached for induration and pruritus, a trend (P =.10) was observed for erythema, and no change was found for scaling (P =.37). CONCLUSIONS: These findings indicate that the topical administration of methotrexate-laurocapram is safe and in general well tolerated. This treatment may represent a new therapeutic potential for patients with mycosis fungoides.
Administration, Topical↗
Prognosis, clinical outcomes and quality of life issues in cutaneous T-cell lymphoma.
Although the need for a specific QOL index for MF/SS has been recognized, little work has been done in this area. QOL instruments should address general health concepts, as well as specific issues that are relevant to patients who have MF/SS; a combination of two instruments may be appropriate. Confirming the validity, reliability, and responsiveness to change of a combination of QOL instruments, such as SKINDEX-29 and FACT-G, in patients who have MF/SS will be relevant. For patients who have MF/SS, focusing our efforts on improving the disease and their QOL should translate into improvements that are meaningful to them. Thus, our goal should be to incorporate the findings of QOL research into practice and use the results to guide our practices, as they relate to therapy. Some important considerations are: We must be explicit about what will be done with the information that is obtained about an individual's QOL. We should consider what additional knowledge QOL measures provide that we could not otherwise have. We should be ready for unexpected results, as exemplified by instances where aggressive therapy could result in improved QOL. Although challenges exist in moving forward QOL research in CTCL, the words of wisdom of Tannock bring the concept of QOL into perspective: "When cure remains elusive, it is time to start treating the patient, not just the tumor." A final consideration is that we should not forget the dimension of spirituality, which is especially relevant to patients who have advanced MF/SS. Spirituality is characterized by the capacity to seek purpose and meaning, to have faith, to love, to forgive, and to see beyond current circumstances. Spirituality enables a person to rise above suffering. Unfortunately, research on spirituality is scarce, in part, because of the difficulty in assessing spiritual suffering. Nevertheless, physicians who are caring for patients who have advanced MF/SS should acknowledge the spiritual dimension as an integral component of the dying process.
Disease-Free Survival↗
Primary cutaneous B-cell lymphomas: a practical approach.
PCBCL are a heterogeneous group of B-cell lymphomas that originate in the skin, with the absence of extracutaneous disease at diagnosis. Overall, these cutaneous lymphomas have an excellent prognosis. Recurrences are common but dissemination is rare. The EORTC classification allows a more uniform diagnosis and treatment of patients with PCBCL. Careful clinical and pathologic correlation is critical in confirming a diagnosis of PCBCL, before deciding on therapy. Several therapeutic options that are aimed at cure, are available. In most instances, chemotherapy should not be the first line of treatment.
Algorithms↗
The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985-1999.
BACKGROUND: In response to the precipitous increase of melanoma, the American Academy of Dermatology (AAD) has coupled melanoma/skin cancer education with free skin cancer screening programs throughout the United States since 1985. The purpose of this analysis is to investigate the risk factors, access to dermatologic services, and screening results of participants in AAD-sponsored programs during the first 15 years that this service was available to the US public. METHODS: Before screening, participants completed a standardized AAD screening form. Screening forms were counted in the AAD central office and recorded in annual summaries. Forms were sent for keypunching and returned to the AAD on a computer disk annually. In 1999, disks were sent to Boston University and a master file was created. RESULTS: Computerized records were available for 819,019 screening forms and 639,835 individuals. In all, 65% of screenees had at least 1 risk factor and 33% had at least 2 risk factors. Of screenees, 33% reported a changing mole and 37% had skin type I or II. Among all screenees, nearly 80% did not have a regular dermatologist, 78% reported no prior AAD skin cancer screening, 60% had never had their skin checked by any doctor, and 51% would not have seen a doctor for skin cancer without the free screening. Nearly 30% of screenees had a presumptive diagnosis of skin cancer or a precursor lesion. Melanomas confirmed by postscreening biopsy were more likely than those in population-based registries to be less than 1.50 mm in thickness. CONCLUSIONS: AAD national screening and educational programs have expanded to all 50 states, provided educational messages about sun protection and early detection to millions, and served many US citizens with an above average risk for skin cancer and suboptimal access to dermatologic care. Screenees had a disturbingly high point prevalence of malignant and premalignant skin lesions. Sustained commitment by the AAD leadership and membership to the screening program is critical to reducing the morbidity and mortality of skin cancer.
Adolescent↗
Melanoma incidence and mortality among US whites, 1969-1999.
Explore the source record for details and available documents.
Adult↗
Transformation in mycosis fungoides: the role of methotrexate.
BACKGROUND: Large cell transformation in patients with mycosis fungoides (MF) has been well reported in the literature. Although the risk factors have not been clearly elucidated, advanced stage seems to be associated with a higher incidence of transformation. Because MF is a rare disorder, little is known about the influence of other factors such as immunosuppressive therapy in the occurrence of transformation. OBJECTIVE: We questioned the role of methotrexate (MTX) in the transformation of MF to large cell lymphoma (LCL). METHODS: We identified all patients with MF who were registered in our cutaneous lymphoma database. Transformation was defined by the presence of large cells exceeding 25% of the infiltrate in at least one skin biopsy. In one patient, we followed the histologic, immunophenotypic, and genotypic changes taking place as transformation occurred. RESULTS: A total of 134 patients with MF were identified. Of 21 patients who received MTX, 3 transformed, and of the 113 patients in the non-MTX group, only 2 transformed. The incidence of transformation in the patients who received MTX was significantly higher than in those who did not receive the drug (14.3% vs. 1.8%; p = 0.03). This significance was maintained, even after controlling for stage and sex. For one patient who transformed, we demonstrated an identical dominant T-cell clone in all skin specimens, including the large cell lymphoma. CONCLUSION: Our results demonstrate a significant association between MTX exposure and transformation to LCL in patients with MF. In light of the small sample size, short followup of patients, and the inherent tendency of mycosis fungoides to transform, the role for MTX in transformation is unproven and needs to be confirmed in a multicenter study.
Adult↗
Thin melanomas and regression, thick melanomas and older men: prognostic implications and perspectives on secondary prevention.
Explore the source record for details and available documents.
Humans↗
Should the skin cancer examination be taught in medical school?
BACKGROUND: The fact that thin melanomas are associated with a greater than 95% survival rate, while later, more deeply invasive melanomas have a 5-year survival rate of less than 10%, demonstrates the potential personal and public health impact of early detection. The majority of patients with skin lesions are seen by nondermatologists who infrequently counsel patients about skin cancer prevention or perform a complete skin examination as part of routine care. We documented the antecedents of physician practice by evaluating medical students' observation, training, performance, and self-reported skill level for the skin cancer examination and sun protection counseling. METHODS: Surveys were administered and completed in classrooms and student workshops in each of the 4 medical school years during the spring of 1996 and 1997. We concentrate our analysis on the graduating fourth-year students. RESULTS: Of the 302 fourth-year students enrolled at Boston University School of Medicine, Boston, Mass, in 1996 and 1997, 223 (74%) completed surveys. Among fourth-year students, 52% rated themselves as unskilled in skin cancer examinations. Twenty-eight percent of fourth-year students had never observed a skin cancer examination, 40% had received no training, and 35% had never practiced the examination. However, fourth-year students reporting at least 1 opportunity to observe, train, or practice an examination were 3 times as likely to report themselves as moderately to very skilled as students without such opportunities. CONCLUSION: If medical student training rates for the skin cancer examination are equally low elsewhere, as is likely, the present data suggest that even brief additions to the current curriculum, integrated into systems teaching, would augment student exposure and likely boost student skill levels.
Adult↗
Cutaneous Rosai-Dorfman disease: histopathological presentation as inflammatory pseudotumor. A literature review.
Purely cutaneous Rosai-Dorfman disease is exceptional. The disease is characterized histologically by large, proliferating histiocytes exhibiting inflammatory cells within their cytoplasm (emperipolesis). We present here a case of purely cutaneous generalized disease in which the routine histopathology was suggestive of an inflammatory pseudotumor. Positivity for S-100 protein, alpha1-antitrypsin, alpha1-antichymotrypsin, lysozyme, Mac387 and CD68 proteins, and negativity for CD1a protein confirmed the diagnosis of Rosai-Dorfman disease. The rarity of this case lies in the presence of conspicuous inflammatory pseudotumor-like histopathologic changes, masking an otherwise typical sinus histiocytosis cell infiltrate. This unusual presentation of the disease requires a high index of suspicion by clinicians and pathologists.
Adult↗
Sun care advertising in popular U.S. magazines.
PURPOSE: We assessed the placement of magazine advertising for sun care products to lay the groundwork for broader promotion to more diverse and high-risk demographic groups. METHODS: We reviewed 579 issues of 24 magazines published between the months of May and September from 1997 to 2002. We conducted a cover-to-cover review of top-selling magazines for men, women, teens, parents, travelers, and outdoor recreation users. We determined if there were any advertisements for the following sun care products: sun tanning lotions containing sun protection factor (SPF), sunless tanners without SPF, sunscreen with SPF, moisturizers with SPF, or cosmetics with SPF (which include sunless tanners containing SPF. RESULTS: Sun care products, including sunscreens, were advertised primarily in women's magazines (77%). Nearly two thirds of all sun care products advertised were either for cosmetics (38%) or moisturizers (26%) containing SPF, followed by ads for sunscreen sold as a stand-alone product (19%). None of the ads contained all of the recommendations for safe use of sunscreen: a minimum SPF of 15, both UVA and UVB protection, reapplication instructions, and an adequate application coverage of 2 milligrams per square centimeter. DISCUSSION: Magazine advertising to men, travelers, outdoor recreation users, and parents/families (totaling a circulation of 41 million readers) during this six-year period were far fewer than those for women, despite high rates of excessive sun exposure in these groups.
Advertising↗
Consideration of statins for chemoprevention of cutaneous melanoma.
The Skin Cancer Foundation is the only national and international organization devoted exclusively to malignancies of the skin. It conducts public and medical education programs andprovides support for research and professional training to reduce the incidence, morbidity, and mortality of skin cancers. The following article is reprinted from The Melanoma Letter, Vol. 22, No. 3. Outstanding articles from the Foundation's award-winning publications, The Skin Cancer Foundation Journal, The Melanoma Letter, and Sun & Skin News will regularly appear here in upcoming issues. The Skin Cancer Foundation Journal, published annually, is a major part of the Foundation's professional and public education programs. Directed primarily to dermatologists, it also has an extensive readership among the general public. The Melanoma Letter, a widely respected quarterly newsletter for clinicians and researchers, focuses on the diagnosis, treatment, and prevention of the deadliest form of skin cancer. Sun & Skin News, a quarterly newsletter for the lay public, covers a broad range of topics related to skin health, including prevention and treatment of skin cancers and other sun-induced skin damage, the effectiveness of new sunscreen formulas, sunglasses, and the danger of tanning parlors.
Humans↗