Search PubMed⌕ Search

Biomedical subjects

Martin A Weinstock

Publications and source records attributed to Martin A Weinstock.

At least 19 recordsLinked to original sources
PubMed2026

Identification of Risk Factors for Acral Melanoma in US Veterans.

IMPORTANCE: Acral melanoma (AM), localized to the palms, soles, and nail units, is a unique melanoma subtype less associated with UV radiation. Few studies have evaluated AM risk factors in a population of US veterans. OBJECTIVE: To identify AM risk factors in US veterans. DESIGN, SETTING, AND PARTICIPANTS: Nested case-control study (2000-2024) in the Veterans Affairs (VA) health care system. Individuals with AM were identified using the VA Cancer Registry and a validated natural language processing pipeline applied to pathology reports. Each AM case was matched to 4 nonacral cutaneous melanoma (CM) controls and 4 controls with no melanoma diagnoses at any time by diagnosis year and outpatient visit frequency. Controls with acral, mucosal, or ocular melanoma diagnoses at any time were excluded. Participants were veterans with histologically confirmed AM, nonacral CM controls, and controls with no melanoma diagnoses at any time. EXPOSURE: Age, sex, race and ethnicity, rurality, region, military branch, comorbidities (National Cancer Institute Comorbidity Index), smoking status, unhealthy alcohol use as measured by the Alcohol Use Disorders Identification Test-Consumption, body mass index, Agent Orange exposure (AOE), prior photosensitizing medications, nevi, keratinocyte carcinoma (KC), actinic keratosis (AK), and number of dermatology visits in the 2 years before diagnosis. MAIN OUTCOMES AND MEASURES: Adjusted odds ratios (AORs) comparing AM with controls using conditional logistic regression. Secondary outcomes included analyses limited to Vietnam Era veterans and AM localized to palmoplantar and subungual sites. RESULTS: In total, 1292 individuals with AM (median age, 70.13 [IQR, 61.87-78.66] years; 1215 [94.0%] male) were matched to 5168 controls without melanoma (median age, 73.97 [IQR, 65.53-82.08] years; 5044 [97.6%] male), and 1286 individuals with AM (median age, 70.13 [IQR, 61.97-78.67] years; 1210 [94.1%] male) were matched to 5144 CM controls (median age, 74.58 [IQR, 66.86-82.05] years; 5068 [98.5%] male); 6 individuals with AM were excluded from AM vs CM analyses due to lack of matches. AOE was significantly associated with higher odds of AM vs CM (AOR, 1.31; 95% CI, 1.06-1.62) and vs controls without melanoma (AOR, 1.27; 95% CI, 1.04-1.56). Current smoking was associated with lower odds of AM (vs CM: AOR, 0.65; 95% CI, 0.52-0.81; vs controls without melanoma: AOR, 0.50; 95% CI, 0.40-0.62). Prior KC and AK were associated with higher odds vs controls without melanoma but lower odds vs CM. Prior nevus was associated with higher odds of AM vs controls without melanoma. CONCLUSIONS AND RELEVANCE: Results of this study suggest that several factors were associated with AM in veterans and a need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between AOE and AM in veteran populations.

Aged↗
PubMed2007

Second lymphomas and other malignant neoplasms in patients with mycosis fungoides and Sezary syndrome: evidence from population-based and clinical cohorts.

OBJECTIVE: To assess risks for developing second malignancies in patients with mycosis fungoides or Sézary syndrome. DESIGN: Retrospective study of 2 cohorts. SETTING: Nine population-based US cancer registries that constitute the Surveillance, Epidemiology, and End Results Program (SEER-9), and Stanford University referral center cohort of patients with cutaneous lymphoma. Patients with mycosis fungoides or Sézary syndrome from the SEER-9 registry diagnosed and followed up from 1984 through 2001 and from the Stanford University cohort diagnosed and followed up from 1973 through 2001. MAIN OUTCOME MEASURES: Relative risk was estimated using the standardized incidence ratio (SIR). The expected cancer incidence for both cohorts was calculated using age-, sex-, race-, and calendar year-specific SEER-9 incidence rates for the general population. Nonmelanoma skin cancers were excluded because these cancers are not routinely reported by the SEER database. RESULTS: In the SEER-9 cohort (n = 1798), there were 197 second instances of cancer (SIR = 1.32; 95% confidence interval [CI], 1.15-1.52) at all sites. Significantly elevated risk (P<.01) was observed for Hodgkin disease (6 cases; SIR = 17.14; 95% CI, 6.25-37.26) and non-Hodgkin lymphoma (27 cases; SIR = 5.08; 95% CI, 3.34-7.38). Elevated risk (P<.05) was also observed for melanoma (10 cases; SIR = 2.60; 95% CI, 1.25-4.79), and urinary cancer (21 cases; SIR = 1.74; 95% CI, 1.08-2.66). In the Stanford University cohort (n = 429), there were 37 second instances of cancer (SIR = 1.04; 95% CI, 0.76-1.44). Elevated risk (P<.01) was observed for Hodgkin disease (3 cases; SIR = 27.27; 95% CI, 5.35-77.54). Elevated risk (P<.05) was also observed for biliary cancer (2 cases; SIR = 11.76; 95% CI, 1.51-42.02). CONCLUSION: Updated SEER (population based) and Stanford (clinic based) data confirm the generalizability of earlier findings of increased risk of lymphoma in patients with mycosis fungoides or Sézary syndrome.

Adolescent↗
PubMed2006

Descriptive epidemiology of dermatofibrosarcoma protuberans in the United States, 1973 to 2002.

BACKGROUND: The epidemiology of dermatofibrosarcoma protuberans (DFSP) has not been studied in detail. OBJECTIVE: We sought to describe patterns of DFSP incidence and survival in the United States. METHODS: Data were obtained from 9 population-based cancer registries of the Surveillance, Epidemiology, and End Results Program for 1973 to 2002. RESULTS: DFSP overall annual incidence was 4.2 per million. Incidence increased by 43% (3.1-4.4 per million per year) during the study period, but this increase was restricted to whites. Annual incidence among blacks (6.5 per million) was almost double the incidence among whites (3.9 per million; P < .005, 95% confidence interval of difference 2.02-3.22). Women had higher rates of incidence than men (4.4 vs 4.2 per million per year; P = .052, 95% confidence interval of difference -0.002 to 0.60), except among the elderly. Relative 5-year survival was 99.2% (95% confidence interval 98.3-100%). LIMITATIONS: The Surveillance, Epidemiology, and End Results Program lacks independent verification of diagnoses and case detail. CONCLUSIONS: The racial differences in the incidence of DFSP are significant, and the cause is unknown. Previous literature had suggested that men were more frequently affected, which was not true in our data. The tumor rarely results in death. Epidemiologic investigation using population-based data is important to better understand this disorder.

Adolescent↗
PubMed2006

The use of mole-mapping diagrams to increase skin self-examination accuracy.

BACKGROUND: Monthly skin self-examination (SSE) is associated with reduced incidence of advanced melanoma, but SSE is prone to error in detecting early changes of melanoma. OBJECTIVE: We sought to improve SSE accuracy by requiring participants to complete a mole-mapping diagram. METHODS: After completing a baseline survey, participants received SSE instruction, had their backs digitally photographed, and half were randomized to complete a mole-mapping diagram. Some photographs were altered by adding an image of a 5-mm pigmented lesion. At follow-up, participants were asked to identify any changes introduced to their photographs. RESULTS: A total of 88 participants completed the study. In all, 33% (n = 15) of the control group (no diagram) and 52% (n = 22) of the intervention group (mole-mapping diagram) (P = .06) gave accurate assessments. Analysis of only altered images indicated that the intervention group gave more accurate assessments (60% vs 33%, P = .01). LIMITATIONS: This study was limited by sample size, only addressed lesions on the back, and did not involve actual melanomas in study participants. CONCLUSIONS: Mole-mapping diagrams may improve SSE accuracy, and may be useful as a simple, cost-effective intervention in reducing melanoma mortality.

Female↗
PubMed2006

Progress and prospects on melanoma: the way forward for early detection and reduced mortality.

The public health problem of melanoma is difficult. Recent decades have seen substantial efforts directed at primary prevention, yet the incidence of melanoma continues to increase. Substantial efforts have been devoted to improving treatment, yet melanoma retains a poor prognosis if simple surgical excision is not curative. Early detection has made remarkable progress, however. Five-year relative survival has increased from approximately 80% in 1975 to greater than 90% in 1996. Even so, almost 8,000 Americans are projected to succumb to melanoma in 2005. Because most of these fatal melanomas are visible on the skin surface at a curable phase in their evolution, more can and must be done. To improve the early detection practices of clinicians, we have developed an eight-step Basic Skin Cancer Triage algorithm, which forms the core of a curriculum that we have shown can result in improved skills, attitudes, and practices. We are now in the process of attempting to test a Web-based version of that curriculum in a randomized trial. Skin self-examination also has tremendous potential for contributing to early detection of melanoma. We have tested an intervention to encourage thorough skin self-examination in a randomized trial and found it effective in increasing the performance of this procedure, on increase that is sustained for at least a year, while resulting in only short-term increases in surgical procedures on the skin. Early detection has not yet reached its full potential effect on the public health problem of melanoma and is poised to further reduce melanoma mortality.

Humans↗
PubMed2006

Innovations and challenges in melanoma: summary statement from the first Cambridge conference.

Innovations and Challenges in Melanoma, chaired by Michael Atkins and cochaired by Ulrich Keilholz, John Kirkwood, and Jeffrey Sosman, was held July 15 to 16, 2005, in Cambridge, Massachusetts. The conference brought together leading experts in the fields of cancer research, medical oncology, surgical oncology, anatomic pathology, dermatology, and immunotherapy who wished to advance the field of melanoma treatment by exchanging information and perspectives regarding recent advances and recommendations for further study. The conference proceedings published in this educational supplement to Clinical Cancer Research are intended to provide timely information and recommendations on how genetics, biology, and data information can enhance our understanding of melanoma biology and help inform the use of therapies for this disease.

Humans↗
PubMed2006

Adjuvant local irradiation for Merkel cell carcinoma.

OBJECTIVES: To determine the effect of adjuvant local irradiation on (1) disease recurrence and (2) survival rates in Merkel cell carcinoma (MCC). DATA SOURCES: An Ovid MEDLINE search (January 1966-May 26, 2004) was performed using the following criteria: group 1, "Merkel cell OR trabecular OR neuroendocrine skin OR APUDoma skin OR primary small cell skin OR primary undifferentiated skin OR endocrine skin OR neuroepithelial" AND group 2, "carcinoma OR tumor OR cancer" with mapping modifiers "-title, -abstract, -keyword, -subject heading." The search yielded 843 citations. STUDY SELECTION: The Ovid set was then searched using the following criteria: "surgery OR radiation OR radiotherapy," which yielded 242 discrete citations. Reports from all 242 citations were reviewed. For the remaining 601 citations, abstracts (when available) were reviewed to assess the level of relevance for potential inclusion; reports from 63 of these citations were reviewed. An additional 28 secondary references were reviewed, for a total of 333 reports. DATA EXTRACTION: The following criteria for inclusion were applied to each potential patient: (1) a histopathologic diagnosis of MCC; (2) a single, primary tumor arising on the skin, for which (3) the primary treatment was surgical excision (local excision, wide excision, or Mohs surgery) with or without the use of adjuvant irradiation (to the tumor bed); (4) following surgery, negative (clear) surgical margins were obtained; (5) during the postoperative follow-up period, disease recurrence, progression, and survival and/or duration of event-free interval was documented with (6) a minimum follow-up of 1 month. A total of 1254 patients were included in the analysis. RESULTS: Statistically significant reductions in local (hazard ratio [HR], 0.27; P < .001) and regional (HR, 0.34; P < .001) recurrence were observed among patients treated with combination therapy compared with surgery alone. Similar rates of distant metastasis were observed between treatment groups (HR, 0.79; P = .31). Overall survival rates were 87% (1 year) and 49% (5 years). Cause-specific survival rates were 90% (1 year) and 62% (5 year). In general, differences in overall (HR, 0.78; P = .16) and cause-specific (due to MCC: HR, 0.72; P = .14) survival rates between treatment groups did not reach statistical significance. A subgroup analysis that excluded single-patient case reports and studies of only 1 treatment group revealed a significant overall (HR, 0.63; P = .02) and cause-specific (HR, 0.62; P = .04) survival advantage after treatment with combination therapy. CONCLUSIONS: Surgery plus local adjuvant irradiation was associated with significantly lower rates of local and regional recurrence of MCC than surgery alone. Prospective investigation is needed to clarify the presence of a survival benefit from combination therapy.

Adult↗
PubMed2006

Public health challenges in sun protection.

Sunscreens are a popular choice for protection from ultraviolet radiation, and hence, important components in the public health campaign to reduce the burden of skin cancer. Public health messages in skin cancer prevention have been used effectively in educational campaigns. The benefits of sunscreen extend beyond skin cancer prevention into other aspects of health and disease prevention: sunscreen decreases the risk for sunburn during physical activity outdoors and seems not to increase the risk for osteoporosis. Public health efforts have laid a solid foundation on which to face the continuing challenge of promoting and developing effective public health campaigns and health policies that encourage sunscreen use, sun protection, and the primary prevention of skin cancer. In this article, the controversies, concerns, and challenges of sunscreen use as it relates to public health are discussed.

Health Education↗
PubMed2006

The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology.

Skin disease is one of the top 15 groups of medical conditions for which prevalence and health care spending increased the most between 1987 and 2000, with approximately 1 of 3 people in the United States with a skin disease at any given time. Even so, a national data profile on skin disease has not been conducted since the late 1970s. This study closes the gap by estimating the prevalence, economic burden, and impact on quality of life for 22 leading categories of skin disease. The estimated annual cost of skin disease in 2004 was 39.3 billion dollars, including 29.1 billion dollars in direct medical costs (costs of health services and products) and 10.2 billion dollars in lost productivity costs (defined as costs related to consumption of medical care, costs associated with impaired ability to work, and lost future earning potential because of premature death). Based on a methodology of willingness to pay for symptom relief, the additional economic burden of skin disease on quality of life amounted to an estimated 56.2 billion dollars. Including the economic burden on quality of life, the total economic burden of skin disease to the US public in 2004 was approximately 96 billion dollars.

Cost of Illness↗
PubMed2005

Association of UV index, latitude, and melanoma incidence in nonwhite populations--US Surveillance, Epidemiology, and End Results (SEER) Program, 1992 to 2001.

OBJECTIVE: To estimate the association between UV index, latitude, and melanoma incidence in different racial and ethnic populations in a high-quality national data set. DESIGN: Descriptive study. SETTING: Eleven US cancer registries that constitute the Surveillance, Epidemiology, and End Results Program (SEER-11). PATIENTS: Patients with malignant melanoma of the skin reported between 1992 and 2001. MAIN OUTCOME MEASURES: Pearson correlation coefficients and regression coefficients were used to estimate the relationship of age-adjusted melanoma incidence rates (2000 US standard population) with the UV index or latitude within racial and ethnic groups. RESULTS: A higher mean UV index was significantly associated with an increase in melanoma incidence only in non-Hispanic whites (r = 0.85, P = .001), although a nonsignificant association was noted in Native Americans (r = 0.42, P = .20). Negative, but not significant, correlations with incidence were observed in blacks (r = -0.53, P = .10), Hispanics (r = -0.43, P = .19), and Asians (r = -0.28, P = .41). Latitude also had a significant correlation with incidence only in non-Hispanic whites (r = -0.85, P = .001). A substantial portion of the variance in registry incidence in non-Hispanic whites could be explained by the UV index (R(2) = 0.71, P = .001). CONCLUSIONS: Melanoma incidence is associated with increased UV index and lower latitude only in non-Hispanic whites. No evidence to support the association of UV exposure and melanoma incidence in black or Hispanic populations was found.

Black or African American↗
PubMed2005

Dermatoepidemiology.

Dermatoepidemiology is an important emerging discipline in dermatology. This article reviews clinical and analytic epidemiology pertinent to reading, interpreting, and critically examining the literature, and presents an overview of evidence-based dermatology as a starting point for further study.

Bias↗
PubMed2005

Relationship of treatment delay with surgical defect size from keratinocyte carcinoma (basal cell carcinoma and squamous cell carcinoma of the skin).

Larger keratinocyte carcinoma (KC) lesions are associated with higher morbidity. This study examined the association of potentially modifiable characteristics, including treatment delay, with KC defect size after Mohs micrographic surgery (MMS). A stratified random sample of patients treated for KC with MMS were selected for telephone interview. Two hundred and nineteen interviews were completed (refusal rate 24%). Regression models were used to examine the predictors to defect size and delay. Anatomic site, age, histology, and gender predicted defect size (R(2) = 0.39) and were used as control variables. Self-reported delay between initial physician examination and MMS predicted defect size (p = 0.0004), with greater than 1 y delay being associated with a doubling of defect size (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.3-3.1). Delays of this duration were associated with initial examination by a primary provider (unadjusted OR 3.9; 95% CI 1.7-8.8), misdiagnosis (unadjusted OR 6.8; 95% CI 2.5-18.7), being treated without biopsy (unadjusted OR 23.3; 95% CI 6.5-83.7), and multiple surgical removals (unadjusted OR 6.2; 95% CI 2.5-15.5). All but provider specialty were independent predictors of delay. Attention to processes of care delivery for KC may have a greater impact on morbidity than efforts are earlier detection by the public.

Adult↗
PubMed2004

Sun protective behaviors and sunburn experiences in parents of youth ages 11 to 18.

BACKGROUND: Recent studies suggest that parental sun protective behaviors and communication influence their adolescents. However, there is limited information on sun protection for parents of adolescents. METHODS: A telephone-based, nationally representative prevalence study of sun exposure among youth, aged 11-18, and their parents living in households was conducted in 1998. Separate, independent responses were collected. Weighted prevalence estimates and 95% confidence intervals were estimated and presented for parents only (n = 1187). RESULTS: Approximately one-third of parents planned activities to avoid the sun and used sunscreen. Among parents who used sunscreen, 70% applied it while at the beach or pool, but not as often during other outdoor activities. Almost one-third of parents were participating in water or non-water recreational activities during their most serious sunburn. Differences in sun protection and sunburn experiences were observed by age, gender, sun sensitivity, race and ethnicity, and educational attainment. CONCLUSIONS: Parents have adopted sun protection habits, but have not surpassed national sun-protection goals. Combined use of sun protection behaviors may reduce sunburn prevalence and number of incident skin cancers. These data may be useful for developing or enhancing current sun protection programs for effective sun protection that include parents and their adolescents.

Adolescent↗