Biomedical subjects

Stephen W Dusza

Publications and source records attributed to Stephen W Dusza.

5 recordsLinked to original sources

PubMed2005

The association between large congenital melanocytic naevi and cutaneous melanoma: preliminary findings from an Internet-based registry of 379 patients.

There is ample evidence in the literature to support the fact that there is an increased risk of the development of melanoma in individuals with a large congenital melanocytic naevus (LCMN). The published melanoma risk estimates, by and large, do not distinguish between cutaneous and extracutaneous melanomas. It is currently not known to what extent each contributes to the overall cited melanoma risk estimates. In order to obtain a better understanding of the association between LCMN and cutaneous melanoma arising within an LCMN, we report the preliminary findings of a cross-sectional study of 379 patients, with a median age of 3 years, from the first self-referred, Internet-based registry of patients with LCMN. To date, no cutaneous melanoma has been reported; possible reasons for this finding are discussed. Further research is required to clarify the risk of the development of cutaneous melanoma separate from non-cutaneous melanoma and to identify subgroups of patients with LCMN at highest risk for the development of melanoma. This information will help to formulate appropriate decisions concerning the management of patients with LCMN.

Adolescent↗

PubMed2004

The Framingham school nevus study: a pilot study.

OBJECTIVES: To (1). describe nevus patterns using digital photography and dermoscopy; (2). evaluate the relationship between host and environmental factors and prevalence of nevi in schoolchildren; and (3). demonstrate the feasibility of conducting a longitudinal study. DESIGN: Cross-sectional survey and 1-year prospective follow-up study. PARTICIPANTS: Students from 2 classrooms, grades 6 and 7, in the Framingham, Mass, school system (N = 52). MAIN OUTCOME MEASURES: A survey was completed by students and 1 of their parents that included questions on demographic and phenotypic characteristics, family history of skin cancer, and sun exposure and protection practices. An examination of nevi on the back was performed that included digital photography and digital dermoscopy. Follow-up child and parent surveys and examinations were conducted at 1-year follow-up. RESULTS: At baseline, the median number of back nevi was 15 (mean [SD], 21.9 [15.3]). Older age, male sex, fair skin, belief that a tan is healthier, tendency to burn, and sporadic use of sunscreen were positively associated with mole count, although age was the only statistically significant factor. Predominant dermoscopic patterns for the index nevus were as follows: 38% globular, 14% reticulated, 38% structureless, and 10% combinations of the above patterns with no predominant characteristic. The overall participation rate from baseline to follow-up was 81% (42/52) for the skin examination process. At the 1-year follow-up examination, new nevi were identified in 36% of students (n = 15), while 9.6% of baseline index nevi had changes in the dermoscopic pattern. Dominant dermoscopic pattern was related to nevus size: smaller nevi tended to be structureless, while larger nevi were of mixed pattern. CONCLUSION: This study supports the feasibility and utility of digital photography and dermoscopy for the longitudinal study of nevus evolution in early adolescence.

Adolescent↗

PubMed2004

Patient adherence to skin self-examination. effect of nurse intervention with photographs.

BACKGROUND: Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION: Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS: In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS: The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.

Adolescent↗

PubMed2004

Sunless tanning.

BACKGROUND: Americans continue to desire and pursue the tan. Recent data indicate continued high incidence of sunburn and ultraviolet tanning despite public health skin cancer prevention messages. The rising popularity of recently available sunless tanning booths prompted this review. OBJECTIVE: To present an overview of the history of sunless tanning and the sunless tanning booth industry, and to describe the current availability and safety practices of sunless tanning booth providers. METHODS: The current literature and internet resources were reviewed. Phone surveys of 300 businesses were conducted in July, 2003. RESULTS: Sunless tanning services were offered by 43% (39/90) of businesses with tanning services of any type. Sunless tanning booths were the most commonly offered sunless tanning application modality. The safety precautions most commonly offered to sunless tanning customers were recommendations to close their eyes (100%, 17/17), hold their breath (77%, 13/17), and utilize post-sunless tanning sun protection (82%, 14/17). CONCLUSION: Uniform guidelines should be developed to address safety issues associated with sunless tanning booth use. Future investigations are warranted to assess both the medical and behavioral implications of perpetuating the aesthetic appeal of the tan.

Beauty Culture↗

PubMedDate not supplied

Skin self-examination in patients at high risk for melanoma: a pilot study.

PURPOSE/OBJECTIVES: To compare the effect of providing high-risk patients with standard brochures versus personalized photo books as part of a comprehensive nursing intervention on knowledge, awareness, and confidence with skin self-examination (SSE) performance, as well as compliance in performing SSE. DESIGN: Randomized intervention design. SETTING: The Lawrence E. Rockefeller Ambulatory Outpatient Cancer Center at Memorial Sloan-Kettering Cancer Center in New York, NY. SAMPLE: 100 patients at high risk for melanoma. METHODS: Patients completed a baseline questionnaire before their initial photographs were taken and at the end of a nurse-teaching intervention at the clinic. MAIN RESEARCH VARIABLES: Skin cancer knowledge, awareness, and self-confidence in SSE. FINDINGS: A two-way analysis of variance with repeated measures was performed to examine differences within and among groups in relation to knowledge, awareness, and confidence. The group-time interaction was not significant. In group A (nursing intervention with photo book), 10% of the patients at baseline reported performing SSE three or more times during the prior four months. Mean knowledge scores, awareness, and confidence scores all increased. In group B (nurse-teaching intervention using brochures only, without a photo book), 20% reported practicing SSE three or more times during the prior four months. Mean knowledge, awareness, and confidence scores increased. CONCLUSIONS: The main difficulty that patients experience with self-detection of melanoma is their limited recall of skin appearance; therefore, photographic records may be the most effective aid for detecting changes at longer intervals. The use of a photo book may help to diminish that difficulty. IMPLICATIONS FOR NURSING: This study supports the fact that education can increase knowledge, awareness, and confidence regarding SSE, which is consistent with the findings of other investigators. Therefore, nurses should incorporate teaching patients how to perform SSE into their practice and recognize that personal involvement in health care has become a dominant theme in the cancer education literature in recent years. With this new emphasis, important self-care activities, such as testicular self-examination, breast self-examination, and now SSE, are being stressed because early detection has shown favorable effects in improving the prognosis of cancer.

Analysis of Variance↗