Effects of total-body digital photography on cancer worry in patients with atypical mole syndrome.

IMPORTANCE: Cancer worry about developing melanoma in at-risk patients may affect one's quality of life and adherence to screening. Little is known about melanoma-related worry in patients with atypical mole syndrome (AMS). OBJECTIVES: To quantify levels and elucidate predictors of worry related to developing melanoma in patients with AMS and to determine whether total-body digital photography (TBDP) in pigmented lesion clinics (PLCs) reduces worry. DESIGN, SETTING, AND PARTICIPANTS: In this pretest-posttest study, patients with AMS from PLCs at 2 academic medical centers were recruited from June 1, 2005, through October 31, 2008, to answer questions about cancer worry before and after undergoing TBDP. Questionnaires used included the new melanoma and recurrent melanoma Revised Impact of Event Scale (RIES), the Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale, and the Life Orientation Test. INTERVENTIONS: All patients underwent TBDP. MAIN OUTCOMES AND MEASURES: Changes in the MWS and new melanoma RIES scores. RESULTS: A total of 138 patients completed baseline questionnaires; 108 patients (78.3%) completed questionnaires after TBDP. Baseline levels of worry were low and reduced further after TBDP. In patients with a personal history of melanoma, worry was reduced on all scales. In patients without a personal history of melanoma, only the new melanoma RIES score was significantly decreased. Predictors of baseline MWS scores include female sex, personal history of melanoma, and higher Hospital Anxiety and Depression Scale scores, adjusted for demographics, family history of melanoma, and Life Orientation Test scores. Adjusted predictors of the baseline new melanoma RIES score were similar but also included lower educational level and did not include sex. CONCLUSIONS AND RELEVANCE: Patients with AMS have low levels of melanoma-related worry, which is similar to data from other populations at high risk of cancers. We found that TBDP is a clinically useful tool that can be used in PLCs to help decrease worry about developing melanoma in at-risk patients.

Willingness to pay in dermatology: assessment of the burden of skin diseases.

Willingness to pay (WTP) is a monetary, preference-based, burden-of-disease measure with a potential role in dermatology, where many conditions are temporary and/or mild, and many treatments are inexpensive and one might be able to imagine paying out of pocket. We assessed construct validity by interviewing 254 consecutive dermatology patients at Stanford Medical Center, Grady Hospital, and Parkland Hospital. Instruments asked about an individual's own health status and elicited WTP, time-trade-off (TTO) utilities, and health status quality of life (QOL). We measured WTP cure (short treatment course to eliminate disease) and WTP control (lifelong medication). Our data indicate greater construct validity in non-Medicaid (n=163) than Medicaid (n=91) patients. Non-Medicaid subjects had greater WTP as percent of income for cure (median: 2%) than control (median: 1.6%), P<0.01; Medicaid WTP amounts for control and cure did not differ. Non-Medicaid subjects with verrucae had little QOL impact, no measurable burden by TTO, and a correspondingly low WTP. Medicaid subjects with basal cell carcinoma had a strong, negative QOL impact and high burden by TTO, but had relatively moderate WTP. WTP appears promising in certain income categories. More studies are needed for conclusions about specific diagnoses.

Preference-based measures in dermatology: an overview of utilities and willingness to pay.

In this overview of preference-based measures, utilities and willingness to pay (WTP) are discussed as measures relevant to dermatology for capturing the burden of skin diseases. An overview is provided of the concepts of utilities and WTP and their importance in decision making. Specific examples of elicitation methods for capturing utility and WTP measures are provided. Prior studies exploring utilities and WTP in dermatology are reviewed. Each of these measures has limitations and likely varying relevance to specific dermatologic diseases and to specific individuals.

Economic burden of melanoma in the elderly population: population-based analysis of the Surveillance, Epidemiology, and End Results (SEER)--Medicare data.

OBJECTIVE: To assess health care resources consumed by melanoma in the population 65 years or older, a group with comparatively poor outcomes. DESIGN: Database analysis. SETTING: The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked population-based database for fiscal years 1991 through 1996. PARTICIPANTS: A total of 1858 subjects with pathological confirmation of melanoma. MAIN OUTCOME MEASURES: Resource consumption was examined by stage and treatment phase. Outcomes were measured in monthly charges obtained from the data set and costs were estimated by application of cost to charge ratios. Annual resource consumption by melanoma in patients 65 years or older in the United States was also estimated by incorporation of published SEER cancer statistics. RESULTS: Average monthly, per-patient melanoma charges were $2194 during the initial 4 months of treatment; they dropped by more than half to $902 during the interim phase, which varied in length depending on survival. Monthly charges increased to $3933 during the terminal 6 months of treatment. The estimated annual charge of treating melanoma in the population 65 years or older was $390 million. By using cost to charge ratios, we found the annual cost of melanoma to be up to $249 million and the per-patient lifetime costs to be $28 210 from the time of diagnosis to the time of death. CONCLUSIONS: Melanoma care presents a significant economic burden in the elderly population, particularly in late-stage disease. If effective, prevention and early detection efforts may reduce the economic burden.

Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.

OBJECTIVE: To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes. DESIGN: We developed a computer-simulation, probabilistic, decision model to perform a cost-effectiveness analysis, with each patient serving as his or her own control. SETTING: University of Connecticut dermatology clinic, a tertiary care referral center. PARTICIPANTS: Input data were derived from results of a consecutive sample of 98 patients with nonmelanoma skin cancer on the face and ears, estimates in the literature on 5-year recurrence rates, and a query of healthy focus-group participants. INTERVENTION: We considered Mohs and traditional excision strategies. MAIN OUTCOME MEASURES: Outcomes were measured in quality-adjusted life years, cost, and cost-effectiveness. RESULTS: The Mohs strategy was $292 less expensive than the traditional surgical strategy and was more effective by an incremental quality-adjusted life year of 0.056 (translating to approximately 3 weeks of optimal quality of life). Results were robust to subgroup and sensitivity analyses. CONCLUSIONS: Mohs may be more cost-effective than traditional excision in eradicating nonmelanoma skin cancer. Further investigation of costs from various geographic payment localities and assessment of quality-of-life outcomes from a population-based sample are needed.

Dermatomyositis induced by drug therapy: a review of case reports.

BACKGROUND: Drugs have occasionally been implicated in dermatomyositis (DM) onset. OBJECTIVE: We sought to review case reports of drug-induced DM. METHODS: Articles were gathered from MEDLINE and bibliographies of acquired reports. Causality was assessed using World Health Organization criteria. Clinical characteristics, management, and resolution were examined. RESULTS: In 70 reported cases, 50% of patients were female and the median age was 57 years. Hydroxyurea was implicated in 51% of cases. All cases had pathognomonic (76%) or compatible (24%) cutaneous findings. Hydroxyurea cases lacked myositis, but myositis was described in 79.4% of nonhydroxyurea cases. Drug causality was probable (25.7%) or possible (74.3%), but not certain in any case. Most patients had underlying pathology associated with DM (44% had malignancy; 16% had rheumatoid arthritis). Of the sample, 84.3% had improvement of DM after discontinuation of the drug. LIMITATIONS: Case reports may emphasize unusual findings. CONCLUSIONS: Further work is needed to differentiate drug effects from underlying, predisposing factors.

Amyopathic dermatomyositis resembling stasis dermatitis.

This case describes an unusual presentation of dermatomyositis in a patient with ovarian carcinoma. The eruption appeared as a venous stasislike dermatitis. The temporal sequence of onset after chemotherapy administration suggested a possible drug-induced process. However, in the context of underlying ovarian carcinoma, a paraneoplastic process offered an alternative explanation for the dermatomyositis.