Trends in mortality from cutaneous malignant melanoma in Spain (1982-2016): sex-specific age-cohort-period effects.

BACKGROUND: Mortality from malignant cutaneous melanoma increased alarmingly during the second half of the 20th century in Spain and other European countries. OBJECTIVE: The aim was to analyse sex- and age-specific trends in melanoma mortality in Spain in the period 1982-2016. METHODS: European age-standardized melanoma mortality rates during the period 1982-2016 were calculated from mortality figures provided by the National Statistics Institute. Joinpoint regressions were used to identify significant points of change in trends and to compute average annual per cent change (AAPC). Age-cohort-period models were fitted to explore the effect of these variables on mortality. RESULTS: During the period 1982-2016, age-standardized melanoma mortality rates increased in Spain from 0.90 to 1.80 deaths per 100 000 people in men and from 0.64 to 1.11 per 100 000 in women, rising noticeably from 1982 to 1995 in both sexes and in all age groups. From the mid-90s different trends were observed depending on sex and age: there was a decrease in mortality in the population younger than 45 years (AAPC -2 in both sexes) and aged 45-64 years (AAPC -1 among men and -0.2 among women), but in the group over 64 years rates continued to increase (AAPC 1.7 and 0.2, respectively, for men and women). The mortality sex ratio decreased in the younger population but increased in older individuals. A cohort effect was observed with lower mortality in the cohorts born after 1943 in men and 1956 in women. There was also a period effect with decreased mortality rates at the beginning of the 1990s. CONCLUSIONS: Melanoma mortality rates in Spain increased during the last decades of the 20th century; however, later they stabilized in women and began to decrease in younger cohorts and middle-aged men. Promotion of primary and secondary prevention measures should continue, with particular emphasis on males over 65 years.

Selective sunscreen application on nevi: frequency and determinants of a wrong sun-protective behaviour.

BACKGROUND: Sunscreen use is generally recommended in order to prevent skin cancer but erroneous patterns of use were reported, including the selective application on melanocytic nevi. OBJECTIVE: To assess prevalence and determinants of selective sunscreen application on nevi and participants' behavioural risk profile overall. METHODS: A multilingual, dichotomous, funnel-designed questionnaire about sun exposure/protection habits and perceived nevus count was administered to patients attending five Dermatology Departments in three countries (Italy, Austria and France). Multivariate logistic regression models were used to determine independent predictors of each answer. RESULTS: Among the 1816 subjects surveyed (59.3% females, age 14-90 (median 45) years, 44.7% Italians), 1273 (70.1%) reported intentional sun exposure and 1109/1273 (87.1%) reported sunscreen use. Among the latter, 1086 (97.9%) stated they have moles on their skin. Fifty-one/1086 (4.7%) reported selective sunscreen application on nevi. Reported information sources were: dermatologist (49.0%), personal belief (31.4%), relative/friend (7.8%), media (7.8%), paediatrician (2.0%) and general practitioner (2.0%). Increasing age (P < 0.05) and being Italian (P < 0.001) were independent predictors of selective sunscreen application on nevi. Sun-seeking behaviours were predicted by decreasing age, female sex and being Italian. CONCLUSION: Selective sunscreen application on nevi was more common than expected. It is of concern that this was recommended mostly by physicians. There is a need to educate patients, non-expert clinicians, media and the sunscreen industry on this matter. Tan patients presenting with halo nevi should be questioned about this behaviour in order to avoid false positive diagnoses.

Multiple lentigines in areas of resolving psoriatic plaques after ustekinumab therapy.

The development of lentigines in areas previously involved by psoriasis has been reported in the literature, classically related to phototherapy but also to topical products. More recently, some authors have described several cases of lentigines appearing in resolving psoriatic plaques during or after treatment with anti-tumour necrosis factor (TNF) drugs used to treat severe plaque psoriasis, including adalimumab, etanercept, and infliximab. We report the case of a patient that developed multiple lentigines after clearance of the plaques of psoriasis receiving treatment with ustekinumab for his psoriasis.

Photosensitivity due to thiazides.

Thiazides are widely used diuretics that first became available in the 1950s. The first reports of photosensitivity reactions to thiazides were published shortly after the introduction of these drugs, but few cases have been described since. We review all the cases of photosensitivity due to thiazides published up to December 2011. We found 62 cases, 33 in women and 29 in men. The most common presentation was eczematous lesions in a photodistributed pattern, and the most common causative agent was hydrochlorothiazide. The results of photobiological studies were published in only some of the cases reviewed. In most cases, phototesting revealed an abnormal response to UV-A alone or to both UV-A and UV-B. In some cases, the results of phototesting were normal and only photopatch testing yielded abnormal results. Diagnosis of photosensitivity due to thiazides requires a high degree of suspicion. Ideally, diagnosis should be confirmed by a photobiological study.

Selenium and impaired physical function in US and Spanish older adults.

BACKGROUND: Selenium (Se) is a trace element with a narrow safety margin. OBJECTIVES: To evaluate the cross-sectional and longitudinal dose-response association between Se exposure and measures of impaired physical function and disability in older adults. DESIGN: NHANES 2011-2014 cross-sectional (US, n = 1733, age ≥60 years) and Seniors-ENRICA-2 2017-2019 cross-sectional and longitudinal (Spain, n = 2548 and 1741, respectively, age ≥65 years) data were analyzed. Whole blood and serum Se levels were measured using inductively coupled plasma-mass spectrometry. Lower-extremity performance was assessed with the Short Physical Performance Battery, and muscle weakness with a dynamometer. Incident mobility and agility limitations, and disability in instrumental activities of daily living (IADL) were ascertained with standardized questionnaires. Analyses were adjusted for relevant confounders, including physical activity. Results across studies were pooled using random-effects meta-analysis. RESULTS: Meta-analyzed odds ratios (95% confidence interval) per log2 increase in whole blood Se were 0.54 (0.32; 0.76) for weakness, 0.59 (0.34; 0.83) for impaired lower-extremity performance, 0.48 (0.31; 0.68) for mobility limitations, 0.71 (0.45; 0.97) for agility limitations, and 0.34 (0.12; 0.56) for disability in at least one IADL. Analyses for serum Se in NHANES showed similar results. Findings suggest the inverse association with grip strength is progressive below 140 µg/L (p-value for non-linear trend in the Seniors-ENRICA-2 study = 0.13), and above 140 µg/L (p-value for non-linear trend in NHANES = 0.11). In the Seniors-ENRICA-2 cohort, with a 2.2 year follow-up period, a doubling in baseline Se levels were associated with a lower incidence of weakness [odds ratio (95% confidence interval): 0.45 (0.22; 0.91)], impaired lower-extremity performance [0.63 (0.32; 1.23)], mobility [0.43 (0.21; 0.91)] and agility [0.38 (0.18; 0.78)] limitations. DISCUSSION: In US and Spanish older adults, Se concentrations were inversely associated with physical function limitations. Further studies are needed to elucidate underlying mechanisms.