Total body skin examination for skin cancer screening in patients with focused symptoms.

BACKGROUND: The value of total body skin examination (TBSE) for skin cancer screening is controversial. OBJECTIVE: We sought to determine whether TBSE could be helpful in patients with focused skin symptoms who would not otherwise have undergone TBSE. METHODS: In a prospective, multicenter, cross-sectional study consecutive adult patients were recruited during a period of 18 months. Physicians first inspected problem areas and uncovered areas and then performed TBSE. Equivocal lesions detected in both steps were excised or biopsied. Primary outcomes were the absolute and relative risks of missing skin cancer and the number of patients needed to examine to detect melanoma or another malignancy. A secondary outcome was the proportion of false-positive results obtained by TBSE. RESULTS: We examined 14,381 patients and detected 40 (0.3%) patients with melanoma and 299 (2.1%) with at least one nonmelanoma skin cancer by TBSE. In 195 (1.3%) patients equivocal lesions found by TBSE turned out to be benign. We calculated that 47 patients need to be examined by TBSE to find one skin malignancy and 400 patients to detect one melanoma. The risk of missing one malignancy if not performing TBSE was 2.17% (95% confidence interval 1.25-3.74). Factors significantly increasing the chance to find a skin cancer were age, male gender, previous nonmelanoma skin cancer, fair skin type, skin tumor as the reason for consultation, and presence of an equivocal lesion on problem/uncovered areas. LIMITATIONS: The impact of TBSE on skin cancer mortality was not evaluated. CONCLUSIONS: TBSE improves skin cancer detection in patients with focused skin symptoms and shows a low rate of false-positive results.

Cutaneous melanoma in Latin America: a population-based descriptive study.

Cutaneous melanoma incidences vary between geographic regions and are a health concern for Caucasians and for all ethnic populations. In Latin America, data from population-based cancer registries of cutaneous melanoma incidence rates have rarely been reported. We searched the Cancer Incidence in Five Continents volume IX (CI5-IX) database for cutaneous melanoma and select cases by topography (C43) from 11 population-based cancer registries in Latin America. Between 1998 and 2002, a total of 4,465 cutaneous melanoma cases were reported in Latin America. The average age-standardized incidence rates (per 100,000 persons-year) was 4.6 (male) and 4.3 (female). This study presents an overview of cutaneous melanoma incidence in Latin America, highlighting the need to enhance coverage of population-based cancer registries in Latin America, to allow for a better understanding of this neoplasm in the region. Thus it can help in implementing primary prevention programs for the whole Latino population. At this point in time, early detection messages should target young women and older men in Latin America.

Cutaneous melanoma in Latin America: a population-based descriptive study / Melanoma cutâneo na América Latina: estudo descritivo de base populacional

Cutaneous melanoma incidences vary between geographic regions and are a health concern for Caucasians and for all ethnic populations. In Latin America, data from population-based cancer registries of cutaneous melanoma incidence rates have rarely been reported. We searched the Cancer Incidence in Five Continents volume IX (CI5-IX) database for cutaneous melanoma and select cases by topography (C43) from 11 population-based cancer registries in Latin America. Between 1998 and 2002, a total of 4,465 cutaneous melanoma cases were reported in Latin America. The average age-standardized incidence rates (per 100,000 persons-year) was 4.6 (male) and 4.3 (female). This study presents an overview of cutaneous melanoma incidence in Latin America, highlighting the need to enhance coverage of population-based cancer registries in Latin America, to allow for a better understanding of this neoplasm in the region. Thus it can help in implementing primary prevention programs for the whole Latino population. At this point in time, early detection messages should target young women and older men in Latin America.

A incidência de melanoma cutâneo varia entre regiões geográficas e é preocupante tanto para a população de pele clara como outras etnias. Na América Latina, dados de incidência de melanoma cutâneo oriundos de registros de câncer de base populacional são escassos. Uma busca na base de dados do Cancer Incidence in Five Continents, volume IX (CI5-IX), foi realizada para melanoma cutâneo pela topografia (C43), e casos de 11 registros de câncer de base populacional na América Latina foram selecionados. Entre 1998 e 2002, encontrou-se um total de 4.465 casos de melanoma cutâneo na América Latina. Os coeficientes padronizados médios de incidência (por 100 mil pessoas-ano) foram 4,6 (homens) e 4,3 (mulheres). Este estudo descreve o panorama da incidência de melanoma cutâneo na América Latina e pontua a necessidade de reforçar a cobertura dos registros de câncer de base populacional nos países sul-americanos, o que permitiria uma melhor compreensão dessa neoplasia, facilitando a implementação efetiva de programas de prevenção primária para toda a população latina. Neste momento, as mensagens de detecção precoce do melanoma cutâneo devem ter, como alvo, mulheres jovens e homens mais velhos na população da América Latina.

Primary oral melanoma: population-based incidence.

Primary oral melanoma (POM) is a rare form of melanoma, generally diagnosed at a late stage and has poor prognosis. Epidemiological information has scarcely been reported in the literature over the past 40 years. Analyzing the Cancer Incidence in Five Continents volume IX (CI5-IX) database we found a total of 124,436 oral cavity cancers reported from all population-based cancer registries and 319 cases of POM reported by 67 cancer registries. To our knowledge this is the largest number of POM cases analyzed and accounts for 0.26% of all oral cavity cancers. ASR(W) for POM do not exceed 0.01 per 100,000 persons-year in all regions. The most common anatomic sites were palate (47%) and gum (27.6%) and a detailed oral mucosa examination and biopsies of nodular or macular lesions in these sites, especially on elderly patients, is advised to be routinely performed.

Cancer registration data and quality indicators in low and middle income countries: their interpretation and potential use for the improvement of cancer care.

Cancer registration data plays a major role in the design and monitoring of cancer control activities and policies, and population-based cancer registries (PBCR) are the main source of information. In developed countries, the healthcare infrastructure enables the registration of quality cancer data. In low and middle Income countries (LMIC), where health care facilities are limited or scarce, cancer registration data may be of low quality. The aim of this article is to demonstrate the value of cancer incidence data for LMIC, even when quality is questionable, as well as to attempt to interpret the messages that the quality indicators convey both for cancer registration and the healthcare system. The study of data submitted to the Cancer incidence in five continents, volume nine (CI5-IX) leads to the conclusion that when PBCR from LMIC cannot provide good quality data it may indicate a deficiency that goes above and beyond the registrar ability. The quality control indicators evaluated provide insight on local conditions for cancer diagnosis and care. Low data quality not only signals lack of collaboration among reporting sources and the inability of the registrar to perform quality abstracting, but also points to specific weaknesses of the cancer care system and can guide improvement goals and efforts.

Melanoma cutâneo: estudo de base populacional em Goiânia, Brasil, de 1988 a 2000 / Cutaneous melanoma: population-based study in Goiania, Brazil, from 1988 to 2000

FUNDAMENTOS: O Registro de Câncer de Base Populacional de Goiânia disponibiliza dados de melanoma de uma série temporal de 13 anos, com 96,6 por cento de confirmação histopatológica. OBJETIVO: Comparar incidência, mortalidade e tendências mundiais com os dados do primeiro estudo de base populacional de melanoma cutâneo do Brasil. MÉTODOS: Foram analisados 290 casos novos diagnosticados em residentes do município (incidência) e 54 óbitos reportados ao Registro de Câncer de Goiânia (mortalidade), entre 1988 e 2000. Os coeficientes padronizados por idade e sexo foram calculados pela população mundial. Para análise das tendências, um modelo de regressão linear simples foi utilizado. RESULTADOS: Cento e quarenta e quatro casos de melanoma em mulheres e 146 em homens. Os coeficientes padronizados médios de incidência foram crescentes tanto para homens (r²=0,33; p=0,040) como para mulheres (r²=0,41; p=0,019), com tendência crescente nos homens acima de 60 anos e mulheres até 59 anos. Os coeficientes padronizados médios de mortalidade foram crescentes nos homens (r²=0,32; p=0,042) e estáveis nas mulheres, com tendência crescente para homens acima de 60 anos. CONCLUSÃO: Tanto em Goiânia como no mundo, a incidência de melanoma cutâneo é crescente para ambos os sexos. A mortalidade tende à estabilidade nas mulheres e é crescente para homens.

BACKGROUND: The Goiania Population-Based Cancer Registry grants access to a 13-year temporal series on melanoma data, with a histopathologic confirmation of 96.6 percent. OBJECTIVE: To compare the world incidence, mortality and trends with data of the first populationbased study on cutaneous melanoma in Brazil. METHODS: Two hundred and ninety new cases of melanoma diagnosed in city residents (incidence) and 54 deaths reported to the Goiania Cancer Registry (mortality) were analyzed between 1988 and 2000. The standardized coefficients of age and sex were calculated using the world population. The trends were analyzed by simple linear regression models. RESULTS: One hundred and forty-four cases of melanoma in women and 146 in men. The mean standardized incidence rates were increasing in both men (r²=0.33; p=0.040) and women (r²=0.41; p=0.019), with a significant increase in men over 60 years old and women aged up to 59. The mean standardized mortality rates were increasing in men (r²=0.32; p=0.042) and stable in women, with a significant increase in men aged over 60 years. CONCLUSIONS: In Goiania, as well as around the world, cutaneous melanoma incidence rates are increasing in both sexes. Mortality rates tend to stabilize in women and increase in men.