Modifiable Risk-factors for Keratinocyte Cancers in Australia: A Case-control Study.

Keratinocyte cancer is the most common malignancy in Caucasians. The aim of this study was to investigate risk-factors responsible for development of keratinocyte cancer in Australia. A case-control study was conducted, including 112 cases of squamous cell carcinoma (SCC), 95 cases of basal cell carcinoma (BCC) and 122 controls. Freckling during adolescence (SCC: odds ratio (OR) 1.04, p < 0.01; BCC: OR 1.05, p < 0.01), propensity to sunburn (SCC: OR 2.75, p = 0.01, BCC: OR 2.68 p = 0.01) and high cumulative sun-exposure (SCC: OR 2.43, p = 0.04; BCC: OR 2.36 p = 0.04) were independent risk-factors for both SCC and BCC. This study provides further evidence that a sun-sensitive phenotype and excessive sun-exposure during adulthood contribute to the risk of developing keratinocyte cancer. Wearing a hat, long-sleeved shirts, and sunscreen did not significantly reduce the risk of keratinocyte cancer in this study.

Knowledge and perceptions about sunburn and solar keratoses in Australia.

An omnibus telephone survey of 1200 adult Australians determined self-reported prevalence of and attitudes to sunburn and sunspots, knowledge of the term solar keratosis and prevalence of skin checks. Half reported they had been sunburnt in the previous year. Seventy-eight per cent considered sunburn to be extremely or very serious, while 73% considered sunspots as serious or very serious. While 29% reported currently having sunspots, 69% had never heard of the term solar keratosis, 30% had never had a skin check and 28% had their last skin check more than 12 months ago. Respondents 18-29 years old (odds ration [OR] = 2.6; P = 0.002) and men (OR = 2.4; P < 0.001) were most likely to experience multiple sunburn. Persons living in capital cities (OR = 0.63; P = 0.006) and having a university degree (OR = 0.52; P = 0.001) had reduced OR for multiple sunburns. Men (OR = 0.45; P < 0.001) were less likely to consider sunburn serious or extremely serious than women. Compared with respondents 18-29 years old, those 55 years or older were 7.4-fold more likely to have had a skin check (P < 0.001). Sun-protection campaigns need to continue using evidence-based interventions targeting younger people and men to reduce sunburn. The terms used in health promotion need to be understood by the target audience.

Agreement between histological diagnosis of skin lesions by histopathologists and a dermato-histopathologist.

BACKGROUND: Skin cancer is an increasing problem in fair-skinned populations worldwide. It is important that doctors are able to diagnose skin lesions accurately, and this is supported by accurate histological diagnosis. OBJECTIVE: To compare agreement for histological diagnosis between local histopathologists with a dermato-histopathologist from a stratified random sample of excised skin lesions derived from a set of epidemiological data. METHODS: All excised and histologically confirmed skin cancers in Townsville/Thuringowa, Australia from December 1996 to October 1999 were recorded. A stratified sample of 407 of 8694 skin excisions slides was analyzed. Results Positive predictive values (PPVs) for the primary histological diagnosis were above 90% for basal cell carcinoma, cutaneous melanoma, and common naevus. For squamous cell carcinoma (SCC), the PPV was 72.6% [95% CI = (65.5, 79.0)]. DISCUSSION: Lack of agreement between histopathologists regarding the diagnosis of SCC and actinic keratosis has been previously recognized in the literature and this is again reflected in our study. The result also illustrates the difficulty involved for doctors in accurately clinically diagnosing lesions for which a consensus is hard to reach histologically.

Multiple nonmelanoma skin cancer in an exposed Australian population.

BACKGROUND: Patients with nonmelanoma skin cancer (NMSC) frequently develop multiple skin cancers. The study presents incidence rates and rates of excision of NMSC for a population living in a high-risk environment for skin cancer. METHODS: Between 1997 and 1999 a prospective population-based study collected information on all histologically confirmed NMSCs in Townsville, Australia. RESULTS: Of the 6708 patients recorded with NMSC, 38.5% had multiple lesions. Yearly age-standardized incidence rates (per 100,000 inhabitants) of basal cell carcinoma (BCC) were 1444.8 for men, 942.7 for women, and of squamous cell carcinoma (SCC) were 805.0 for men, and 423.6 for women. Compared to incidence rates, age-standardized rates of lesions of BCC were 2.1 times higher in men, 1.6 times higher in women, and of SCC were 1.8 times higher in men and 1.4 times higher in women. CONCLUSIONS: The occurrence of multiple NMSCs compromises results of short-term studies on incidence. Further discussions on the most appropriate strategies to describe the real burden of NMSC are warranted.