Purpose. The diagnosis, management, and therapy of cancer are rapidly advancing and becoming more costly. Data linking the diagnosis, management, and prescription of systemic anticancer therapy (SACT) are not publicly available, are time-consuming to obtain, and are onerous to analyze. We aimed to illustrate how a simple expert elicitation method can be used rapidly to calculate the cost of diagnosing and treating a cancer by stage of disease. We illustrate the method using the example of melanoma. Methods. We designed a simple structured elicitation exercise for melanoma experts from the United Kingdom with the aim of describing the diagnosis, management, and SACT prescription for people with melanoma and the associated proportions offered each option. We modeled experts’ beliefs using scaled beta distributions. We used random-effects meta-analysis to combine the estimates. Published unit costs (£; 2024–2025) were multiplied by estimated proportions to calculate the mean costs for the diagnosis, management, and SACT by disease stage. Results. Seven dermatologists, 5 oncologists, and 4 surgeons participated (2022–2023). There was variation in the estimates of the proportions receiving possible diagnosis, management, or SACT options. Diagnosing suspicious lesions cost £424 to £699 depending on the investigations required. Mean (95% confidence intervals) management costs were £782 (£611, £981) for stage 0, £946 (£776, £1,145) for stage 1a, £4,729 (£4,532, £4,944) for stage 1b/2, £3,719 (£3,213, £4,150) for macroscopic 3, and £2,827 (£2,757, £2,904) for microscopic 3. Mean SACT costs were £65,289 (£50,581, £74,521) for stage 3 and £134,065 (£115,787, £152,938) for stage 4. Conclusions. Our new approach to eliciting and combining estimates balances practical and theoretical considerations. We illustrate how this method produces estimates of the costs, and associated uncertainty, of the diagnosis, management, and SACT for melanoma by stage of disease in the absence of readily accessible diagnosis, management, and prescribing data. These cost estimates were not validated against registry data. Highlights Linked diagnosis, primary surgical management (hereafter “management”), and prescribing of systemic anticancer therapies (SACT) data describing the number and proportion of people with cancer offered these options are not readily available. The time to obtain data together with the time to conduct onerous analyses are a key barrier to obtaining values for use by decision analysts building economic models for evaluating new options for the early detection or prevention of cancer. We designed a simple expert elicitation exercise, completed in Excel. The exercise was designed to provide estimates of the total cost of cancer by stage of disease and crucially also to understand the extent of uncertainty around these estimates. We used melanoma as an exemplar cancer. Clinical experts (consultant dermatologists, surgeons, and oncologists) estimated the proportions of people offered possible diagnostic, management, or SACT options for melanoma (by stage of disease). Our study suggested that they found the expert elicitation exercise easy to understand and managed to complete the task. Random-effects meta-analysis used to pool the individual estimates indicated substantial heterogeneity across experts’ estimates of most elicited proportions. This finding suggested wide variation in possible approaches to the diagnosis, management, and use of SACT for melanoma.

BACKGROUND:The lifetime risk of cutaneous melanoma in Australia is the highest in the world. The most important melanoma risk factor is the number of acquired cutaneous melanocytic naevi (AMN) on a person, the majority of these forming in adolescence. Childhood exposure to ultraviolet radiation (UVR) is a strong determinant of naevus count. OBJECTIVES:To examine childhood AMN and its risk factors over a 25-year period in the high-UVR environment of South-East Queensland. METHODS:The Brisbane Twin Nevus Study recorded sun behaviours and counted naevi on annual new samples of 12-year-old twins (and siblings nearest in age) from 1992 to 2016. Participants were re-examined 2 years later, and a subset was seen 20 years after the initial exam. RESULTS:Among 3957 participants (158 per year), we saw an approximate halving of naevus counts over the 25-year period, and examined multiple explanations for this trend. As this trend was seen for both large (> 5 mm) and smaller naevi, we inferred errors in counting were unlikely. There was an increase in the number of participants reporting non-European ancestry, but this explained only a small proportion of the change in naevus count. CONCLUSIONS:We propose that, in Queensland through the 1990s and 2000s, children's sun exposure has been altered by changes in behaviour. Looking at studies counting naevi in populations at different latitudes, we estimate the observed fall in naevus counts would be consistent with a 11.7% fall in average annual UVR dose (clear sky erythemal spectrum, from 1503 kJ m-2 to 1327 kJ m-2). Based on published risk prediction equations, the fall in mean naevus number over time should lead to a fourfold drop in lifetime melanoma risk for those born after 2000 compared with those born in the 1980s.

Pre‐ and post‐diagnosis physical activity (PA) have been associated with decreased mortality and recurrence in cancer patients, but its effect is under‐studied in patients with cutaneous melanoma. We investigated the association between pre‐diagnosis PA (most recent level and long‐term trajectories) and melanoma‐specific, other‐cause, and overall mortality. Additionally, PA levels before and after a melanoma diagnosis were compared. We used information at recruitment and follow‐ups in the prospective population‐based Norwegian Women and Cancer cohort linked to the Cancer Registry of Norway. In total 1829 women were diagnosed with a first primary melanoma in 1991─2020, aged 34–93 years. We used Cox regression adjusted for age at diagnosis, education, smoking status, region of residence, melanoma thickness, and summary stage. Most recent pre‐diagnosis PA was non‐significantly associated with lower risk of melanoma‐specific mortality (hazard ratio (HR) = 0.69, 95% confidence interval (CI) = 0.44─1.07, high vs. low) and significantly associated with other‐cause (HR = 0.50, 95% CI = 0.28─0.89) and overall mortality (HR = 0.59, 95% CI = 0.42─0.82). Four pre‐diagnosis PA trajectory classes were identified using a latent class mixed model (low, decreasing, moderate, and high). The PA trajectory classes were not significantly associated with melanoma‐specific mortality. However, significantly decreased risks of other‐cause (HR = 0.51, 95% CI = 0.30─0.87) and overall mortality (HR = 0.59, 95% CI = 0.42─0.84) were found in the moderate versus low class. Only 275 patients reported both pre‐ and post‐diagnosis PA, and among those, 69% had a similar PA level before and after melanoma diagnosis. Our results suggest that pre‐diagnosis PA reduces mortality in middle‐aged Norwegian women with melanoma.

Skin cancer referrals in the UK continue to rise, with an increasing burden on the National Health Service. Many naevi are difficult to diagnose clinically as definitively benign or malignant. There is debate about whether these naevi, termed ‘indeterminate naevi’, are best excised or monitored after initial presentation. Thus, our aim was to compare the costs associated with each management strategy. Data on indeterminate naevi presenting between September 2021 and February 2022 were retrospectively analysed. The surveillance arm included 63 patients, and the excision arm, 55 patients. The mean cost per patient seen was £732 in the excision arm and £924 in the surveillance arm. When a patient was seen for one follow-up, the cost was £775, which increased to £1178 after two follow-ups. The cost of excising an indeterminate naevus is lower than that of monitoring. Serial monitoring on more than one occasion results in higher costs.

IntroductionSolid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors.MethodsIn a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases.ResultsOf 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%).ConclusionsSOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.

Abstract There are long-standing concerns that the use of biologic therapies to treat patients with psoriasis could confer an increased risk of developing cancer due to their immunomodulatory effects. We aimed to assess the risk of any incident cancer (excluding keratinocyte carcinoma, KC), hereafter termed ‘incident cancer’, in patients with moderate-to-­severe psoriasis treated with biologic therapy compared with nonbiologic systemic therapy. We used data from BADBIR, a multicentre register evaluating the long-term safety and effectiveness of systemic therapy for patients with moderate-to-severe psoriasis, between September 2007 and November 2023, with linkage to data from NHS Digital to ascertain incident cancers not captured in BADBIR. Eligible for inclusion were patients with chronic plaque psoriasis, who were biologic naive at registration to BADBIR, who had no personal history of cancer (excluding KC) and who had completed at least one follow-up visit. To balance between the compared groups in their baseline characteristics, we calculated probability-weighted regression adjustment estimators with a propensity score model including age, sex, body mass index, smoking, alcohol consumption, previous exposure to nonbiologic systemic therapy and number of comorbidities. Therefore, these weights were used in a flexible parametric survival model to estimate hazard ratios for developing incident cancers, using imputed data. There were 11 185 patients (66%) registered to the biologic cohort and 5673 patients (34%) to the nonbiologic systemic cohort. The biologic cohort was older (median age 44 years, interquartile range 34–54 vs. 42 years, interquartile range 32–53), with more men (59% vs. 57%) and comorbidities (68% vs. 61%) compared with the nonbiologic systemic cohort. Patients in the biologic cohort contributed 73 643 person-years of follow-up and patients in the nonbiologic systemic cohort contributed 23 694 person-years. During follow-up, 467 patients (4%) in the biologic cohort and 169 patients (3%) in the nonbiologic systemic cohort developed incident cancer. There was no significant difference in the risk of developing incident cancer between the biologic cohort and the nonbiologic systemic cohort (adjusted hazard ratio 0.88, 95% confidence interval 0.69–1.11). The results from these real-world data are reassuring for patients with psoriasis and clinicians, as it appears that treatment with biologic therapy does not confer an increased risk of developing overall cancer (excluding KC), in the short-to-medium term, compared with nonbiologic systemic therapy. However, given the heterogeneity of all cancers combined, risks of developing cancers from common subgroups or site-specific cancers (breast, prostate, lung, colorectal and melanoma) in biologic-treated patients need to be investigated. This study is funded by the Psoriasis Association.

Abstract Previous literature suggests an association between the use of biologics and the development of keratinocyte carcinoma in psoriasis. Our aim was to evaluate the risks of developing basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) in patients with moderate-to-severe psoriasis treated with biologic therapy compared with those receiving nonbiologic systemic therapy. We used data from BADBIR, a multicentre register evaluating the long-term safety and effectiveness of systemic therapy for patients with moderate-to-severe psoriasis, between September 2007 and November 2023. Data are linked with additional keratinocyte carcinoma events recorded in NHS Digital. Patients (Fitzpatrick skin types I–IV) with chronic plaque psoriasis, who were biologic naive at registration to BADBIR, with no history of any cancer, and who had completed at least one follow-up visit, were eligible for study inclusion. To balance between the compared groups in their baseline characteristics, we calculated probability-weighted regression adjustment estimators with a propensity score model including age, sex, previous acitretin, previous ciclosporin, and number of courses of psoralen and ultraviolet A or narrowband ultraviolet B. These weights were therefore used in a flexible parametric survival model to estimate hazard ratios (HRs) for developing incident BCC and SCC, using imputed data. In total, there were 9303 patients (67%) registered to the biologic cohort and 4622 patients (33%) in the nonbiologic systemic cohort. The biologic cohort was older (median age 44 years, interquartile range 35–53) vs. median 42 years, interquartile range 32–53), with more men (58% vs. 56%) and comorbidities (68% vs. 61%) compared with those in the nonbiologic systemic cohort. Patients in the biologic cohort contributed 62 141 and 62 433 person-years of follow-up for the BCC and SCC analyses, respectively, while patients in the nonbiologic systemic cohort contributed 19 565 and 19 592 person-years of follow-up. In total, 119 patients (1.3%) developed first BCC and 60 patients (0.6%) developed first SCC in the biologic cohort during follow-up. In the nonbiologic systemic cohort, 28 patients (0.6%) developed first BCC, with 17 patients (0.4%) developing first SCC. These differences in risk of developing first BCC or SCC were not statistically significant between the two cohorts: for BCC, adjusted hazard ratio (aHR) 1.18, 95% confidence interval (CI) 0.71–1.95; and for SCC, aHR 0.91, 95% CI 0.41–1.73. The findings from these real-world data showed no increased risk of BCC or SCC for biologic-treated patients compared with those receiving nonbiologic systemic therapy. However, caution is needed in interpreting the current findings due to the small number of first events. This study is funded by the Psoriasis Association.

Monitoring melanoma incidence time trends by tumour thickness is essential to understanding the evolution of melanoma occurrence and guiding prevention strategies. To assess long-term incidence trends, tumour thickness was extracted from pathology reports in the Cancer Registry of Norway (1983–2007) and the Norwegian Melanoma Registry (2008–2019), n = 45,635 patients. Across all anatomic sites, T1 (≤ 1 mm) incidence increased most (men annual percentage change [AAPC] = 4.6, 95% confidence interval [95% CI] 4.2–5.0; women AAPC = 3.2, 95% CI 2.8–3.6); the increase was steep until 1989/90, followed by a plateau, and a further steep increase from 2004/05. Increased incidence was also observed for T2 (>1.0–2.0) melanoma (men AAPC = 2.8, 95% CI 2.4–3.2; women AAPC = 1.5, 95% CI 1.1–1.9), and T3 (>2.0–4.0) in men (AAPC = 1.4, 95% CI 0.9–1.9). T4 (>4.0) melanoma followed a similar overall pattern (men AAPC = 1.3, 95% CI 0.9–1.7, head/neck, upper limbs, and trunk; women AAPC = 0.9, 95% CI 0.4–1.4, upper limbs and trunk). Men had the highest T3 and T4 incidence and the sex difference increased with age. Regarding birth cohorts, age-specific incidence increased in all T categories in the oldest age groups, while stabilizing in younger patients born after 1950. Overall, the steep increase in T1 melanoma was not accompanied by a decrease in thick melanoma.

BACKGROUND:Understanding the quality of the diet of heart transplant recipients (HTRs) is essential to developing effective dietary interventions for weight control, but relevant evidence is scarce. We investigated diet quality and its association with post-transplant increase in weight adjusted for height (body mass index [BMI]) in Australian HTRs. METHODS:We recruited adult HTRs from Queensland's thoracic transplant clinic, 2020-2021. Study participants completed a 3-day food diary using a smart-phone app. Socio-demographic information was collected by self-administered questionnaire, and height, serial weight and clinical information were obtained from medical records. We calculated the Dietary Approaches to Stop Hypertension (DASH) index based on nine food groups and nutrients (index of 90 indicates highest possible quality), and any changes in BMI (≤ 0 kg m-2 or >0 kg m-2) post-transplantation. Median DASH index values were assessed in relation to sex and BMI change using Mann-Whitney U test. RESULTS:Among 49 consented HTRs, 25 (51%) completed the food diary (median age 48 years, 52% females). Median BMI at enrolment was 27.2 kg m-2; median BMI change since transplant was +3.7 kg m-2. Fruit, vegetable, and whole grain intakes were generally lower than recommended, giving a low overall median DASH index of 30 with no sex differences. HTRs for which the BMI increased post-transplant had significantly lower median DASH indices than those whose BMI did not increase (30 vs. 45, p = 0.013). CONCLUSIONS:The diet quality of HTRs appears suboptimal overall, with fruit and vegetable intakes especially low. HTRs whose BMI increased post-transplant had substantially lower quality diets than HTRs whose BMI did not increase.

INTRODUCTION:We aimed to study the frequency (prevalence) and histology of benign melanocytic naevus cells in regional lymph nodes in relation to age and sex and nodal location. MATERIAL AND METHODS:Histopathology reports of sentinel lymph node (SLN) biopsies from melanoma patients, 2002 - 2014, and from breast cancer patients, 2010- 2019, were obtained from records of a single hospital in England. All sections were similarly processed and examined. For standardisation, presence of naevus cells was assessed in a single node per patient: the first SLN biopsied (melanoma) or the node nearest the first SLN (breast cancer). RESULTS:Associations were tested using Fisher's exact test. Naevus cells were found in 10% (60/585) of melanoma patients' index SLNs. Frequency varied significantly by anatomic region: 13% in axillary to 0% cervical SLNs (p = 0.03), but not by sex or age. Within nodes, naevus cells were present in capsular or pericapsular tissue (93%), or trabeculae (7%). In breast cancer patients' index axillary nodes, 6% (11/196) contained naevus cells, all intracapsular. In the predominant 40-69 years age-group, prevalence was similar in breast cancer (7%) and female melanoma (9%) patients, but in those aged 70-100, prevalence was lower in breast cancer (2%) than in female melanoma (15%) patients (p = 0.05). CONCLUSIONS:Standard methods of assessment yielded no clear pattern of naevus cell frequency in lymph nodes by age or sex, but confirmed naevus cell location as mostly intracapsular.

ABSTRACT:Concerns have been raised about the possibility of effects from exposure to short wavelength light (SWL), defined here as 380-550 nm, on human health. The spectral sensitivity of the human circadian timing system peaks at around 480 nm, much shorter than the peak sensitivity of daytime vision (i.e., 555 nm). Some experimental studies have demonstrated effects on the circadian timing system and on sleep from SWL exposure, especially when SWL exposure occurs in the evening or at night. The International Commission on Non-Ionizing Radiation Protection (ICNIRP) has identified a lack of consensus among public health officials regarding whether SWL from artificial sources disrupts circadian rhythm, and if so, whether SWL-disrupted circadian rhythm is associated with adverse health outcomes. Systematic reviews of studies designed to examine the effects of SWL on sleep and human health have shown conflicting results. There are many variables that can affect the outcome of these experimental studies. One of the main problems in earlier studies was the use of photometric quantities as a surrogate for SWL exposure. Additionally, the measurement of ambient light may not be an accurate measure of the amount of light impinging on the intrinsically photosensitive retinal ganglion cells, which are now known to play a major role in the human circadian timing system. Furthermore, epidemiological studies of long-term effects of chronic SWL exposure per se on human health are lacking. ICNIRP recommends that an analysis of data gaps be performed to delineate the types of studies needed, the parameters that should be addressed, and the methodology that should be applied in future studies so that a decision about the need for exposure guidelines can be made. In the meantime, ICNIRP supports some recommendations for how the quality of future studies might be improved.

ImportancePatients diagnosed with a primary melanoma are at high risk of subsequent melanomas. Understanding the risk of second primary invasive melanoma and associated factors is crucial to optimize patient follow-up. ObjectiveTo assess the incidence rate of second primary invasive melanoma and time between the first and second primary invasive melanoma in the Norwegian population. Design, Setting, and ParticipantsThis population-based cohort study included data from deidentified records of all invasive melanomas diagnosed in Norway in 2008 to 2020, obtained from the Cancer Registry of Norway. Data were from adults aged 18 years or older diagnosed with a first primary melanoma. Data analysis was performed from March to August 2023. Main Outcomes and MeasuresThe main outcome was the incidence rate of second primary invasive melanoma at least 30 days after the first. Accelerated failure time models were fitted to examine potential associations with patient and tumor characteristics. Median time between first and second primary melanomas and 95% CIs were calculated. The likelihood of, and median interval for, second primary melanomas on the same or different site as the first primary were calculated. ResultsA total of 19 196 individuals aged 18 years or older were diagnosed with a first primary melanoma. The mean (SD) age at diagnosis of the first primary melanoma was 62 (16) years (range, 18-104 years), and 9763 (51%) were female. The incidence rate in the year following diagnosis was 16.8 (95% CI, 14.9-18.7) per 1000 person-years, which decreased to 7.3 (95% CI, 6.0-8.6) during the second year and stabilized thereafter. Median time between first and second primaries decreased with advancing age and was 37 months (95% CI, 8-49) in patients younger than 40 years, 18 (95% CI, 13-24) in patients aged 50 to 59 years, and 11 (95% CI, 7-18) in patients aged 80 years or older. The second primary was on the same site as their first primary for 47% (359 patients), and on a different site for 53% (407 patients). The median interval until second melanoma on the same site as the initial melanoma was 12 (95% CI, 7-19) months in men and 22 (95% CI, 11-35) months in women. Conclusions and RelevanceOlder age and male sex were associated with an increased risk, suggesting that increased surveillance intensity may be considered for men, especially those older than 50 years, for at least 3 years after their initial diagnosis, regardless of the characteristics of their first invasive melanoma.

Cancers of the skin are the most commonly occurring cancers in humans. In fair-skinned populations, up to 95% of keratinocyte skin cancers and 70-95% of cutaneous melanomas are caused by ultraviolet radiation and are thus theoretically preventable. Currently, however, there is no comprehensive global advice on practical steps to be taken to reduce the toll of skin cancer. To address this gap, an expert working group comprising clinicians and researchers from Africa, America, Asia, Australia, and Europe, together with learned societies (European Association of Dermato-Oncology, Euromelanoma, Euroskin, European Union of Medical Specialists, and the Melanoma World Society) reviewed the extant evidence and issued the following evidence-based recommendations for photoprotection as a strategy to prevent skin cancer. Fair skinned people, especially children, should minimise their exposure to ultraviolet radiation, and are advised to use protective measures when the UV index is forecast to reach 3 or higher. Protective measures include a combination of seeking shade, physical protection (e.g. clothing, hat, sunglasses), and applying broad-spectrum, SPF 30+ sunscreens to uncovered skin. Intentional exposure to solar ultraviolet radiation for the purpose of sunbathing and tanning is considered an unhealthy behaviour and should be avoided. Similarly, use of solaria and other artificial sources of ultraviolet radiation to encourage tanning should be strongly discouraged, through regulation if necessary. Primary prevention of skin cancer has a positive return on investment. We encourage policymakers to communicate these messages to the general public and promote their wider implementation.

Little is known about if and how nevi and pigmentation are associated with melanoma-specific mortality. However, increased melanoma awareness in people with lighter pigmentation and many nevi may result in earlier diagnosis of thinner less-lethal tumors. The aim of this study was to investigate associations between nevus count (asymmetrical > 5 mm and small symmetrical), pigmentary characteristics (hair colour, eye colour, skin colour, freckling, pigmentary score), and melanoma-specific mortality in subjects with melanomas > 1 mm. Data from the Norwegian Women and Cancer cohort, established in 1991, with complete follow-up of melanoma patients until 2018 through the Cancer Registry of Norway, were used to estimate hazard ratios with 95% confidence intervals for the associations between nevus count, pigmentary characteristics, and melanoma-specific mortality, stratified by tumor thickness using Cox regression. Estimated hazard ratios consistently indicated a higher risk of melanoma death for those with darker vs lighter pigmentary characteristics in patients with tumors > 1.0–2.0 mm and > 2.0 mm thick (e.g. pigmentary score hazard ratio 1.25, 95% confidence interval (0.74–2.13)). Among women with melanomas > 1.0 mm thick, lighter pigmentation and asymmetrical nevi may be associated with lower melanoma-specific mortality, suggesting that factors that increase the risk of melanoma may also be associated with decreased risk of death from melanoma.

Introduction: There appear to be several variants of naevoid melanoma suspected as having different outcomes, but follow-up studies have been few. We aimed to assess the prognosis of naevoid melanomas in a multi-centre study.Material and methods: From histopathology records we ascertained patients in the UK, Australia and Italy diagnosed with maturing naevoid melanoma (n = 65; 14; 7 respectively) and nodular/papillomatous naevoid melanoma (12; 6; 0), and patients with superficial spreading melanoma (SSM) from UK (73) and Australia (26). Melanoma deaths in UK patients were obtained from NHS Digital; in Australia, via the National Death Index and cancer registry; and in Italy, through clinical records. For maturing naevoid vs. SSM, we used Cox-proportional hazard regression models to compare survival adjusted for age, sex, tumour thickness, and ulceration, and additionally Fine-Gray regression analysis, to calculate sub-hazard ratios (SHR) in the UK cohort, accounting for competing causes of death.Results: Among UK patients, there was a non-significantly lower risk of melanoma death in maturing naevoid vs SSM, including after accounting for competing causes of death (SHR 0.40, 95% confidence interval (CI) 0.12-1.31), while among nodular/papillomatous naevoid melanoma patients, there were no melanoma deaths on follow-up. Two melanoma deaths occurred in Australian SSM patients, and none in maturing or nodular/ papillomatous naevoid melanoma patients, after 5 years' minimum follow-up. None of the 7 Italian patients with maturing naevoid melanoma died of melanoma after nearly 12 years' average follow-up.Conclusions: There was no significant difference in risk of death from melanomas with naevoid features, and SSM. Nodular/ papillomatous naevoid melanoma patients did not carry higher risk of death than SSM patients though the very few cases of the papillomatous naevoid variant limited our assessment.

Identifying prognostic biomarkers to predict clinical outcomes in stage I and II cutaneous melanomas could guide the clinical application of adjuvant and neoadjuvant therapies. We aimed to investigate the prognostic value of phosphorylated signal transducer and activator of transcription 5 (pSTAT5) as a biomarker in early-stage melanoma. This study evaluated all initially staged Ib and II melanoma patients undergoing sentinel node biopsy at a tertiary centre in Brisbane, Australia between 1994 and 2007, with survival data collected from the Queensland Cancer Registry. Primary melanoma tissue from 189 patients was analysed for pSTAT5 level through immunohistochemistry. Cox regression modelling, with adjustment for sex, age, ulceration, anatomical location, and Breslow depth, was applied to determine the association between pSTAT5 detection and melanoma-specific survival. Median duration of follow-up was 7.4 years. High pSTAT5 detection was associated with ulceration and increased tumour thickness. However, multivariate analysis indicated that high pSTAT5 detection was associated with improved melanoma-specific survival (hazard ratio: 0.15, 95% confidence interval: 0.03–0.67) as compared to low pSTAT5 detection. This association persisted when pSTAT5 detection was limited to immune infiltrate or the vasculature, as well as when sentinel node positivity was accounted for. In this cohort, staining for high-pSTAT5 tumours identified a subset of melanoma patients with increased survival outcomes as compared to low-pSTAT5 tumours, despite the former having higher-risk clinicopathological characteristics at diagnosis. pSTAT5 is likely an indicator of local immune activation, and its detection could represent a useful tool to stratify the risk of melanoma progression.

PDF file - 45K, Associations between cumulative HPV load and SCC, stratified by skin type and time since transplantation (for OTR). In each case the reference category is HPV negative combined with the lowest load tertile.

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Two healthcare researchers argue that an outright ban on sunbeds would help prevent skin cancers