Rarely are sufficient resources available to support the full suite of management actions to promote recovery of a species across its entire distribution. Decision support models are a tool that can inform natural resource management decisions with consideration of the perspectives from a variety of stakeholders who work across large geographic and jurisdictional extents. We offer an example of a decision support model that was developed by several federal and state natural resource agencies to rank Bull Trout Salvelinus confluentus core areas for prioritizing conservation investment within Oregon, USA. We engaged state-level decision makers to identify parameters that were believed to be influential in determining funding allocations for Bull Trout core areas. Parameters were linked in a model framework that was further refined with input from local Bull Trout experts with knowledge specific to the various core areas. The model produces a relative priority value that is a combination of the conservation risk to the species and the management capacity to address threats. A series of sensitivity analyses suggested that Bull Trout persistence and threat score were most influential in determining the relative priority of a core area, whereas life history and genetic diversity were least influential. One of the more powerful products from this work is an interactive Web-based application (https://das.ecosphere.fws.gov/public/obts/) that anyone can use to explore how their beliefs in parameter values will affect the relative priority of Bull Trout core areas across Oregon. Our modeling effort is an example of engaging stakeholders with different roles in species recovery and across a large geographic area to create a clearer path forward in allocating limited resources for species recovery. This approach can be employed to address a number of natural resource management situations across species and habitats.

BACKGROUND:Lung transplant recipients are at high risk of skin cancer, but precise annual incidence rates of treated skin cancers per patient are unknown.OBJECTIVES:To perform a prospective assessment of the total burden of histologically confirmed squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) and associated factors in lung transplant recipients.METHODS:A population-based cohort of 125 Queensland lung transplant recipients aged 18 years and over, recruited between 2013 and 2015, were followed to the end of 2016. All underwent dermatological skin examinations at baseline and annually thereafter and patients self-reported all interim treated skin cancers, which were verified against pathology databases. Standard skin cancer risk factors were obtained via questionnaire, and details of medications were acquired from hospital records.RESULTS:During a median follow-up time of 1·7 years, 29 (23%) and 30 (24%) lung transplant recipients with a median duration of immunosuppression of 3·3 years developed SCC and BCC, respectively. The general population age-standardized incidence rates of SCC and BCC were 201 and 171 per 1000 person-years, respectively (based on first primary SCC or BCC during follow-up); however, on accounting for multiple primary tumours, corresponding incidence rates were 447 and 281 per 1000 person-years. Risk of multiple SCCs increased around sixfold in those aged ≥ 60 years and in those with previous skin cancer, and increased around threefold in those treated with the antifungal medication voriconazole. Multiple BCC risk rose threefold from age 60 years and tenfold for patients with previous skin cancer.CONCLUSIONS:Lung transplant recipients have very high incidence of multiple primary skin cancers. Close surveillance and assiduous prevention measures are essential. Linked Comment: Proby and Harwood. Br J Dermatol 2020; 183:416-417.

Organ transplant recipients have over 100-fold higher risk of developing skin cancer than the general population and are in need of further preventive strategies. We assessed the possible preventive effects of omega-3 polyunsaturated fatty acid (PUFA) intake from food on the two main skin cancers, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in kidney and liver transplant recipients. Adult kidney or liver transplant recipients transplanted for at least 1 year and at high risk of skin cancer were recruited from the main transplant hospital in Queensland, 2012–2014 and followed until mid-2016. We estimated their dietary total long-chain omega-3 PUFAs and α-linolenic acid intakes at baseline using a food frequency questionnaire and ranked PUFA intakes as low, medium, or high. Relative risks (RRsadj) of skin cancer adjusted for confounding factors with 95% confidence intervals (CIs) were calculated. There were 449 transplant recipients (mean age, 55 years; 286 (64%) male). During follow-up, 149 (33%) patients developed SCC (median 2/person; range 1–40) and 134 (30%), BCC. Transplant recipients with high total long-chain omega-3 PUFA compared with low intakes showed substantially reduced SCC tumour risk (RRadj 0.33, 95% CI 0.18–0.60), and those with high α-linolenic acid intakes experienced significantly fewer BCCs (RRadj 0.40, 95% CI 0.22–0.74). No other significant associations were seen. Among organ transplant recipients, relatively high intakes of long-chain omega-3 PUFAs and of α-linolenic acid may reduce risks of SCC and BCC, respectively.

Abstract is missing (Short communication)

A proportion of cutaneous melanomas display neval remnants on histologic examination. Converging lines of epidemiologic and molecular evidence suggest that melanomas arising from nevus precursors differ from melanomas arising de novo. In a large, population-based study comprising 636 cutaneous melanomas subjected to dermatopathology review, we explored the molecular, host, and environmental factors associated with the presence of neval remnants. We found that nevus-associated melanomas were significantly associated with younger age at presentation, non-brown eye color, trunk site, thickness of less than 0.5 mm, and BRAFV600E mutation. Compared with patients with de novo melanomas, those with nevus-associated tumors were more likely to self-report many moles on their skin as a teenager (odds ratio = 1.94, 95% confidence interval = 1.01-3.72) but less likely to report many facial freckles (odds ratio = 0.49, 95% confidence interval = 0.25-0.96). They also had high total nevus counts (odds ratio = 2.18, 95% confidence interval = 1.26-3.78). On histologic examination, nevus-associated melanomas exhibited less dermal elastosis in adjacent skin compared with de novo melanomas (odds ratio = 0.55, 95% confidence interval = 0.30-1.01). These epidemiologic data accord with the emerging molecular paradigm that nevus-associated melanomas arise through a distinct sequence of causal events that differ from those leading to other cutaneous melanomas.

The increased skin cancer incidence in organ transplant recipients is well-known, but the skin cancer burden at any one time is unknown. Our objective was to estimate the period prevalence of untreated skin malignancy and actinic keratoses in high-risk kidney and liver transplant recipients and to assess associated factors. Organ transplant recipients underwent full skin examinations by dermatologically trained physicians. The proportion of examined organ transplant recipients with histopathologically confirmed skin cancer in the 3-month baseline period was estimated. Prevalence ratios with 95% confidence intervals indicated significant associations. Of 495 high-risk organ transplant recipients (average age = 54 years, time immunosuppressed = 8.9 years), 135 (27%) had basal cell carcinoma, squamous cell carcinoma or Bowen's disease (intraepidermal carcinoma) present and confirmed in the baseline period, with respective prevalence proportions of 10%, 11%, and 18% in kidney transplant recipients and 10%, 9%, and 13% in liver transplant recipients. Over 80% had actinic keratosis present, with approximately 30% having 5 or more actinic keratoses. Organ transplant recipients with the highest skin cancer burden were Australian born, were fair skinned (prevalence ratio = 1.61, 95% confidence interval = [1.07, 2.43]), reported past skin cancer (prevalence ratio = 3.39, 95% confidence interval = [1.93, 5.95]), and were receiving the most frequent skin checks (prevalence ratio = 1.76, 95% confidence interval = [1.15, 2.70]). In conclusion, high-risk organ transplant recipients carry a substantial measurable skin cancer burden at any given time and require frequent review through easily accessible, specialized services.

Elisabeth Aberer, Graz, Austria Z. Meltem Akkurt, Diyarbakir, Turkey Víctor Alegre de Miquel, Valencia, Spain Lacy M. Alexander, University Park, Pa., USA Sharique A. Ali, Bhopal, India Nawaf Al-Mutairi, Kuwait, Kuwait Augustin Alomar, Barcelona, Spain Wim Annaert, Leuven, Belgium Richard Joseph Antaya, New Haven, Conn., USA Ercan Arca, Ankara, Turkey Giuseppe Argenziano, Naples, Italy Aimée H. Arits, Maastricht, The Netherlands Nicola Balato, Naples, Italy Robert Baran, Cannes, France Barouyr Baroudjian, Paris, France Veronique Bataille, London, UK Jaideep Bhat, Birmingham, UK Wolf-Henning Boehncke, Geneva, Switzerland Roland Boeni, Zurich, Switzerland Yong Chool Boo, Daegu, Republic of Korea Jean-David Bouaziz, Paris, France Lise Boussemart, Paris, France Ralph-Peter Braun, Zurich, Switzerland Leena Bruckner-Tuderman, Münster, Germany Dianne Campbell, Sydney, N.S.W., Australia Caterina Campisi, Genoa, Italy Mollie Carruthers, Columbus, Ohio, USA Annamaria Cesinario, Modena, Italy Wah Cheuk, Hong Kong, SAR, China Wei-Sheng Chong, Singapore, Singapore Olivier Chosidow, Créteil, France Arnon D. Cohen, Tel Aviv, Israel Rafael Contreras-Galindo, Ann Arbor, Mich., USA Monica Corazza, Ferrara, Italy Luisa Costa, Naples, Italy Diona L. Damian, Camperdown, N.S.W., Australia Esteban Dauden, Madrid, Spain Claire Dauphin, Clermont-Ferrand, France David de Berker, Bristol, UK

BACKGROUND:Organ transplant recipients (OTRs) have a high risk of skin cancer, and excessive sun exposure is a major contributing factor.OBJECTIVE:To document the prevalence of sun protection and associated factors in OTRs in Queensland, Australia.METHODS:Cross-sectional study of the frequency of wearing hats, long sleeves and using sunscreens among OTRs and factors associated with regular use. Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using Poisson regression models.RESULTS:Among 446 OTRs, 66, 49 and 39% wore a hat, sunscreen and long sleeves, respectively, mostly when outdoors. 52% regularly practiced multiple sun protection measures while 19% did not. Sunburn-prone skin (PR = 1.43, 95% CI = 1.06-1.93) and frequent whole-body skin examinations (PR = 1.48, 95% CI = 1.19-1.84) were independently associated with regular use of multiple sun protection measures.CONCLUSION:Findings are consistent with sun-conscious OTRs also having more regular skin screening and that having frequent skin examinations promotes sun-protective habits.

Cutaneous melanomas are postulated to arise through at least two causal pathways, namely the chronic sun exposure and nevus pathways. While chronic sun exposure probably causes many head/neck melanomas, its role at other sites is unclear. In a population-based, case-case comparison study conducted in Brisbane, Australia, we determined the prevalence and epidemiologic correlates of chronic solar damage in skin adjacent to invasive, incident melanomas on the trunk (n=418) or head/neck (n=92) among patients aged 18-79 in 2007-2010. Participants self-reported information about environmental and phenotypic factors, and a dermatologist counted nevi and actinic keratoses. Dermatopathologists assessed solar elastosis adjacent to each melanoma using a four-point scale (nil, mild, moderate, marked), and noted the presence or absence of adjacent neval remnants. We measured associations between various factors and solar elastosis using polytomous logistic regression. Marked or moderate solar elastosis was observed in 10% and 27%, respectively, of trunk melanomas, and 60% and 17%, respectively, of head/neck melanomas. At both sites, marked elastosis was positively associated with age (p(trend)<0.0001) and inversely associated with neval remnants (p(trend)<0.001). For trunk melanomas, marked elastosis was associated with highest quartiles of total sun exposure [odds-ratio (OR)=5.47, 95% confidence interval (CI)=1.08-27.60] and facial freckling (OR=2.98, 95% CI=1.17-7.56), and inversely associated with deeply tanning skin (OR=0.29, 95% CI=0.08-1.11) and high nevus counts (OR=0.08, 95% CI=0.01-0.66). Mostly similar associations were observed with moderate solar elastosis. About one in three trunk melanomas in Queensland have evidence of moderate-to-marked sun damage, and they differ in risk associations from those without.What's new? Cutaneous melanomas are caused by sunlight, but the patterns of sun exposure that lead to disease appear to vary according to host factors and the anatomic location of the melanocytes involved. Using a case-case approach, the authors of the present study explored the predictors of chronic sun damage in skin adjacent to melanomas arising on the trunk (a sun-protected site). They found that such melanomas are associated with sun-sensitive phenotype, history of sunburns, measures of cumulative sun exposure, and numbers of actinic keratoses.

The prevalence of human papillomavirus (HPV)-associated head and neck cancers is increasing, but the prevalence of oral HPV infection in the wider community remains unknown. We sought to determine the prevalence of, and identify risk factors for, oral HPV infection in a sample of young, healthy Australians. For this study, we recruited 307 Australian university students (18-35 years). Participants reported anonymously about basic characteristics, sexual behaviour, and alcohol, tobacco and illicit drugs use. We collected oral rinse samples from all participants for HPV testing and typing. Seven of 307 (2.3%) students tested positive for oral HPV infection (3 HPV-18, one each of HPV-16, -67, -69, -90), and six of them were males (p = 0.008). Compared to HPV negative students, those with oral HPV infection were more likely to have received oral sex from more partners in their lifetime (p = 0.0004) and in the last year (p = 0.008). We found no statistically significant associations with alcohol consumption, smoking or numbers of partners for passionate kissing or sexual intercourse. In conclusion, oral HPV infection was associated with male gender and receiving oral sex in our sample of young Australians.

BACKGROUND:Cutaneous melanomas have been hypothesized to arise through different pathways according to phenotype, body site, and sun exposure. To further test this hypothesis, we explored associations between phenotype and melanoma at different sites using a case-case comparative approach. METHODS:Melanoma patients (n = 762) aged 18 to 79 years and diagnosed from 2007 to 2010 were ascertained from pathology laboratories in Brisbane, Australia. Patients reported phenotypic information and a dermatologist counted melanocytic nevi and solar keratoses. We compared data for patients with trunk melanoma (n = 541, the reference group), head/neck melanoma (n = 122), or lentigo maligna melanoma (LMM) of the head/neck (n = 69). ORs and 95% confidence intervals were calculated using classical or polytomous logistic regression models. RESULTS:Compared with trunk melanoma patients, those with head/neck melanoma were significantly less likely to have high nevus counts (≥135: OR = 0.27; Ptrend = 0.0004). Associations between category of nevus count and LMM head/neck were weaker and significantly different (≥135: OR = 1.09; Ptrend = 0.69; Phomogeneity = 0.02). Patients with head/neck melanoma were more likely than those with truncal melanoma to have high solar keratosis counts (≥7: OR = 1.78, Ptrend = 0.04). Again, associations with LMM head/neck were weaker, albeit not significantly different (≥7: OR = 1.61; Ptrend = 0.42; Phomogeneity = 0.86). CONCLUSION:Trunk melanomas are more strongly associated with nevus counts than head/neck melanomas, but are less strongly associated with number of solar keratoses, a marker of chronic sun exposure. IMPACT:These findings underscore the notion that melanomas on the trunk typically arise through a causal pathway associated with nevus propensity, whereas melanomas on the head/neck arise through a pathway associated with cumulative sun exposure.

Direct underwater observation techniques (e. g., snorkel surveys) are widely used in fisheries science. Data collected from these surveys are used to estimate species abundance, detect presence and absence, and construct statistical models that predict microhabitat use and nonuse. To produce an unbiased estimate or model, fish should ideally behave as if there were no observer present. We conducted a study using underwater video to test whether snorkeling can elicit a change in fish behavior. Four behavioral metrics were measured: upstream movement, downstream movement, total movement, and number of fish in the field-of-view. Significant differences were detected in upstream, downstream, and total movements as a function of the in-water observer. These results suggest that an in-water observer can disturb fish, resulting in altered behavior, which in turn may bias study results. We suggest researchers use caution in making inferences to an entire population when data-collection methods have potential to bias fish behavior.