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Although cutaneous melanoma diagnoses are rising, morbidity and mortality can be reduced through early detection. This investigation seeks to improve melanoma identification accuracy, attitudes, and intentions among a lay population by comparing the effectiveness of different melanoma identification training strategies and the effect of real-time decisional feedback on a melanoma identification task. We developed an innovative, game-based approach and hypothesize differences among frequently used melanoma identification training modalities (i.e, the Asymmetry/Border/Color/Diameter [ABCD] rule, the Ugly Duckling Rule [UDS], and a modality that combines them both, ABCDF (where the F stands for 'funny looking"), and investigate differences in types of immediate feedback on a melanoma identification task.We conducted a national online randomized experiment to test a 4 (melanoma training strategies: ABCD, UDS, ABCD-F, control) × 3 (feedback: Dermatological, Dermatological + Motivational, control) factorial design on melanoma identification, skin cancer beliefs (perceived susceptibility, severity, response efficacy, self-efficacy), attitudes, and prevention intentions.ABCD training (p .001) and UDS training (p = .05) resulted in significantly higher melanoma identification than the control. All training types resulted in significantly higher self-efficacy than the control (p = .02). Both Dermatological (p = .02) and Dermatological + Motivational feedback (p = .01) elicited significantly lower melanoma identification than the control condition, although this effect may be due to differences observed among participants who received UDS training. There was a significant main effect of feedback on self-efficacy (p = .002), where both Dermatological and Dermatological + Motivational feedback elicited higher levels of self-efficacy than the control.Our results suggest that game-based ABCD and UDS training strategies could increase melanoma identification accuracy. Real-time feedback reduced accuracy, but was associated with increased self-efficacy related to melanoma detection outcomes.

The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.

Hispanics are generally diagnosed at more advanced stages of melanoma than non-Hispanic Whites, leading to lower survival rates. As skin cancer incidence is attributable to lifetime exposure to ultraviolet light, encouraging the performance of sun safety behaviors in childhood is an important strategy to address this divide. Problematically, we know little about the barriers to sun safety among Hispanic youth, especially among the Hispanics living in South Florida. To address this gap, we conducted focus groups among parents of Hispanic children aged 4-10 to understand the unique barriers to sun protection among this audience. Results revealed four categories of barriers: child-based barriers, external barriers, parental enactment barriers, and parental proper adherence barriers. These results are discussed in terms of their implications for future intervention research among this audience.

10564 Background: Cutaneous melanoma is a deadly form of skin cancer. Several studies have shown that early melanoma detection is associated with decreased mortality through self-examination and dermatology full-body skin exams. ABCD rule and the ugly duckling sign (UDS) are used to identify melanomas, but little research has explored the comparative efficacy of these approaches. This investigation compares the effectiveness of different mole identification training strategies and explores the effect of real-time feedback on decision-making. Methods: We developed an online melanoma identification game that tests differences between training types and expert feedback on mole identification. This online RCT tests a 4 (training: ABCD, UDS, both, control) X 3 (feedback: standard, motivational, control) factorial design on melanoma identification, skin cancer beliefs (perceived susceptibility and self-efficacy), and skin cancer prevention intentions. Standard feedback included expert evaluations of moles, whereas motivational feedback added statements grounded in fear appeals theory to encourage skin self-examination. An online research panel service was used to recruit 1025 US adults. Participants were randomly assigned to condition, completed a pretest, participated in the game intervention, and completed a posttest. Gameplay incorporates the same mechanics as Tinder (swipe left on benign moles and swipe right on malignant moles). Results: In total, participants reviewed 48 moles, 12 of which were melanomas. We used two-way ANCOVA for the analysis. ABCD training resulted in significantly higher melanoma identification than the control ( p =.011). Every training type resulted in significantly higher self-efficacy than the control ( p =.007). Additionally, there was a significant main effect of feedback on self-efficacy ( p =.001), where both standard and motivational feedback elicited significantly higher levels of self-efficacy than the control condition. Around 88% of participants intend to conduct skin self-exams and wear sunscreen. Conclusions: Our data suggests that “Whack a Mole” is an efficacious tool for melanoma training. ABCD and UDS training with interactive feedback are important to improve accuracy and ability for melanoma identification.

This study determines the rates of dermoscopy in melanoma detection at the Miami Veterans Affairs Medical Center where dermatology residents are the frontline clinicians.

Background Although age-adjusted incidence rates (per 100,000) for melanoma are lower among Hispanics and blacks (4.5 and 1.0, respectively) compared with white non-Hispanics (21.6), melanomas among minority populations in the United States are more likely to metastasize and have poorer outcomes. Methods A review of the literature was conducted on melanomas affecting Hispanic and black Americans. Results Because of the low index of suspicion in both the medical community and these ethnic populations, diagnosis is often delayed, resulting in advanced presentation and a poorer prognosis. Conclusions More comprehensive medical training, expanded public educational campaigns, and increased awareness among patients of all skin types to perform self skin checks are recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are warranted.

Although age-adjusted incidence rates (per 100,000 population) for melanoma are lower among Hispanics (4.5) compared with non-Hispanic whites (21.6), melanoma in Hispanics is more likely to be diagnosed at more advanced stages, resulting in higher mortality than non-Hispanic whites in the USA. It is likely due to, in part, a lower index of suspicion in both the healthcare providers and the minority populations and, as such, diagnosis is often delayed, resulting in advanced presentation and a worse prognosis. More comprehensive medical training, expanded public education campaigns and increased awareness among patients of all skin types to perform self skin checks are highly recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are needed.

Background The incidence rates of melanoma and non-Hodgkin's lymphoma (NHL) have increased substantially worldwide over the past several decades. It has been hypothesized that ultraviolet light exposure through sunlight may be a common environmental risk factor shared by both skin cancer and NHL. Objective The purpose of this study was to better understand the association between skin cancer and NHL and to evaluate its implication in clinical practice. Methods We reviewed the current literature on the link between the two malignancies and on the role of ultraviolet light in the development of NHL. Publications were selected using a PUBMED search with the terms “non-Hodgkin's lymphoma” and “skin cancer.” Epidemiologic studies in English and published after 1995 were the focus. Conclusions Large population-based studies support an increased risk of subsequent NHL among patients with skin cancers (both melanoma and nonmelanoma skin cancers) and a risk of skin cancer development in patients with NHL, although support for a direct relationship between ultraviolet light and the incidence of NHL is weak and inconsistent. Given their increased risk of developing skin cancers, patients with a history of NHL may benefit from a full-body examination during their visits. SHASA HU, MD, DANIEL G. FEDERMAN, MD, FANGCHAO MA, MD, PHD, AND ROBERT S. KIRSNER, MD, PHD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.

Eccrine syringofibroadenoma is a rare eccrine tumor first described by Mascaro in 1963. The clear cell variant was reported by Fretzin in 1995. We describe a hemorrhagic papule on the knee of a 64-year-old woman. Microscopic examination revealed epidermal-based anastomosing thin epithelial cords with ductal structures surrounded by a fibrovascular stroma. Multiple nests of glycogen-containing clear cells were also present. The tumor cells forming the epithelial cords expressed keratin. The eccrine ductal structures and clear cells additionally expressed gross cystic disease fluid protein-15 (GCDFP-15). Reactivity with antibodies against estrogen receptor or progesterone receptor was negative. These results favor the dual differentiation of the clear cell variant of eccrine syringofibroadenoma toward ductal and secretory portions of the eccrine sweat gland.

Minority populations have disproportionately more advanced stage melanoma and worse survival. To clarify the impact of race and ethnicity on late-stage melanoma diagnosis, we performed spatial analysis of geocoded melanoma cases diagnosed in Florida, 1999–2008, to identify geographic clusters of higher-than-expected incidence of late-stage melanoma and developed predictive models for melanoma cases in high-risk neighborhoods accounting for area-based poverty, race/ethnicity, patient insurance status, age, and gender. In the adjusted model, Hispanic ethnicity and census tract-level poverty are the strongest predictors for clustering of late-stage melanoma. Hispanic whites were 43% more likely to live in neighborhoods with excessive late-stage melanoma (P

To examine and compare the temporal trends in melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida from 1990 to 2004.Cross-sectional and retrospective analysis.Florida Cancer Data System.Melanoma cases with known stage and race/ethnicity reported from 1990 to 2004.Age-adjusted melanoma incidence and stage at diagnosis.Of 41 072 cases of melanoma, 39 670 cases were reported for white non-Hispanics (WNHs), 1148 for white Hispanics (WHs), and 254 for blacks. Melanoma incidence rates increased by 3.0% per year among WNH men (P.001), 3.6% among WNH women (P.001), 3.4% among WH women (P = .01), and 0.9% among WH men (P = .52), while remaining relatively stable among black men and women. Both WHs and blacks had significantly more advanced melanoma at presentation: 18% of WH and 26% of black patients had either regional or distant-stage melanoma at diagnosis compared with 12% of WNH patients. The proportion of distant-stage melanoma diagnosed among WHs and blacks changed little from 1990 to 2004, compared with a steady decrease in the percentage of melanoma cases diagnosed at distant stage among WNHs (P.001). Such differences in the time trends of the proportion of distant-stage melanoma remained after excluding in situ cases.The rising melanoma incidence among WNHs and WHs emphasizes the need for primary prevention. The persistence of disparity in melanoma stage at diagnosis among WHs, blacks, and WNHs warrants closer examination of secondary prevention efforts in minority groups.

Despite improvements in prevention and screening, mortality from advanced melanoma has not improved (Geller et al., 2007) and ultraviolet radiation (UV) is a major risk factor for melanoma development (Fears et al., 2002). Greater understanding of the mechanisms of melanoma development may lead to novel treatment options. As opposed to keratinocytes, which routinely undergo apoptosis after UVB irradiation, melanocytes resist apoptosis. In previous work, melanocytes and melanoma cells responded to UVB by activating an original pathway involving Gadd45a, one of the several growth-arrest and DNA damage–inducible genes (Lefort et al., 2001).

Objective To compare stage at diagnosis of melanoma between non-Hispanic white, non-Hispanic black, and Hispanic patients. Design Retrospective analysis. Setting Melanoma cases reported to the Florida Cancer Data System, with known stage and race/ethnicity information, for residents of Miami-Dade County, Florida, from 1997 to 2002. Patients Those diagnosed as having melanoma according to the Florida Cancer Data System. Main Outcome Measure Stage of melanoma at diagnosis. Results Of the 1690 melanoma cases reported with both stage and race/ethnicity information, 1176 (70%) were among non-Hispanic white patients, 485 (29%) were among Hispanic patients of any race, and 29 (2%) were among non-Hispanic black patients. Late-stage (regional and distant) diagnosis was more common among Hispanic (26%) and non-Hispanic black patients (52%) compared with non-Hispanic white patients (16%) ( P Conclusion Advanced stage of melanoma diagnosis among Hispanic and black patients suggests suboptimal secondary prevention efforts in minority populations.

Little information exists on the epidemiology of melanoma and the role of solar radiation in the development of melanoma in pigmented populations.To evaluate the relationship between exposure to solar radiation and the incidence of melanoma in US Hispanics and blacks.Population-based ecological study.State cancer registries of New York, New Jersey, Illinois, California, Texas, and Florida. Subjects Patients with invasive melanoma recorded by cancer registries.We obtained age-adjusted, race/ethnicity- and sex-specific incidence rates of melanoma from similar time periods from the 6 cancer registries. The incidence rates were correlated with the annual mean UV index and the latitude of residency.For both Hispanics and blacks, the incidence of melanoma was positively associated with the UV index and negatively associated with the latitude of residency. Statistically significant correlation between melanoma and the UV index (R = 0.93; P =.01) and latitude (R = -0.80; P =.05) was observed in black males. Hispanics and blacks have a significantly lower incidence of melanoma than whites, with blacks having the lowest rates of melanoma.Exposure to solar radiation appears to play a role in the development of melanoma in both Hispanics and blacks. Sun protection and melanoma risk education should be performed in these populations.

Non-melanoma skin cancer (NMSC) has been associated with several other conditions, including melanoma and non-Hodgkin's lymphoma (Hjalgri et al., 2000; Hu et al., 2005). In addition, the risk of NMSC has been found to be greater in various chronic disease groups (Frisch and Melbye, 1995; Frisch et al., 1996). It is uncertain whether this association is related to the treatments for those chronic diseases (such as radiation therapy or immunosuppressant therapy) rather than the disease itself (Karagas et al., 2001; Saladi and Persaud, 2005). Moreover, using a Danish nationwide cohort of patients with NMSC, Jensen et al. (2006) found a lower mortality in basal cell carcinoma (BCC) patients compared with the general population, reflecting what the authors suggested to be a selection bias to that data set.