Primary Cutaneous Melanoma-Management in 2024.

Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

Sentinel lymph node biopsy is unreliable in predicting melanoma mortality for both younger and older patients.

BACKGROUND: Melanoma disease patterns vary with patient age. AIM: To evaluate sentinel lymph node biopsy (SLNB) in managing melanoma at differing patient ages. METHODS: Online prediction tools were applied to compare SLNB positivity (SLNB+) and survival risk at patient ages 20-80. Tübingen melanoma data were used to determine variations in the hazard ratio of SLNB+ for mortality at different patient ages. RESULTS: Regardless of tumour thickness, predicted SLNB+ rates were markedly higher than mortality rates for 20-year-old patients. For 80-year-old patients, it is the opposite. DISCUSSION: If 1000 20-year-olds with a 0.4 mm thickness non-ulcerated melanoma underwent SLNB, 100 would likely be positive. If all 100 were to be offered adjuvant drug therapy (ADT), fewer than three more melanoma deaths in those 1000 patients would be avoided. In total, 97 patients would have received medication they may never have needed. If 1000 80-year-olds with a 3 mm thickness non-ulcerated melanoma underwent SLNB, only 40 would likely be positive. In total, 274 patients would be predicted to die of melanoma, 245 being SLNB negative and 29 SLNB+. ADT linked to SLNB+ could deny treatment to 89% of these high-risk patients. LIMITATIONS: The authors relied on published risk data. CONCLUSION: SLNB has poor specificity at predicting mortality in young melanoma patients and poor sensitivity in older patients. SLNB is not indicated in managing cutaneous melanoma for patients under 40 or over 60 years of age. Many such patients could be managed with wide local excision alone in their clinician's office-based practice. For all cutaneous melanoma patients at all ages, linking ADT to BAUSSS biomarker, (an algorithm of Breslow thickness, age, ulceration, subtype, sex and Site) rather than SLNB+ is likely more appropriate. BAUSSS provides a more accurate melanoma-specific mortality risk assessment for patients without burdening them with added surgery, hospitalization, costs or morbidity risk.

Domestic abuse in the Covid-19 pandemic: measures designed to overcome common limitations of trend measurement.

Research on pandemic domestic abuse trends has produced inconsistent findings reflecting differences in definitions, data and method. This study analyses 43,488 domestic abuse crimes recorded by a UK police force. Metrics and analytic approaches are tailored to address key methodological issues in three key ways. First, it was hypothesised that reporting rates changed during lockdown, so natural language processing was used to interrogate untapped free-text information in police records to develop a novel indicator of change in reporting. Second, it was hypothesised that abuse would change differentially for those cohabiting (due to physical proximity) compared to non-cohabitees, which was assessed via a proxy measure. Third, the analytic approaches used were change-point analysis and anomaly detection: these are more independent than regression analysis for present purposes in gauging the timing and duration of significant change. However, the main findings were largely contrary to expectation: (1) domestic abuse did not increase during the first national lockdown in early 2020 but increased across a prolonged post-lockdown period, (2) the post-lockdown increase did not reflect change in reporting by victims, and; (3) the proportion of abuse between cohabiting partners, at around 40 percent of the total, did not increase significantly during or after the lockdown. The implications of these unanticipated findings are discussed. Supplementary Information: The online version contains supplementary material available at 10.1186/s40163-023-00190-7.

Illegal waste fly-tipping in the Covid-19 pandemic: enhanced compliance, temporal displacement, and urban-rural variation.

Objective: Illegal dumping of household and business waste, known as fly-tipping in the UK, is a significant environmental crime. News agencies reported major increases early in the COVID-19 pandemic when waste disposal services were closed or disrupted. This study examines the effect of lockdowns on illegal dumping in the UK. Method: A freedom of information request was sent to all local authorities in the UK asking for records of reported incidents of fly-tipping for before and after the first national lockdown. ARIMA modelling and year-on-year comparison was used to compare observed and expected levels of fly-tipping. Urban and rural local authorities were compared. Results: A statistically significant decline in fly-tipping during the first lockdown was followed by a similar increase when lockdown ended. The effects largely cancelled each other out. There was pronounced variation in urban-rural experience: urban areas, with higher rates generally, experienced most of the initial drop in fly-tipping while some rural authorities experienced an increase. Conclusion: Waste services promote compliance with laws against illegal dumping. When those services were disrupted during lockdown it was expected that fly-tipping would increase but, counter-intuitively, it declined. This enhanced compliance effect was likely due to increased perceived risk in densely populated urban areas. However, as lockdown restrictions were eased, fly-tipping increased to clear the backlog, indicating temporal displacement. Supplementary Information: The online version contains supplementary material available at 10.1186/s40163-022-00170-3.

Anti-social behaviour in the coronavirus pandemic.

Anti-social behaviour recorded by police more than doubled early in the coronavirus pandemic in England and Wales. This was a stark contrast to the steep falls in most types of recorded crime. Why was ASB so different? Was it changes in 'traditional' ASB such as noisy neighbours, or was it ASB records of breaches of COVID-19 regulations? Further, why did police-recorded ASB find much larger early-pandemic increases than the Telephone Crime Survey for England and Wales? This study uses two approaches to address the issues. The first is a survey of police forces, via Freedom of Information requests, to determine whether COVID-regulation breaches were recorded as ASB. The second is natural language processing (NLP) used to interrogate the text details of police ASB records. We find police recording practice varied greatly between areas. We conclude that the early-pandemic increases in recorded ASB were primarily due to breaches of COVID regulations but around half of these also involved traditional forms of ASB. We also suggest that the study offers proof of concept that NLP may have significant general potential to exploit untapped police text records in ways that inform policing and crime policy.

Prey life-history influences the evolution of egg mass and indirectly reproductive investment in a group of free-living insect predators.

The balance between risk and benefit of exploiting resources drives life-history evolution in organisms. Predators are naturally recognized as major drivers of the life-history evolution of their prey. Although prey may also influence the life-history evolution of their predators in the context of an evolutionary arms race, there is far more evidence of the role of predators than of prey.The goal of this study was to investigate the role of prey in life-history evolution of predators using ladybird beetle predators of aphids and coccids. These particular ladybirds and their prey were chosen because literature shows that the pace of life of aphids is faster than that of coccids and this difference is reflected in the life histories of the ladybirds that specialize on feeding on aphids or coccids.Thirty-four species of ladybird predators of aphids and eight of coccids belonging to five different tribes were collected and reared in the laboratory. The females were weighed as well as their eggs, and their reproductive investment estimated as the number of ovarioles. Phylogenetic relatedness was controlled for in the statistical analyses.Controlling for female mass revealed that ladybird predators of aphids lay bigger eggs than ladybird predators of coccids. This difference is not influenced by phylogenetic relatedness but only by the type of prey eaten. We suggest that ladybird predators of coccids lay smaller eggs because neonate larvae do not have to search, catch, and subdue prey. Both types of ladybirds have a similar reproductive investment relative to their body mass when phylogeny is controlled for.Recognizing the influence of prey on the life-history evolution of predators is important for understanding food web dynamics. From an applied perspective, this fine evolutionary tuning of prey-predator relationships should be used to guide and increase the efficiency of biological control programs.

Six months in: pandemic crime trends in England and Wales.

Governments around the world have enforced strict guidelines on social interaction and mobility to control the spread of the COVID-19 virus. Evidence has begun to emerge which suggests that such dramatic changes in people's routine activities have yielded similarly dramatic changes in criminal behavior. This study represents the first 'look back' on six months of the nationwide lockdown in England and Wales. Using open police-recorded crime trends, we provide a comparison between expected and observed crime rates for fourteen different offence categories between March and August, 2020. We find that most crime types experienced sharp, short-term declines during the first full month of lockdown. This was followed by a gradual resurgence as restrictions were relaxed. Major exceptions include anti-social behavior and drug crimes. Findings shed light on the opportunity structures for crime and the nuances of using police records to study crime during the pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40163-021-00142-z.

Keratoacanthoma: Update on the Debate.

ABSTRACT: Keratoacanthoma (KA) is a cutaneous tumor with a biphasic pattern of growth. A rapidly growing phase is usually followed by involution. KA occurs on sun-damaged skin. There are many listed causative associations, which include some therapeutic agents. Debate continues as to whether KA is a variant of squamous carcinoma (SCC) or a separate entity. Reporting of KA versus SCC is markedly inconsistent. Reasons for inconsistency include overlapping microscopic criteria, variants of KA with more aggressive features, and possibly medicolegal concerns. Genetic studies have shown some differences between the 2 entities. Activation of apoptotic pathways has been demonstrated in KA. Genetic studies have shown a possible role of human polyomavirus 6 in the pathogenesis of at least some KAs. Given that some cases of KA have components that behave as conventional SCCs, KA can be considered as a low-grade variant of SCC with some genetic differences.

Small area variation in crime effects of COVID-19 policies in England and Wales.

Purpose: The aim of this study is to examine small area variation in crime trajectories during the COVID-19 pandemic in England and Wales. While we know how police-recorded crime responded to lockdown policies at the 'macro' level, less is known about the extent to which these trends were experienced uniformly at localized spatial scales. Methods: Longitudinal k-means clustering is used to unpick local area variation in police notifiable offences across England and Wales. We describe the clusters identified in terms of their spatial patterning, opportunity structures and crime type profile. Results: We find that in most small areas, crime remained fairly stable throughout the pandemic. Instead, a small number of meso-level areas contributed a disproportionately large amount to the macro-level trend. These were typically city centers with plentiful pre-pandemic crime opportunities, dominated by theft and shoplifting offences. Conclusion: Findings offer support for opportunity theories of crime and for a mobility theory of crime during the pandemic. We explore potential implications for policy, theory and further research.

Aphid colony duration does not limit the abundance of Harmonia axyridis in the mediterranean area.

There is a lot of information on the factors limiting the distributions of species in their native areas, but much less on those limiting potential changes in distributions of species that are currently spreading outside their present range, especially invasive species. However, this information is often quite essential, as it enables the prediction of future spatial distributions and local abundances of invasive species and the potential effect they may have on people and crops. Arising from glasshouse escapes in North America and the Netherlands, the invasive ladybird, Harmonia axyridis (Pallas) (Coleoptera: Coccinellidae), originally from the east Palearctic, has now spread across the whole of North America and most of Europe, both of which caused serious concern. Recent observations show that the spread of H. axyridis towards the equator is limited. For example, it is quite rare in the Mediterranean area and its northward spread in South America is also quite slow, as if there was something limiting its spread towards the equator. European literature indicates it is neither climate, nor the distance of the Mediterranean from the original release location in the Netherlands. Therefore, we hypothesized that it may be biotic factors. In particular, the duration of colonies of prey (colony is the set of individuals in one patch, usually on one plant) that becomes shorter as one approaches the equator. This may lower the fitness of the predator and subsequently lead to low population densities. We test here, whether the duration of aphid colonies is shorter in the Mediterranean area than in Central Europe. Unfortunately, our data does not support this hypothesis. Therefore, the question of what limits the distribution of H. axyridis towards the equator remains to be resolved.

Age-period-cohort effects in half a century of motor vehicle theft in the United States.

Adopting and refining O'Brien's S-constraint approach, we estimate age-period-cohort effects for motor vehicle theft offences in the United States for over half a century from 1960. Taking the well-established late-teen peak offending age as given, we find period effects reducing theft in the 1970 s, and period, but particularly cohort effects, reducing crime from the 1990s onwards. We interpret these effects as consistent with variation in the prevailing level of crime opportunities, particularly the ease with which vehicles could be stolen. We interpret the post-1990s cohort effect as triggered by a period effect that operated differentially by age: improved vehicle security reduced juvenile offending dramatically, to the extent that cohorts experienced reduced offending across the life-course. This suggests the prevailing level of crime opportunities in juvenile years is an important determinant of rates of onset and continuance in offending in birth cohorts. We outline additional implications for research and practice.

Crime and coronavirus: social distancing, lockdown, and the mobility elasticity of crime.

Governments around the world restricted movement of people, using social distancing and lockdowns, to help stem the global coronavirus (COVID-19) pandemic. We examine crime effects for one UK police force area in comparison to 5-year averages. There is variation in the onset of change by crime type, some declining from the WHO 'global pandemic' announcement of 11 March, others later. By 1 week after the 23 March lockdown, all recorded crime had declined 41%, with variation: shoplifting (- 62%), theft (- 52%), domestic abuse (- 45%), theft from vehicle (- 43%), assault (- 36%), burglary dwelling (- 25%) and burglary non-dwelling (- 25%). We use Google Covid-19 Community Mobility Reports to calculate the mobility elasticity of crime for four crime types, finding shoplifting and other theft inelastic but responsive to reduced retail sector mobility (MEC = 0.84, 0.71 respectively), burglary dwelling elastic to increases in residential area mobility (- 1), with assault inelastic but responsive to reduced workplace mobility (0.56). We theorise that crime rate changes were primarily caused by those in mobility, suggesting a mobility theory of crime change in the pandemic. We identify implications for crime theory, policy and future research.

Computational Fluid Dynamics for Fixed Bed Reactor Design.

Flow, heat, and mass transfer in fixed beds of catalyst particles are complex phenomena and, when combined with catalytic reactions, are multiscale in both time and space; therefore, advanced computational techniques are being applied to fixed bed modeling to an ever-greater extent. The fast-growing literature on the use of computational fluid dynamics (CFD) in fixed bed design reflects the rapid development of this subfield of reactor modeling. We identify recent trends and research directions in which successful methodology has been established, for example, in computer generation of packings of complex particles, and where more work is needed, for example, in the meshing of nonsphere packings and the simulation of industrial-size packed tubes. Development of fixed bed reactor models, by either using CFD directly or obtaining insight, closures, and parameters for engineering models from simulations, will increase confidence in using these methods for design along with, or instead of, expensive pilot-scale experiments.

Adrenal lymphoma presenting as primary hypoadrenalism in the elderly.

Adrenal lymphoma causing primary hypoadrenalism in the elderly is a very rare finding. We describe a case of an 85-year-old man who was admitted to our hospital. He had a short history of hypotension and unresponsiveness. He was referred to the endocrine team, after a CT scan of his thorax abdomen and pelvis demonstrated significant enlargement of both his adrenal glands with associated lymphadenopathy. This scan was originally done to rule out an occult intra-abdominal malignancy. In addition, a tetracosactide (short Synacthen) test demonstrated adrenal insufficiency. This case demonstrates that adrenal lymphoma should be considered as an important differential when there is evidence of adrenal gland hyperplasia, lymphadenopathy and adrenal insufficiency.

Management of invasive melanoma.

BACKGROUND: Maximising survival for patients with invasive melanoma hinges on early diagnosis of primary melanoma and appropriate management. Despite well-documented guidelines, many patients with melanoma have not been managed ideally. OBJECTIVE: The aim of this paper is to identify suboptimal aspects of melanoma management. DISCUSSION: Delayed or erroneous diagnosis is more likely to occur when a shave or punch biopsy is used to obtain histopathology. Wherever feasible, local excision with a narrow margin is the preferred biopsy choice for a suspected melanoma. The Breslow thickness of the primary melanoma remains the greatest predictor of outcome. Ulceration is associated with a poorer prognosis. Most invasive melanomas are managed with a margin of ≥10 mm of normal tissue. Patients who have developed one primary melanoma are at high risk of a second tumour. Ongoing management includes regular lifelong skin checks. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet radiation are useful. Imaging is largely used when metastases are suspected on the basis of clinical symptoms or signs.

Cutaneous melanoma: Latest developments.

BACKGROUND: Several new medications have shown improved survival rates in high-risk patients with melanoma. OBJECTIVE: The aim of this article is to discuss the new medications and outline their roles, the expected benefit from each and the risk of adverse events. We explain the place of sentinel lymph node biopsy (SLNB) and ultrasonography with fine needle aspiration (US-FNA) in assessing and treating patients with melanoma. DISCUSSION: Ipilimumab has limited efficacy and a very concerning complication profile. More than 50% of patients taking ipilimumab have severe or life-threatening adverse events. BRAF inhibitors have greater efficacy and fewer adverse events than ipilimumab. Combining BRAF inhibitors with mitogen-activated protein kinase inhibitors enhances their effect and improves the overall adverse event profile. BRAF inhibitors are only effective when the melanoma has a BRAF gene mutation, something that occurs in only 50% of cases. Programmed cell death protein 1 medications are also more effective and have a much more acceptable adverse event profile than ipilimumab. Both SLNB and US-FNA can detect early node involvement in patients with melanoma, although US-FNA is a safer procedure.