ABSTRACT
BACKGROUND: Anatomic location of melanoma has been shown to independently influence melanoma-specific survival (MSS). OBJECTIVE: We aimed to compare the MSS of specific anatomic subsites and between chronically, intermittently, and rarely sun-exposed sites. METHODS: A prospective cohort study was performed of primary invasive cutaneous melanomas with known thickness and location reviewed at a tertiary referral center over 21 years. RESULTS: Overall, 3570 primary cutaneous invasive melanoma cases were included. After adjustment for clinicopathologic variables (including thickness, ulceration, mitotic rate, sex, age, and subtype), posterior scalp melanoma was associated with worse MSS (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.38-4.40) compared with the upper back, whereas melanoma on the thighs, forearms/hands, and anterior upper arms had better MSS. Intermittent (HR, 0.56; 95% CI, 0.41-0.76) and chronically sun-exposed sites (HR, 0.70; 95% CI, 0.51-0.96) had improved survival compared with rarely exposed sites on multivariate analysis. LIMITATIONS: Potential selection bias of a tertiary referral center selecting for advanced cases. CONCLUSION: Altered MSS in the posterior scalp, thighs, forearms, hands, and anterior upper arms appears to be independent of clinicopathologic factors. Results were similar for both sexes and age groups. The posterior scalp should be considered a poor prognosis site.
Subject(s)
Head and Neck Neoplasms/mortality , Melanoma/mortality , Scalp , Skin Neoplasms/mortality , Adult , Aged , Aged, 80 and over , Arm , Back , Female , Forearm , Hand , Head and Neck Neoplasms/pathology , Humans , Male , Melanoma/pathology , Middle Aged , Prognosis , Prospective Studies , Radiation Exposure , Skin Neoplasms/pathology , Sunlight , Survival Rate , Thigh , Victoria/epidemiology , Young AdultSubject(s)
Anti-HIV Agents/adverse effects , Emtricitabine/adverse effects , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/chemically induced , Tenofovir/adverse effects , Adult , Anti-HIV Agents/administration & dosage , Emtricitabine/administration & dosage , Humans , Male , Purpura, Thrombocytopenic, Idiopathic/immunology , Tenofovir/administration & dosageABSTRACT
The number of solid organ transplants has been increasing annually worldwide. Advances in transplantation surgery and community awareness of organ donation have been key contributors. Combined with increased understanding of immunosuppression, there are a growing number of solid organ transplant recipients in the community as a result of improved long-term outcomes. There remains a high incidence of deaths worldwide post-transplant due to non-melanoma skin cancer (NMSC), which has greater morbidity and mortality in this population than in the general community. Many transplant candidates are not screened prior to organ transplantation and not followed up dermatologically after transplant. After a comprehensive review of the MEDLINE database, we present an update of literature on risk factors for melanoma and non-melanoma skin cancer development in transplant recipients. Medications used by transplant recipients, including immunosuppressants and antibiotics, are discussed along with their respective risks of skin cancer development. We conclude with evidence-based recommendations for models of care, including patient education and dermatological review of transplant recipients.
