Skin Cancer Risk of Narrow-Band UV-B (TL-01) Phototherapy: A Multi-Center Registry Study with 4,815 Patients.

Narrow-band TL-01 ultraviolet B phototherapy (TL-01) is an effective and widely used treatment for many skin diseases. The purpose of the investigation was to assess the risk of skin cancers in patients treated with TL-01 phototherapy who have not received any other phototherapy modalities. This cohort study included 4,815 TL-01 treated patients in Finland with psoriasis or atopic dermatitis. Clinical information was collected from the hospital records and linked with Finnish Cancer Registry data. The follow-up started from the first TL-01 treatment and the mean follow-up time was 8.4 years. Standardized incidence ratios were calculated for basal cell carcinoma, cutaneous melanoma, and squamous cell carcinoma. The standardized incidence ratio for basal cell carcinoma was 2.5 (95% confidence interval 1.8-3.5), for cutaneous melanoma 4.0 (95% confidence interval 2.1-6.8) and for squamous cell carcinoma 3.7 (95% confidence interval 1.7-7.0). For basal cell carcinoma and squamous cell carcinoma, the standardized incidence ratios remained similar during the whole follow-up time while the standardized incidence ratio for cutaneous melanoma was markedly higher during the first 5 years of follow-up. In conclusion, an increased incidence of skin cancers was observed among TL-01 treated patients. It should be confirmed in the future whether the skin cancer risk of TL-01 phototherapy will remain high in a longer follow-up.

Premalignant lesions, basal cell carcinoma and melanoma in patients with cutaneous squamous cell carcinoma.

The incidence of keratinocyte carcinomas is increasing worldwide and currently there is no standardised strategy for the follow-up of patients with multiple tumours. The objective of this study was to assess the prevalence of premalignant lesions, i.e., actinic keratosis and Bowen's disease, as well as basal cell carcinoma (BCC) and cutaneous melanoma (CM) among patients with cutaneous squamous cell carcinoma (cSCC). Pathology database search was performed to identify all cSCC patients diagnosed in the Pirkanmaa region of Finland in 2006-2015. Details of the patients and tumours were obtained through medical record review. The cohort consisted of 774 patients with 1131 cSCC tumours. Overall 559 patients (72%) had premalignant lesions. A total of 316 patients (41%) had BCC and 52% of these (n = 164) had more than one BCC tumour. 50 patients (6%) had CM. Overall 180 cSCC patients (23%) had no premalignant changes, BCC or CM. The median age of these patients was 6 years less than that of the patients with premalignant lesions (p < 0.001) or BCC (p < 0.001). The invasion depth of the tumours was deeper in the patients with only cSCC (median 3 mm, interquartile range 2-6) than in those with premalignant lesions or BCC (median 2 mm, interquartile range 1-3), p < 0.001. CSCC patients have a high risk of developing multiple skin cancers and need long-term follow-up.

Recurrent and Metastatic Cutaneous Squamous Cell Carcinomas in a Cohort of 774 Patients in Finland.

Recognising patients with high risk cutaneous squamous cell carcinomas is essential in planning effective monitoring. The aim of this study was to determine the rate of local recurrences and metastases of cutaneous squamous cell carcinomas in a previously defined patient cohort in Finland. Pathology database search was performed to identify cutaneous squamous cell carcinoma patients and their medical records were reviewed. The cohort consisted of 774 patients with 1,131 cutaneous squamous cell carcinoma tumours. Overall, 4.2% (48/1,131) of the tumours were metastatic and 2.2% (25/1,131) had a local recurrence. Three of the metastatic tumours and 8 of the recurrent tumours had an invasion depth of ≤ 2 mm. The majority of metastases (28/48; 58%) were found within 3 months of the diagnosis of cutaneous squamous cell carcinoma. In conclusion, our study demonstrated recurrences and metastases even in the case of thin cutaneous squamous cell carcinomas and in high-risk cases close monitoring should be organised during the first years after diagnosis.

Differences in Risk Factors for Melanoma in Young and Middle-aged Higher-risk Patients.

BACKGROUND/AIM: Differences in risk factors for melanoma between young adults (18-39 years) and middle-aged (40-60 years) are not well documented. In this study, we aimed to determine differences in risk factors and characteristics of melanoma between these groups. PATIENTS AND METHODS: This retrospective study is a review on 330 patients, including 250 middle-aged and 80 young adults, during the period 2006-2016 in the Tampere university hospital, in Finland. RESULTS: Forty-one per cent of middle-aged and 47% of young adults were defined as higher-risk patients. High nevus count was the most common host risk factor in both groups. Young were more likely to have a family history of melanoma. Middle-aged had more often excessive intermittent sun exposure and a history of sunburn. Host risk characteristics were less commonly associated with thicker melanomas. CONCLUSION: A high number of patients have host risk factors for melanoma. Several differences exist in risk factors and characteristics of melanomas between young adults and middle-aged patients.

Sentinel node tumor burden in prediction of prognosis in melanoma patients.

Recent data have demonstrated no survival benefit to immediate completion lymph node dissection (CLND) for positive sentinel node (SN) disease in melanoma. It is important to identify parameters in positive SNs, which predict prognosis in melanoma patients. These might provide prognostic value in staging systems and risk models by guiding high-risk patients' adjuvant therapy in clinical practice. In this retrospective study of university hospital melanoma database we analyzed tumor burden and prognosis in patients with positive SNs. Patients were stratified by the diameter of tumor deposit, distribution of metastatic focus in SN, ulceration and number of metastatic SNs. These were incorporated in Cox proportional hazard regression models. Predictive ability was assessed using Akaike information criterion and Harrell's concordance index. A total of 110 patients had positive SN and 104 underwent CLND. Twenty-two (21%) patients had non-SN metastatic disease on CLND. The 5-year melanoma specific survival for CLND-negative patients was 5.00 years (IQR 3.23-5.00, range 0.72-5.00) compared to 3.69 (IQR 2.28-4.72, range 1.01-5.00) years in CLND-positive patients (HR 2.82 (95% CI 1.17-6.76, p = 0.020).The models incorporating distribution of metastatic focus and the largest tumor deposit in SN had highest predictive ability. According to Cox proportional hazard regression models, information criterions and c-index, the diameter of tumor deposit > 4 mm with multifocal location in SN despite of number of metastatic SN were the most important parameters. According to the diameter of tumor deposit and distribution of metastatic focus in SN, adequate stratification of positive SN patients was possible and risk classes for patients were identified.

A second expert pathology review of cutaneous melanoma in multidisciplinary meetings: Impact on treatment decisions.

Melanoma causes substantial burden of medical costs and years of life lost. Wide variations in melanoma diagnosis and treatment have been identified at least in the United States, Australia, Germany, Italy and France [1]. The variation especially in the quality of reporting on pathological specimens has been reported. The aim of this retrospective study was to assess the impact of expert pathology review of melanoma on the staging and thus treatment decisions in cutaneous melanoma patients in a multidisciplinary tumor board. A total of 567 patients were referred to the multidisciplinary meeting with a diagnosis of new invasive or in situ melanoma from 14.10.2014 to 31.5.2018. Among these patients, a second expert histopathologic review resulted in changes in interpretation for 46 out of 567 (8%) patients. Of patients originally diagnosed with melanoma, pathologic review led to a change in diagnosis to benign lesions in 19 cases. The Breslow thickness changed >0.3 mm in 22 cases leading changes in staging and thus treatment. Minor changes (≤0.3 mm) in Breslow thickness was found in 5 cases. Our data suggest that review of melanoma by an expert dermatopathologist results in frequent, clinically meaningful alterations in diagnosis, staging and surgical treatment. The confirmation of a cancer diagnosis should be the first step in the initiation of multidisciplinary monitoring especially in patients younger than 40 years old and early-stage tumors.

Characteristics and Trends of Cutaneous Squamous Cell Carcinoma in a Patient Cohort in Finland 2006-2015.

The incidence of cutaneous squamous cell carcinoma is increasing worldwide. In most epidemiological studies, only the first case of cutaneous squamous cell carcinoma is registered, underestimating the burden of the disease. To determine the frequency and detailed characteristics of cutaneous squamous cell carcinoma in a Finnish patient cohort, we performed a retrospective 10-year study taking into account multiple tumours in one patient. On the pathology database search and medical record review we identified 774 patients with a total of 1,131 cutaneous squamous cell carcinomas. The crude incidence increased from 18.6/100,000 persons in 2006 to 28.1 in 2015. The location of tumours differed between men and women: the greatest difference concerned cutaneous squamous cell carcinoma of the ear, with 93% of cases occurring in men. One fourth (24%) of patients had more than one tumour. A small shift from poorly to well-differentiated tumours was seen. In conclusion, the incidence of cutaneous squamous cell carcinoma increased, with many patients presenting with multiple tumours.

Fall-induced fractures of the calcaneus and foot in older people: nationwide statistics in Finland between 1970 and 2013 and prediction for the future.

BACKGROUND: Although fall-induced fractures of elderly persons are a major problem, epidemiologic knowledge on their time trends is limited. We assessed the trends in fall-induced fractures of the calcaneus and foot in older Finns between 1970 and 2013. METHODS: The current trends in the number and incidence (per 100,000 persons) of fall-induced fractures of the calcaneus and foot of older Finns were determined by taking into account individuals 50-year-olds or older who were admitted to Finnish hospitals for primary treatment of such injury in 1970-2013. RESULTS: The number and raw incidence of these fractures increased considerably between 1970 and 2013, from 64 (number) and 5.6 (incidence) in 1970, to 325 and 15.0, respectively, in 2013. The age-adjusted incidence of fracture was higher in men than women and showed a clear rise in both sexes in 1970-2013, from 7.2 to 15.2 in men (111% increase), and from 4.3 to 13.9 in women (223% increase). A similar rise was observed in the age-specific incidences. If trends in the age-specific fracture incidence continue at the same rate as were observed in 1970-2013, and the 50-year-old or older population increases as predicted (by 15% by the year 2030), the annual number of fall-induced fractures of the calcaneus and foot in this population will be 1.8 times higher in the year 2030 (580 fractures) than it was in 2013 (325 fractures). CONCLUSIONS: The number of fall-induced fractures of the calcaneus and foot among Finns 50 years of age or older has risen sharply between 1970 and 2013 with a rate that cannot be explained merely by demographic changes. Further studies should examine the reasons for the rise and possibilities for fracture prevention.

Rapid increase in fall-induced cervical spine injuries among older Finnish adults between 1970 and 2011.

BACKGROUND: fall-related injuries in older adults are a major public heath challenge. METHODS: we determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons in 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2011. Similar patients aged 20-49 years served as a reference group. RESULTS: the number of fall-induced cervical spine injuries among older Finns rose six-fold from 59 in 1970 to 372 in 2011. The age-adjusted incidence of injury (per 100 000 persons) was higher in men than in women throughout this period and showed a clear increase from 1970 to 2011: from 8.5 to 20.3 in men, and from 2.8 to 11.7 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 70 years or older. In the reference group, the injury incidence did not rise by time. CONCLUSIONS: the number and incidence of fall-induced severe cervical spine injuries among older Finns increased considerably between 1970 and 2011. An increase in the average risk of serious falls may partly explain the phenomenon. Wide-scale fall and injury prevention measures are urgently needed, because further ageing of the population is likely to worsen the problem in the near future.

Fall-induced deaths among older adults: nationwide statistics in Finland between 1971 and 2009 and prediction for the future.

BACKGROUND: Fall-related injuries and deaths of elderly people are a major public health concern. METHODS: Using the Official Cause-of-Death Statistics of Finland we determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced deaths among older Finnish men and women by taking into account all persons 50 years of age or older who died because of a fall-induced injury between 1971 and 2009. RESULTS: Among elderly Finnish men, the number of deaths due to falls increased considerably between the years 1971 and 2009, from 162 to 627 (a 287% increase). The age-adjusted incidence also increased from 43.4 (per 100,000 persons) in 1971 to 57.9 in 2000, but stabilized thereafter (57.3 in 2009). Among elderly Finnish women, the number of fall-induced deaths increased till the beginning of the new millennium (from 279 in 1971 to 499 in 2000) but stabilized thereafter (506 in 2009), and, in sharp contrast to men, women's age-adjusted incidence of fall-induced deaths declined during the entire study period, the incidence being 77.2 in 1971 while only 35.3 in 2009. CONCLUSIONS: Between 1971 and 2009 the number of fall-induced deaths increased among elderly Finns. The changes were sex-specific so that men surpassed women in both the number and age-adjusted incidence of these fatal falls. Welcome observations were that men's age-adjusted incidence of fall-induced deaths started to stabilize during the new millennium and that in women this incidence continuously declined between 1971 and 2009.

Declining age-adjusted incidence of fall-induced injuries among elderly Finns.

BACKGROUND: Elderly people's fall-induced injuries are a major public health challenge. METHODS: We determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced injuries among older adults in Finland by taking into account all persons 80 years of age or older who were admitted to Finnish hospitals for primary treatment of a first fall injury over the period 1970-2009. RESULTS: The number of fall-induced injuries in elderly Finns increased considerably during the study period: for women and men separately, these numbers were from 927 to 10,333 (an 11-fold rise), and from 212 to 3,258 (a 15-fold rise), respectively. In both genders, the age-adjusted incidence (per 100,000 persons) of fall-induced injuries increased till the late 1990s but decreased thereafter, the incidence being 2,729 (women) and 1,455 (men) in 1970, and 5,930 (women) and 4,240 (men) in 2009. Even with the current injury incidence the number of these injuries is expected to more than double by the year 2030. CONCLUSION: The rise in the age-adjusted incidence of hospital-treated fall injuries of 80 year old and older Finns from the 1970s to the late 1990s has been followed by declining injury rates. Despite this we have to effectively continue implementation of fall prevention actions.

Unintentional injury deaths among adult Finns in 1971-2008.

Injuries are a significant public health problem and among the leading causes of death worldwide. In Finland, nearly 1.2 million accidents or assaults lead to physical injury annually. This study examined the nationwide trends in unintentional injury deaths of adults in Finland. For this purpose, we obtained from the Finnish Official Cause-of-Death Statistics (OCDS) the data for persons aged 15 years or older whose deaths occurred in 1971-2008 due to an unintentional injury. A drastic decline occurred in road traffic crashes. The age-standardized death rate (per 100,000 person-years) of men's road traffic crashes was 48 in 1971 but only 10 in 2008. Traffic caused fewer deaths in women than men, but the declining trend in women's death rates was also clear, from 17 in 1971 to 3 in 2008. During the study period, falls became the leading category of men's unintentional injury death, although their rate rose rather slowly from 19 in 1971 to 21 in 2008. Among Finnish women, the rate of fall-induced deaths declined from 32 in 1971 to 16 in 2008. There was a notable rise in men's unintentional alcohol poisoning deaths, especially since 2003. In 2008, alcohol poisonings were the second leading cause of men's injury death (rate 18). The rate of women's deaths due to alcohol poisoning was yet low during the entire study period but its rise was clear, from 1 in 1971 to 5 in 2008. Poisoning deaths caused by other substances also increased: among men their rate was 4 in 1971 and 11 in 2008, and among women 2 in 1971 to 4 in 2008. Between 1998 and 2008, psychotropic drugs, narcotics and opioid analgesics caused the majority of both men's and women's non-alcohol poisoning deaths. In conclusion, unintentional injury deaths in road traffic crashes declined steeply among adult Finns during 1971-2008. The rate of fall-induced deaths in Finnish men was rather stable during the study period while in women it clearly declined. In contrast, increase in poisoning deaths due to alcohol and other substances was alarming. Vigorous preventive actions should be initiated to control this development.