The Pathogenesis and Clinical Management of Cutaneous Melanoma: An Evidence-Based Review.

Cutaneous malignant melanoma (CM) is the leading cause of skin cancer-related mortality and accounts for approximately 1,250 deaths in Canada each year. It is also one of few cancers continuing to display rates of increasing incidence throughout the world. The past decade has brought significant growth in our understanding of the pathogenesis and clinical management of CM. This evidence-based review synthesizes that knowledge, beginning with a review of the epidemiology and etiology of the disease followed by a broad review of the roles of diagnostic imaging in its management. Special attention is given to the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) in supporting assessment at primary presentation of disease, follow-up to surgical and nonsurgical treatment, and for the surveillance of high-risk asymptomatic patients. After a brief review of current treatment options, this article concludes with a demonstration of how and when uncertainty exists at the point of care systematic review processes may be used to resolve clinical questions. Learning Objectives: By the end of this Continuing Medical Education article, participants will be able to 1. Describe the epidemiology and etiology of cutaneous melanoma, 2. Describe broadly the role of diagnostic imaging in the clinical management of cutaneous melanoma, 3. Describe the specific roles and limitations of 18F-FDG PET/CT in the clinical management of cutaneous melanoma, 4. Describe broadly the best practice in the treatment of cutaneous melanoma, 5. Define the value of systematic review for synthesizing knowledge pertaining to a specific clinical question, and 6. Discuss the utility of 18F FDG PET/CT in the management of early-stage (AJCC 0-IIc) cutaneous melanoma. This is a CME article and provides the equivalent of 2 hours of continuing education that may be applied to your professional development credit system. A 12-question multiple choice quiz follows this reading. Please note that no formalized credit (Category A) is available from CAMRT.

Carrots, Not Sticks: Adverse Impact and Wellness Programs.

OBJECTIVE: The purpose of this study was to determine if wellness programs are likely to produce an adverse impact in various protected groups and to determine what features of the program may contribute to adverse impact. METHODS: Using a nationally representative sample of US adults, we examined the proportions of protected groups that would be expected to encounter adverse impact using various health factors such as weight, blood pressure, and cholesterol levels. RESULTS: The results of this study indicate that disincentive-based programs pose a high risk of differentially selecting protected groups into program categories. This is especially true for members of multiple protected classes. CONCLUSIONS: We suggest organizations carefully consider both the type of program and the health factors incorporated into their wellness efforts and use incentives rather than disincentives to encourage health promotion.