Melanoma chemoprevention.

BACKGROUND: Despite efforts to promote sun protection behaviors, melanoma incidence continues to increase. The prognosis of advanced melanoma remains extremely poor in spite of treatment advances, emphasizing the importance of exploring additional preventive measures. OBJECTIVE: We sought to summarize the results of published research on candidate chemoprevention agents for melanoma. METHODS: We conducted a narrative review of the literature. RESULTS: Investigation into a possible role in melanoma chemoprevention continues for multiple agents, including sunscreen, lipid-lowering medications, nonsteroidal anti-inflammatory drugs, dietary nutrients, immunomodulators, and other drugs, including retinoids, difluoromethylornithine, and T4 endonuclease V. LIMITATIONS: Systematic review of the literature was not performed. CONCLUSION: Because no agent yet emerges as a clear choice for effective melanoma chemoprevention, sun avoidance and sun protection remain the mainstay of melanoma prevention for persons at high risk.

Indoor tanning attitudes and practices of US dermatologists compared with other medical specialists.

OBJECTIVE: To compare the indoor tanning attitudes and practices of dermatologists with physicians in other medical specialties (internal medicine, pediatrics, and family medicine) commonly providing sun safety counseling to patients. DESIGN: Cross-sectional study. SETTING: Questionnaire mailed to randomly selected US dermatologists, internists, family practitioners, and pediatricians. RESULTS: The overall response rate was 38% (364/949): 71% indicated that patients had asked their opinions about indoor UV tanning, 80% believed that UV tanning was unsafe, and 90% agreed they would counsel patients against nonmedical indoor UV tanning. Many supported increased UV tanning legislation, including minimum age restrictions (91%) and parental consent requirements (90%). Dermatologists were significantly more likely than other physicians to respond to the survey (52% vs 31%, P<.001), speak with patients about indoor UV tanning (odds ratio [OR], 26.5; 95% confidence interval [CI], 9.5-74.1]), believe that indoor UV tanning is unsafe (OR, 14.0; 95% CI, 5.0-39.4), and support increased regulation (OR, 11.7; 95% CI, 1.5-88.5). Women discouraged indoor UV tanning more than men (OR, 5.2; 95% CI, 1.8-15.2). Physicians who had used indoor UV tanning (19%) more often agreed that non-UV tanning lotion (OR, 2.0; 95% CI, 1.1-3.8) and airbrush tanning (OR, 1.9; 95% CI, 1.1-3.4) were safe but did not differ in attitudes regarding UV tanning safety. Physicians practicing in the Northeast and Midwest were more likely to support UV tanning to improve mood (OR, 2.0; 95% CI, 1.1-3.5) and more commonly believed that UV tanning could help treat depression (OR, 2.6; 95% CI, 1.5-4.6) or prevent vitamin D deficiency (OR, 1.7; 95% CI, 1.0-2.8). CONCLUSIONS: Physicians, especially dermatologists, are frequently asked about and generally discourage indoor UV tanning. Dermatologists regard indoor UV tanning more negatively compared with other physicians. Physician sex and geographic location were associated with specific indoor UV tanning attitudes.

What dermatologists do not know about smallpox vaccination: results from a worldwide electronic survey.

The risk of a bioterrorist attack with smallpox has increased owing to breakthroughs in the de novo synthesis of long-chain DNA molecules. Although the leading roles of dermatologists in diagnosing recent outbreaks of cutaneous anthrax and monkeypox demonstrate the importance of dermatologist preparedness for bioterrorism, dermatologist knowledge regarding smallpox vaccination has not been extensively examined. We conducted a cross-sectional worldwide electronic survey of all members of the American Academy of Dermatology with available e-mail addresses. The response rate was 23% (1,303/5,723): 34% of respondents were women, 52% were age 50 or older, 85% practiced in the US, and 90% reported English as their primary language. Less than 37% indicated the Centers for Disease Control and Prevention estimated rate of death owing to smallpox vaccination (1 in 1,000,000), and many failed to identify vaccination contraindications: previous myocardial infarction (83%), angina (83%), congestive heart failure (78%), steroid eye drop use (65%), and the non-emergency vaccination of those younger than age 18 (95%). Widespread dermatologist smallpox vaccination knowledge deficits pinpoint opportunities for educational efforts.