| 1. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Assessment of Incidence Rate and Risk Factors for Keratoacanthoma Among Residents of Queensland, Australia
- 2020
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Ingår i: Jama Dermatology. - : American Medical Association (AMA). - 2168-6068. ; 156:12, s. 1324-1332
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Keratoacanthoma (KA) is a common and generally benign keratinocyte skin tumor. Reports of the incidence rates of KA are scant. In addition, the risk factors for KA are not well understood, although associations with UV radiation exposure and older age have been described. OBJECTIVE To investigate the incidence rate of KA and the risk factors for developing KA. DESIGN, SETTING, AND PARTICIPANTS The study included data from 40 438 of 193 344 randomly selected residents of Queensland, Australia, who participated in the QSkin Sun and Health (QSkin) prospective population-based cohort study. All participants completed a baseline survey between 2010 and 2011 and were ages 40 to 69 years at baseline. Histopathologic reports of KA were prospectively collected until June 30, 2014, through data linkage with pathologic records. Cox proportional hazards models were used to identify risk factors associated with KA while controlling for potential confounding variables. Data were analyzed from January 2 to April 8, 2020. EXPOSURES Demographic characteristics, phenotypes, UV radiation exposure, medical history, and lifestyle. RESULTS Among 40 438 participants (mean [SD] age, 56 [8] years; 18 240 men [45.1%]), 596 individuals (mean [SD] age, 62 [6] years; 349 men [58.6%]) developed 776 KA tumors during a median follow-up period of 3.0 years (interquartile range, 2.8-3.3 years). The person-based age-standardized incidence rate for KA in the age-restricted cohort was 409 individuals per 100 000 person-years (based on the 2001 Australian population). Risk factors after adjustment for potential confounders were older age (age >= 60 years vs age <50 years; hazard ratio [HR], 6.38; 95% CI, 4.65-8.75), male sex (HR, 1.56; 95% CI, 1.33-1.84), fair skin (vs olive, dark, or black skin; HR, 3.42; 95% CI, 1.66-7.04), inability to tan (vs ability to tan deeply; HR, 1.69; 95% CI, 1.19-2.40), previous excisions of keratinocyte cancers (ever had an excision vs never had an excision; HR, 6.28; 95% CI, 5.03-7.83), current smoking (vs never smoking, HR, 2.02; 95% CI, 1.59-2.57), and high alcohol use ( >= 14 alcoholic drinks per week vs no alcoholic drinks per week; HR, 1.42; 95% CI, 1.09-1.86). CONCLUSIONS AND RELEVANCE This is, to date, the first large prospective population-based study to report the incidence rate and risk factors for KA. The high person-based incidence rate (409 individuals per 100 000 person-years) highlights the substantial burden of KA in Queensland, Australia. Furthermore, the study's findings suggest that older age (>= 60 years), male sex, UV radiation-sensitive phenotypes, indications of high sun exposure (eg, previous keratinocyte cancer excisions), smoking, and high alcohol use are independent risk factors for the development of KA.
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| 2. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Clinicopathological factors associated with death from thin (<= 1 center dot 00 mm) melanoma
- 2020
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 0007-0963 .- 1365-2133. ; 182:4, s. 927-931
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Tidskriftsartikel (refereegranskat)abstract
- Background Thin cutaneous melanomas (<= 1 center dot 00 mm) are increasing worldwide, causing around a quarter of all melanoma deaths in the U.S.A. and Australia. Identification of predictive factors for potentially fatal thin melanomas could allow better use of resources for follow-up. Objectives To identify the clinicopathological factors associated with fatal thin melanomas. Methods This large, nested case-case study extracted data from the population-based Queensland Cancer Registry, Australia. Our cohort consisted of Queensland residents aged 0-89 years who were diagnosed with a single, locally invasive thin melanoma (<= 1 center dot 00 mm) between 1995 and 2014. Fatal cases (eligible patients who died from melanoma) were individually matched to three nonfatal cases (eligible patients who were not known to have died from melanoma) according to sex, age, year of diagnosis and follow-up interval. Using conditional logistic regression, we calculated odds ratios (ORs) for melanoma-specific death, adjusting for all collected clinicopathological variables. Results In the cohort, 27 660 eligible patients were diagnosed with a single, thin melanoma. The final case-case series included 424 fatal cases and 1189 nonfatal cases. Fatal cases were sixfold as likely to arise on the scalp as on the back [OR 6 center dot 39, 95% confidence interval (CI) 2 center dot 57-15 center dot 92] and six times as likely to be of thickness 0 center dot 80-1 center dot 00 mm as of < 0 center dot 30 mm (OR 6 center dot 00, 95% CI 3 center dot 55-10 center dot 17). Conclusions Scalp location is a strong prognostic factor of death from thin melanoma. Further, this study provides support that melanomas with a thickness of 0 center dot 80-1 center dot 00 mm are the more hazardous thin lesions. Patients with these tumour characteristics require specific attention during follow-up. What's already known about this topic? Thin invasive melanomas (<= 1 center dot 00 mm) contribute a substantial proportion of melanoma fatalities, owing to the high volume of disease. There is a need to find prognostic factors that will better identify fatal thin melanomas at the time of diagnosis. What does this study add? In this large population-based study, fatal thin tumours were sixfold as likely to be located on the scalp as on the back. Thin melanomas of 0 center dot 80-1 center dot 00 mm thickness were six times as likely to be associated with death as tumours < 0 center dot 30 mm. Scalp location and increasing thickness are strong predictive factors of fatal thin melanomas, indicating that patients with these tumour characteristics require close follow-up.
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| 4. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Incidence of cutaneous melanoma in Western Sweden, 1970-2007.
- 2012
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Ingår i: Melanoma research. - 1473-5636. ; 22:5, s. 392-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the increasing incidence of cutaneous malignant melanoma (CMM) in Western Sweden during the period 1970-2007. A secondary aim was to show a geographical variation in incidence between coastal and inland areas, considering the effects of the local average duration of sunshine, and the sun exposure-related behavior in the populations. The Swedish Cancer Registry provided data on invasive melanomas during 1970-2007. Meteorological maps showed the annual average duration of sunshine during 1961-1990. A survey from 2007 with 2871 participants, carried out by the National Board of Health and Welfare, provided data on self-reported sun exposure. During the period studied, the age-standardized incidence for men in Western Sweden more than quadrupled to 31.1/100 000 inhabitants, whereas it tripled for women to 27.1/100 000. Coastal areas, including Gothenburg city, had a high average duration of sunshine (1701-1900 h of sun/year), whereas inland areas had lower average duration of sunshine (≤1700 h). The incidence of CMM was higher in coastal areas and in Gothenburg city, compared with inland areas. This may be linked to ultraviolet radiation, a consequence of the higher average duration of sunshine. The sun exposure survey showed additional factors, which possibly led to the increased incidence, for example high sun exposure on holidays abroad. The alarming increase in the incidence of CMM in Western Sweden, during the period 1970-2007, shows the need for additional primary preventive measures, for example sun protection programs targeted at populations in this area.
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| 5. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Lethal Melanomas: A Population-based Registry Study in Western Sweden from 1990 to 2014.
- 2017
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 97:10, s. 1206-1211
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Tidskriftsartikel (refereegranskat)abstract
- The incidence rates of thin melanomas (≤1 mm Breslow thickness) have increased in many fair-skinned populations, prompting a need to better identify patients with thin melanomas who will eventually die from the disease. This study aimed to describe the clinicopathological characteristics of lethal melanomas in Western Sweden, with a focus on thin lesions. Population-based data on invasive melanomas diagnosed during the years 1990 to 2014 were extracted from the Swedish Melanoma Registry, and linked to the Swedish Cause of Death Registry. The age-standardized incidence (US population 2000) of thin melanomas increased from 9.1×10-5 (95% confidence interval (95% CI) 8.5-9.8) to 21.3×10-5 (95% CI 20.4-22.1) during the study period. Thin melanomas comprised 55.2% of the total and contributed to 13.5% of all melanoma deaths. Non-ulcerated melanomas 0.76-1 mm and ulcerated melanomas 0.26-1.0 mm showed a poorer survival compared with other thin melanomas.
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| 7. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway
- 2016
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 96:2, s. 181-185
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Tidskriftsartikel (refereegranskat)abstract
- Incidence rates for cutaneous malignant melanoma are increasing worldwide. Estimates of the future number of melanoma cases are important for strategic planning of the care pathway. The aim of this study was to use system dynamics modelling to evaluate the long-term effects of changes in incidence, population growth and preventive interventions. Historical data on invasive melanoma cases in Western Sweden from 1990 to 2006 were obtained. Using computer simulation software, a model estimating the accumulated number of melanoma cases for 2014 to 2023 was developed. Five future scenarios were designed: stable incidence, business-as-usual, 25% reduced patient's delay, 50% reduced doctor's delay, and a combination of the last 2, called improved overall secondary prevention. After 10 years, improved overall secondary prevention would have resulted in a 42% decrease in melanomas >4 mm and a 10% increase in melanomas ≤1 mm, compared with business-as-usual. System dynamics is a valuable tool, which can help policymakers choose the preventive interventions with the greatest impact.
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| 8. |
- Claeson, Magdalena, 1976, et al.
(författare)
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Multiple primary melanomas in Western Sweden; 1990-2013
- 2016
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Ingår i: 3rd International Conference on UV and Skin Cancer Prevention, Melbourne.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionIn Sweden, the incidence of cutaneous malignant melanoma rises yearly with 5.5% for men and 5.2% for women and has now reached world standard rates of 17.6 for men and 18.8 for women per 100,000 population. Over the past decades, the incidence of melanoma has been higher in Western Sweden than the national average. Previous international studies have shown that melanoma patients have an elevated risk of developing a new separate primary melanoma. This study aimed at describing multiple primary melanomas (MPMs) in Western Sweden with focus on the number of tumours detected, tumour characteristics and the time to diagnosis of a subsequent melanoma.MethodsData was extracted retrospectively from the Swedish Melanoma Registry and provided information on all invasive and in situ melanoma cases in Western Sweden (1.6 million inhabitants) from 1990 to 2013. Results Within the studied period, 12,152 patients developed 13,291 melanomas. 11,254 of the patients developed only a single primary melanoma. In total, 898 patients (7.4% of all melanoma patients) developed 2,037 MPMs. Preliminary results show that the median Breslow thickness for all invasive melanomas was below 1 mm. The median Breslow thickness for the MPMs was slightly thinner for the second and third invasive melanoma as compared to the first invasive melanoma. Further, there was a higher percentage of in situ tumours among the subsequent melanomas. The median time to diagnosis of a subsequent melanoma was approximately 3 years. DiscussionSubsequent primary melanomas in Western Sweden are most commonly diagnosed with a somewhat thinner Breslow thickness than the first primary melanoma. The comparatively high percentage of melanoma survivors developing MPMs and the short median time to diagnosis of a subsequent melanoma stresses the importance of follow-up for melanoma patients, particularly during the first years.
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| 9. |
- Claeson, Magdalena, 1976, et al.
(författare)
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MultiplePrimary Melanomas: A Common Occurrencein Western Sweden.
- 2017
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 1651-2057 .- 0001-5555. ; 97:6, s. 715-719
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Tidskriftsartikel (refereegranskat)abstract
- Patients diagnosed with a single primary cutaneous melanoma are at increased risk of developing multiple primary melanomas. The aim of this study is to describe the epidemiology of multiple primary melanomas (invasive and in situ) in Western Sweden. Data from the Swedish Melanoma Registry from 1990 to 2013 revealed that 898 patients (7.4%) developed 2,037 multiple primary lesions and 11,254 patients developed single lesions. The proportion of subsequent lesions that were melanoma in situ was 47%, compared with 26% of first melanomas (p<0.0001). The median time to diagnosis of a subsequent melanoma was 38 months (95% confidence interval (CI), 53-62 months). In total, 49% of subsequent melanomas were detected within 3 years. Patients and physicians should be aware of the high proportion of multiple primary melanomas in Western Sweden, especially during the first years of follow-up.
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