• Actinic keratosis-related signs predictive of squamous cell carcinoma in renal transplant recipients: a nested case-control study.

      Jiyad, Z; O'Rourke, P; Soyer, H; Green, Adèle C; Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Brisbane, QLD 4029, Australia. (2017-04)
      Squamous cell carcinoma (SCC) and intraepidermal carcinoma (IEC) commonly arise in actinically damaged skin.
    • Clinical comparison of actinic changes preceding squamous cell carcinoma vs. intraepidermal carcinoma in renal transplant recipients.

      Jiyad, Z; O'Rourke, P; Soyer, H; Green, Adèle C; Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia (2017-09-19)
      Intraepidermal carcinoma (IEC) is a type of in situ squamous cell carcinoma (SCC), although progression of IEC is rare. We sought to investigate differences between the actinic skin changes preceding the development of both SCC and IEC. Photographs of 63 skin sites at which either SCC or IEC subsequently developed in 37 renal transplant recipients (RTRs) were examined for features of actinic change. We found that areas of skin with an actinic keratosis (AK) > 1 cm(2) in size were four times more likely to develop SCC as opposed to IEC (OR = 4.42; 95% CI 1.25-15.60). Skin sites with ≥ 25% of the area affected by AK were again four times more likely to develop SCC than IEC. These results highlight the scale of visible actinic damage required for development of SCC compared with IEC, emphasizing the importance of treating areas of skin with marked visible actinic change to reduce SCC risk in RTRs.
    • Counting actinic keratosis - is photographic assessment a reliable alternative to physical examination in clinical trials?

      Sinnya, S; O'Rourke, P; Ballard,; Tan, J; Morze, C; Sahebian, A; Hames, S; Prow, T; Green, Adèle C; Soyer, H; et al. (2015-05)
    • Diagnosis of an additional in situ melanoma does not influence survival for patients with a single invasive melanoma: A registry-based follow-up study.

      Youlden, D; Khosrotehrani, K; Green, Adèle C; Soyer, H; Kimlin, M; Youl, P; Aitken, J; Baade, P; Cancer Council Queensland, Brisbane, Queensland, Australia (2016-02)
      Using a large (N= 25 493) population-based cohort from Queensland, Australia, we compared melanoma survival among cases with a single invasive melanoma only against those who also had a diagnosis of a single in situ melanoma. After adjustment for sex, age, body site, clinicopathological subtype, thickness and ulceration, it was found that there was no difference (P = 0.99) in 10-year melanoma-specific mortality following a diagnosis of an invasive lesion, whether or not an in situ melanoma was also present. We conclude that in situ melanomas do not alter the prognosis of an invasive melanoma.
    • Do hand-addressed envelopes improve community response rates for a longitudinal study?

      Nguyen, T; Soyer, H; Green, Adèle C; Janda, M; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane (2017-09-21)
    • Generational shift in melanoma incidence and mortality in Queensland, Australia, 1995-2014.

      Aitken, Joanne F; Youlden, Danny R; Baade, Peter D; Soyer, H; Green, Adèle C; Smithers, B; Cancer Council Queensland, Brisbane, QLD, AustraliaInstitute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia (2017-11-06)
      Public campaigns encouraging sun protection for skin cancer prevention began in Queensland, Australia, in the early 1980s. We examined recent trends to assess whether earlier evidence of stabilizing melanoma incidence in young people has persisted. Anonymized incidence and mortality data for in situ and invasive melanoma for the 20 years 1995-2014 were obtained from the Queensland Cancer Registry. Time trends were analyzed using JoinPoint regression. Birth cohort patterns were assessed using age-period-cohort models. Melanoma incidence in Queensland remains the highest recorded in the world (age-standardized incidence of invasive melanoma (2010-2014) = 72/100,000/annum). Over the 20-year period, incidence of in situ melanoma increased in all age groups. Incidence of both thin (≤1 mm) and thick (>1 mm) invasive melanoma was either stable or decreased in people under 60, while it increased in those aged 60 and above, particularly in men. Age-period-cohort analysis revealed decreasing age-specific incidence of invasive melanoma under 40 years of age, beginning with the birth cohort born around the mid-1960s, with steepest falls for those born around 1980 and later. Age-specific incidence was stable between 40 and 59 years of age from the 1945 birth cohort onwards. Melanoma mortality over the period was stable or decreased in all groups except in men aged 60 or over. These findings are evidence of real advances in the prevention and early detection of invasive melanoma in this very high-risk population. They make a compelling case for continued public health efforts to reduce the burden of melanoma in susceptible populations.
    • High prevalence of skin cancers and actinic keratoses in lung transplant recipients.

      Sahebian, A; Pandeya, N; Chambers, D; Soyer, H; Green, Adèle C; Dermatology Research Centre, The University of Queensland, and the Translational Research Institute, Brisbane, Queensland, Australia (2017-11-15)
    • In response to: immigration is the most likely reason for the generational change in melanoma incidence in Queensland, Australia.

      Aitken, J; Youlden, D; Baade, P; Soyer, H; Green, Adèle C; Smithers, B; Cancer Council Queensland, Brisbane, QLD, Australia (2018-02-28)
    • 'Mind your Moles' study: protocol of a prospective cohort study of melanocytic naevi.

      Koh, U; Janda, M; Aitken, J; Duffy, D; Menzies, S; Sturm, R; Schaider, H; Betz-Stablein, B; Prow, T; Soyer, H; et al. (2018-09-19)
      Having many melanocytic naevi or 'moles' on the skin is the strongest predictor of melanoma; thus, much can be learnt from investigating naevi in the general population. We aim to improve the understanding of the epidemiology and biology of naevi by conducting a 3-year prospective study of melanocytic naevi in adults.
    • Prevalence of skin cancer and related skin tumors in high-risk kidney and liver transplant recipients in Queensland, Australia.

      Iannacone, M; Sinnya, S; Pandeya, N; Isbel, N; Campbell, S; Fawcett, J; Soyer, H; Ferguson, L; Davis, M; Whiteman, D; et al. (2016-03-08)
      The increased skin cancer incidence in organ transplant recipients (OTRs) is well-known, but the skin cancer burden at any one time is unknown. Our objective was to estimate the period prevalence of untreated skin malignancy and actinic keratoses (AKs) in high-risk kidney and liver transplant recipients and assess associated factors. OTRs underwent full skin examinations by dermatologically-trained physicians. The proportion of examined OTRs with histopathologically-confirmed skin cancer in the 3-month baseline period was estimated. Prevalence ratios (PR) with 95% confidence intervals (CIs) indicated significant associations. Of 495 high-risk OTRs (average age 54, immunosuppressed 8.9 years), 135 (27%) had basal cell carcinoma, squamous cell carcinoma or Bowen Disease (intra-epidermal carcinoma) present and confirmed in the baseline period with respective prevalence proportions of 10%, 11%, and 18% in kidney recipients and 10%, 9% and 13% in liver transplant recipients. Over 80% had AKs present with approximately 30% having >5AKs. OTRs with the highest skin cancer burden were Australian-born; fair-skinned (PR=1.61, 1.07-2.43); reported past skin cancer (PR=3.39, 95% CI=1.93-5.95); and were receiving the most frequent skin checks (PR=1.76, 95% CI=1.15-2.70). In conclusion, high-risk OTRs carry a substantial measurable skin cancer burden at any given time and require frequent review through easily accessible, specialized services.
    • Response to commentary 'utility and limitations of large population-based data for skin cancer outcomes'.

      Youlden, D; Baade, P; Soyer, H; Youl, P; Kimlin, M; Aitken, J; Green, Adèle C; Khosrotehrani, K; Cancer Council Queensland, Brisbane, Queensland, Australia. (2016-12-12)
    • Ten-year survival after multiple invasive melanomas is worse than after a single melanoma: a population-based study.

      Youlden, D; Baade, P; Soyer, H; Youl, P; Kimlin, M; Aitken, J; Green, Adèle C; Khosrotehrani, K; Cancer Council Queensland, Brisbane, Queensland, AustraliaCancer Council Queensland, Brisbane, Queensland, Australia (2016-03-23)
      The prognosis of melanoma patients who are diagnosed with multiple primary lesions remains controversial. We used a large, population-based cohort to re-examine this issue, applying a delayed entry methodology to avoid survival bias. Of 32,238 eligible patients diagnosed between 1995 and 2008, 29,908 (93%) had a single invasive melanoma, 2,075 (6%) had two and 255 (1%) had three. Allowing for differences in entry time, 10-year cause-specific survival for these three groups was 89% (95% CI = 88%-90%), 83% (95% CI = 80%-86%) and 67% (95% CI = 54%-81%), respectively. After adjustment for key prognostic factors, the hazard ratio (HR) of death within 10 years from melanoma was two times higher for those with two melanomas (HR = 2.01, 95% CI = 1.57-2.59; p<0.001) and nearly three times higher when three melanomas were diagnosed (HR = 2.91, 95% CI = 1.64-5.18; p<0.001) compared to people with a single melanoma. Melanoma-specific mortality remained elevated after adjusting for maximum thickness or ulceration of any melanoma regardless of the index tumor. After appropriately accounting for the interval between diagnosis of the first and subsequent melanomas, patients with multiple invasive melanomas have significantly poorer survival than patients with a single invasive melanoma.