Melanoma

SAN FRANCISCO — Having a history of melanoma should not preclude a patient from receiving an organ transplant, according to Dr. Daniel Berg.

Roughly half of the approximately 100,000 new cases of melanoma diagnosed in the United States each year are in situ melanomas, and there is no reason these patients should not proceed to organ transplantation, but "the transplant docs don't necessarily separate these out" from other melanomas, Dr. Berg said at the annual meeting of the Pacific Dermatologic Association.

Patients with a history of stage T1a melanoma probably can safely undergo organ transplantation if they have gone 2 years without a recurrence of the melanoma, he said. At least 5 years without recurrence should be required in patients with melanoma stage greater than T1a or with tumor stage b before considering organ transplantation, added Dr. Berg, director of dermatologic surgery at the University of Washington, Seattle. Transplantation should be avoided if there is a history of metastatic melanoma.

Should a new melanoma in a posttransplant patient be found, treatment is the same as for other melanoma patients, with a couple of exceptions. For more aggressive melanoma (with a tumor larger than 1 mm in diameter, or a positive sentinel node), consider reducing immunosuppressive therapy, Dr. Berg suggested. If a posttransplant patient develops metastatic melanoma, try to determine if the melanoma originated in the patient's own body or in the organ donor. Metastatic melanoma that came from transplant should prompt you to notify other recipients of organs from the same donor. Their risk for metastatic melanoma is very high.

One study of 20 recipients of organs from 11 donors who retrospectively were diagnosed with metastatic melanoma found that 17 recipients developed to stage IV, and most died. Ceasing immunosuppression produced complete remission in five organ recipients (Transplantation 1996;61:274–8).

If an organ recipient gets metastatic melanoma from a donor, consider withdrawing immunosuppression, an allograft explantation, or retransplantation to improve the chance of survival, Dr. Berg said. The medical literature recommends against using organs from donors with any history of melanoma, but this may be overkill, he suggested. A review of data on 140 transplant patients who unwittingly received organs in 2000–2005 from donors with a history of melanoma found that one organ recipient died of metastatic melanoma (Transplantation 2007;84:272–4).

The organ in the recipient who died came from a donor who had been diagnosed with melanoma 32 years earlier. Another 27% of donors were diagnosed with melanoma within 5 years of their deaths, but none of those recipients died of melanoma.

"So, what do you do with a patient who has a sister who's willing to give him a kidney, and that sister had an in situ melanoma?" Dr. Berg asked. "You should be prepared to be an advocate for them" to proceed with transplantation.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Having a history of melanoma should not preclude a patient from receiving an organ transplant, according to Dr. Daniel Berg.

Roughly half of the approximately 100,000 new cases of melanoma diagnosed in the United States each year are in situ melanomas, and there is no reason these patients should not proceed to organ transplantation, but "the transplant docs don't necessarily separate these out" from other melanomas, Dr. Berg said at the annual meeting of the Pacific Dermatologic Association.

Patients with a history of stage T1a melanoma probably can safely undergo organ transplantation if they have gone 2 years without a recurrence of the melanoma, he said. At least 5 years without recurrence should be required in patients with melanoma stage greater than T1a or with tumor stage b before considering organ transplantation, added Dr. Berg, director of dermatologic surgery at the University of Washington, Seattle. Transplantation should be avoided if there is a history of metastatic melanoma.

Should a new melanoma in a posttransplant patient be found, treatment is the same as for other melanoma patients, with a couple of exceptions. For more aggressive melanoma (with a tumor larger than 1 mm in diameter, or a positive sentinel node), consider reducing immunosuppressive therapy, Dr. Berg suggested. If a posttransplant patient develops metastatic melanoma, try to determine if the melanoma originated in the patient's own body or in the organ donor. Metastatic melanoma that came from transplant should prompt you to notify other recipients of organs from the same donor. Their risk for metastatic melanoma is very high.

One study of 20 recipients of organs from 11 donors who retrospectively were diagnosed with metastatic melanoma found that 17 recipients developed to stage IV, and most died. Ceasing immunosuppression produced complete remission in five organ recipients (Transplantation 1996;61:274–8).

If an organ recipient gets metastatic melanoma from a donor, consider withdrawing immunosuppression, an allograft explantation, or retransplantation to improve the chance of survival, Dr. Berg said. The medical literature recommends against using organs from donors with any history of melanoma, but this may be overkill, he suggested. A review of data on 140 transplant patients who unwittingly received organs in 2000–2005 from donors with a history of melanoma found that one organ recipient died of metastatic melanoma (Transplantation 2007;84:272–4).

The organ in the recipient who died came from a donor who had been diagnosed with melanoma 32 years earlier. Another 27% of donors were diagnosed with melanoma within 5 years of their deaths, but none of those recipients died of melanoma.

"So, what do you do with a patient who has a sister who's willing to give him a kidney, and that sister had an in situ melanoma?" Dr. Berg asked. "You should be prepared to be an advocate for them" to proceed with transplantation.

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Having a history of melanoma should not preclude a patient from receiving an organ transplant, according to Dr. Daniel Berg.

Roughly half of the approximately 100,000 new cases of melanoma diagnosed in the United States each year are in situ melanomas, and there is no reason these patients should not proceed to organ transplantation, but "the transplant docs don't necessarily separate these out" from other melanomas, Dr. Berg said at the annual meeting of the Pacific Dermatologic Association.

Patients with a history of stage T1a melanoma probably can safely undergo organ transplantation if they have gone 2 years without a recurrence of the melanoma, he said. At least 5 years without recurrence should be required in patients with melanoma stage greater than T1a or with tumor stage b before considering organ transplantation, added Dr. Berg, director of dermatologic surgery at the University of Washington, Seattle. Transplantation should be avoided if there is a history of metastatic melanoma.

Should a new melanoma in a posttransplant patient be found, treatment is the same as for other melanoma patients, with a couple of exceptions. For more aggressive melanoma (with a tumor larger than 1 mm in diameter, or a positive sentinel node), consider reducing immunosuppressive therapy, Dr. Berg suggested. If a posttransplant patient develops metastatic melanoma, try to determine if the melanoma originated in the patient's own body or in the organ donor. Metastatic melanoma that came from transplant should prompt you to notify other recipients of organs from the same donor. Their risk for metastatic melanoma is very high.

One study of 20 recipients of organs from 11 donors who retrospectively were diagnosed with metastatic melanoma found that 17 recipients developed to stage IV, and most died. Ceasing immunosuppression produced complete remission in five organ recipients (Transplantation 1996;61:274–8).

If an organ recipient gets metastatic melanoma from a donor, consider withdrawing immunosuppression, an allograft explantation, or retransplantation to improve the chance of survival, Dr. Berg said. The medical literature recommends against using organs from donors with any history of melanoma, but this may be overkill, he suggested. A review of data on 140 transplant patients who unwittingly received organs in 2000–2005 from donors with a history of melanoma found that one organ recipient died of metastatic melanoma (Transplantation 2007;84:272–4).

The organ in the recipient who died came from a donor who had been diagnosed with melanoma 32 years earlier. Another 27% of donors were diagnosed with melanoma within 5 years of their deaths, but none of those recipients died of melanoma.

"So, what do you do with a patient who has a sister who's willing to give him a kidney, and that sister had an in situ melanoma?" Dr. Berg asked. "You should be prepared to be an advocate for them" to proceed with transplantation.

ELSEVIER GLOBAL MEDICAL NEWS

Imagine detecting skin cancer at a very early stage merely by using a sensor with an alarm that sounds when it detects abnormal variations in volatile chemical odors in the patient's skin.

Although still in the prototype stage, researchers proved the technology works with basal cell carcinoma, and plan to soon assess efficacy for early detection of melanoma and squamous cell cancers as well.

"It's very promising. There are volatiles present that are indicative of cancer. They are present in normal and cancerous skin, but levels change in a quantitative manner," said George Preti, Ph.D.

Using gas chromatography and mass spectrometry, Dr. Preti and his associates demonstrated that basal cell carcinoma lesions in 11 people emitted different levels of volatile organic skin chemicals, compared with noncancerous skin, in 11 controls. They found many of the chemicals to be odorous. Coauthor Michelle Gallagher, Ph.D., presented their findings at the annual meeting of the American Chemical Society. Specific chemical identities have not been released.

The current study builds on previous research done by Dr. Gallagher and her associates.

In a report, they identified nearly 100 different chemical compounds normally emitted by the forearm and upper back of 25 healthy volunteers (Brit. J. Derm. 2008 July 12; [doi: 10.1111/j.1365–2133.2008. 08748.x]). The study included patients aged 19–79 years and found some changes in skin emissions with age.

Other reports are anecdotal or only evaluate skin odor differences at the underarm (J. Chem. Ecol. 2005;31:1607–19; Chem. Biodivers. 2004;1:2042–50). The researchers began assessing skin emissions after studies showed that dogs were able to identify people with early-stage cancers using their heightened sense of smell (Integr. Cancer. Ther. 2006;5:30–9; BMJ 2004;329:712).

This was a proof-of-principle study, said Dr. Preti, who estimated clinical availability could take 7–10 years. He and his colleagues used a volatile organic chemical sensor designed for industrial and other applications, and next plan to design a probe specific to human skin.

Dr. Preti is a member of the Monell Chemical Senses Center, a nonprofit institute in Philadelphia. Dr. Gallagher was a postdoctorate fellow in Dr. Preti's lab at the time of the study; she is now at Rohm and Haas in Spring House, Pa. The authors of the study had no relevant financial disclosures.

Imagine detecting skin cancer at a very early stage merely by using a sensor with an alarm that sounds when it detects abnormal variations in volatile chemical odors in the patient's skin.

Although still in the prototype stage, researchers proved the technology works with basal cell carcinoma, and plan to soon assess efficacy for early detection of melanoma and squamous cell cancers as well.

"It's very promising. There are volatiles present that are indicative of cancer. They are present in normal and cancerous skin, but levels change in a quantitative manner," said George Preti, Ph.D.

Using gas chromatography and mass spectrometry, Dr. Preti and his associates demonstrated that basal cell carcinoma lesions in 11 people emitted different levels of volatile organic skin chemicals, compared with noncancerous skin, in 11 controls. They found many of the chemicals to be odorous. Coauthor Michelle Gallagher, Ph.D., presented their findings at the annual meeting of the American Chemical Society. Specific chemical identities have not been released.

The current study builds on previous research done by Dr. Gallagher and her associates.

In a report, they identified nearly 100 different chemical compounds normally emitted by the forearm and upper back of 25 healthy volunteers (Brit. J. Derm. 2008 July 12; [doi: 10.1111/j.1365–2133.2008. 08748.x]). The study included patients aged 19–79 years and found some changes in skin emissions with age.

Other reports are anecdotal or only evaluate skin odor differences at the underarm (J. Chem. Ecol. 2005;31:1607–19; Chem. Biodivers. 2004;1:2042–50). The researchers began assessing skin emissions after studies showed that dogs were able to identify people with early-stage cancers using their heightened sense of smell (Integr. Cancer. Ther. 2006;5:30–9; BMJ 2004;329:712).

This was a proof-of-principle study, said Dr. Preti, who estimated clinical availability could take 7–10 years. He and his colleagues used a volatile organic chemical sensor designed for industrial and other applications, and next plan to design a probe specific to human skin.

Dr. Preti is a member of the Monell Chemical Senses Center, a nonprofit institute in Philadelphia. Dr. Gallagher was a postdoctorate fellow in Dr. Preti's lab at the time of the study; she is now at Rohm and Haas in Spring House, Pa. The authors of the study had no relevant financial disclosures.

Imagine detecting skin cancer at a very early stage merely by using a sensor with an alarm that sounds when it detects abnormal variations in volatile chemical odors in the patient's skin.

Although still in the prototype stage, researchers proved the technology works with basal cell carcinoma, and plan to soon assess efficacy for early detection of melanoma and squamous cell cancers as well.

"It's very promising. There are volatiles present that are indicative of cancer. They are present in normal and cancerous skin, but levels change in a quantitative manner," said George Preti, Ph.D.

Using gas chromatography and mass spectrometry, Dr. Preti and his associates demonstrated that basal cell carcinoma lesions in 11 people emitted different levels of volatile organic skin chemicals, compared with noncancerous skin, in 11 controls. They found many of the chemicals to be odorous. Coauthor Michelle Gallagher, Ph.D., presented their findings at the annual meeting of the American Chemical Society. Specific chemical identities have not been released.

The current study builds on previous research done by Dr. Gallagher and her associates.

In a report, they identified nearly 100 different chemical compounds normally emitted by the forearm and upper back of 25 healthy volunteers (Brit. J. Derm. 2008 July 12; [doi: 10.1111/j.1365–2133.2008. 08748.x]). The study included patients aged 19–79 years and found some changes in skin emissions with age.

Other reports are anecdotal or only evaluate skin odor differences at the underarm (J. Chem. Ecol. 2005;31:1607–19; Chem. Biodivers. 2004;1:2042–50). The researchers began assessing skin emissions after studies showed that dogs were able to identify people with early-stage cancers using their heightened sense of smell (Integr. Cancer. Ther. 2006;5:30–9; BMJ 2004;329:712).

This was a proof-of-principle study, said Dr. Preti, who estimated clinical availability could take 7–10 years. He and his colleagues used a volatile organic chemical sensor designed for industrial and other applications, and next plan to design a probe specific to human skin.

Dr. Preti is a member of the Monell Chemical Senses Center, a nonprofit institute in Philadelphia. Dr. Gallagher was a postdoctorate fellow in Dr. Preti's lab at the time of the study; she is now at Rohm and Haas in Spring House, Pa. The authors of the study had no relevant financial disclosures.

Tanning dependence, sometimes called "tanorexia," is common in young adults and can be predicted by certain demographic and behavioral variables, according to a survey of 400 college students.

More than a quarter (27%) of survey respondents were classified as tanning dependent, and ethnicity, skin type, lack of skin protective behaviors, tanning behaviors, smoking, and body mass index each were found to be significant independent predictors of tanning dependence, reported Carolyn J. Heckman, Ph.D., of Fox Chase Cancer Center in Cheltenham, Pa., and her colleagues (Am. J. Health Behav. 2008;32:451–64).

The findings could assist clinicians in identifying individuals who are tanning dependent or who are at risk of becoming dependent, the investigators said.

In the article, which is now in press, the investigators stated that tanning dependence has a number of similarities to substance use, including higher prevalence among youth, an initial perception that the behavior is image enhancing, and high health risks and disregard for warnings about those risks. Although a primary motivation for tanning is appearance enhancement, tanners often report other benefits, such as mood enhancement, and socialization, commonly reported by individuals with other types of dependencies, Dr. Heckman and her associates noted.

Tanning dependence also has similarities to disorders such as obsessive compulsive disorder and eating disorders, thus the nickname "tanorexia," but it is unclear which comparisons are most applicable.

Prior studies have suggested that one possible mechanism for tanning dependence is endogenous opioid release during ultraviolet radiation (UVR) exposure: Blinded study participants demonstrated a preference for UVR vs. non-UVR tanning beds, and UVR exposure was associated with a more relaxed and less tense mood in those studies. Furthermore, in at least one other study, the preference for UVR tanning beds was reduced with increasing doses of the opioid antagonist naltrexone.

In the current study, which was sponsored by the National Cancer Institute, tanning dependence was assessed using measures developed to evaluate more traditional addictive behaviors such as substance use, which were adapted for the purpose of assessing tanning addiction. The scales used were the four-question CAGE alcohol evaluation and the American Psychiatric Association's Diagnostic and Statistics Manual IV-Text Revision substance dependence criteria.

Participants, who had a mean age of 21 years and were mostly women (75%), were asked questions about tanning behaviors such as "Do you think you need to spend more and more time in the sun to maintain your perfect tan?" and "Does your belief that tanning can cause skin cancer keep you from spending time in the sun or going to tanning beds?"

Of the 400 individuals surveyed, 106 (27%) were classified as tanning dependent by one or both of the two scales used, the investigators found.

Race was found to be predictive of tanning dependence, with white participants having 7.6-fold greater odds than African Americans. Also predictive was moderate skin type, compared with fair and dark skin. Those with Fitzpatrick type III and IV skin had the highest risk: Sixteen percent of those with type I, 21% with type II, 39% with type III, 32% with type IV, and 4% with type V skin were tanning dependent.

Several exposure and skin protection factors were found to predict tanning dependence:

▸ Those with highest level of summer sunbathing were more likely to be tanning dependent (odds ratio 7.5) than were those with the lowest level.

▸ Respondents who had the highest number of sunburns were more likely to be tanning dependent (OR 2.85).

▸ Those who used moderate (OR 0.27) or high levels (OR 0.36) of sun protection were less likely than were those who used low levels to be tanning dependent.

▸ Those who tanned indoors during warm weather were more likely to be tanning dependent (OR 2.99) than were those who did not use indoor tanning.

The use of chemical sunless tanners and the overall rates of indoor tanning did not predict tanning dependence in this study.

Health-related behaviors that were linked with tanning dependence included current smoking, with smokers having 1.81 greater odds of tanning dependence, and obesity, with those considered obese having lower likelihood of being dependent (odds ratio 0.34).

The findings may offer new avenues for research as well as skin protection and skin cancer prevention interventions, the investigators concluded, but they also noted that "not all tanning behavior or even frequent behavior should be seen as indicative of tanning dependence."

Nonetheless, they expressed concern regarding the finding that about 40% of respondents had used tanning beds, with a mean age of 17 years at first tanning and a mean number of lifetime uses of 57. This is alarming, considering the mean age of 21 in the respondents, they stated.

Tanning dependence bears similarities both to substance use disorder and to eating disorders, thus the nickname "tanorexia." ©Bora

Tanning dependence, sometimes called "tanorexia," is common in young adults and can be predicted by certain demographic and behavioral variables, according to a survey of 400 college students.

More than a quarter (27%) of survey respondents were classified as tanning dependent, and ethnicity, skin type, lack of skin protective behaviors, tanning behaviors, smoking, and body mass index each were found to be significant independent predictors of tanning dependence, reported Carolyn J. Heckman, Ph.D., of Fox Chase Cancer Center in Cheltenham, Pa., and her colleagues (Am. J. Health Behav. 2008;32:451–64).

The findings could assist clinicians in identifying individuals who are tanning dependent or who are at risk of becoming dependent, the investigators said.

In the article, which is now in press, the investigators stated that tanning dependence has a number of similarities to substance use, including higher prevalence among youth, an initial perception that the behavior is image enhancing, and high health risks and disregard for warnings about those risks. Although a primary motivation for tanning is appearance enhancement, tanners often report other benefits, such as mood enhancement, and socialization, commonly reported by individuals with other types of dependencies, Dr. Heckman and her associates noted.

Tanning dependence also has similarities to disorders such as obsessive compulsive disorder and eating disorders, thus the nickname "tanorexia," but it is unclear which comparisons are most applicable.

Prior studies have suggested that one possible mechanism for tanning dependence is endogenous opioid release during ultraviolet radiation (UVR) exposure: Blinded study participants demonstrated a preference for UVR vs. non-UVR tanning beds, and UVR exposure was associated with a more relaxed and less tense mood in those studies. Furthermore, in at least one other study, the preference for UVR tanning beds was reduced with increasing doses of the opioid antagonist naltrexone.

In the current study, which was sponsored by the National Cancer Institute, tanning dependence was assessed using measures developed to evaluate more traditional addictive behaviors such as substance use, which were adapted for the purpose of assessing tanning addiction. The scales used were the four-question CAGE alcohol evaluation and the American Psychiatric Association's Diagnostic and Statistics Manual IV-Text Revision substance dependence criteria.

Participants, who had a mean age of 21 years and were mostly women (75%), were asked questions about tanning behaviors such as "Do you think you need to spend more and more time in the sun to maintain your perfect tan?" and "Does your belief that tanning can cause skin cancer keep you from spending time in the sun or going to tanning beds?"

Of the 400 individuals surveyed, 106 (27%) were classified as tanning dependent by one or both of the two scales used, the investigators found.

Race was found to be predictive of tanning dependence, with white participants having 7.6-fold greater odds than African Americans. Also predictive was moderate skin type, compared with fair and dark skin. Those with Fitzpatrick type III and IV skin had the highest risk: Sixteen percent of those with type I, 21% with type II, 39% with type III, 32% with type IV, and 4% with type V skin were tanning dependent.

Several exposure and skin protection factors were found to predict tanning dependence:

▸ Those with highest level of summer sunbathing were more likely to be tanning dependent (odds ratio 7.5) than were those with the lowest level.

▸ Respondents who had the highest number of sunburns were more likely to be tanning dependent (OR 2.85).

▸ Those who used moderate (OR 0.27) or high levels (OR 0.36) of sun protection were less likely than were those who used low levels to be tanning dependent.

▸ Those who tanned indoors during warm weather were more likely to be tanning dependent (OR 2.99) than were those who did not use indoor tanning.

The use of chemical sunless tanners and the overall rates of indoor tanning did not predict tanning dependence in this study.

Health-related behaviors that were linked with tanning dependence included current smoking, with smokers having 1.81 greater odds of tanning dependence, and obesity, with those considered obese having lower likelihood of being dependent (odds ratio 0.34).

The findings may offer new avenues for research as well as skin protection and skin cancer prevention interventions, the investigators concluded, but they also noted that "not all tanning behavior or even frequent behavior should be seen as indicative of tanning dependence."

Nonetheless, they expressed concern regarding the finding that about 40% of respondents had used tanning beds, with a mean age of 17 years at first tanning and a mean number of lifetime uses of 57. This is alarming, considering the mean age of 21 in the respondents, they stated.

Tanning dependence bears similarities both to substance use disorder and to eating disorders, thus the nickname "tanorexia." ©Bora

Tanning dependence, sometimes called "tanorexia," is common in young adults and can be predicted by certain demographic and behavioral variables, according to a survey of 400 college students.

More than a quarter (27%) of survey respondents were classified as tanning dependent, and ethnicity, skin type, lack of skin protective behaviors, tanning behaviors, smoking, and body mass index each were found to be significant independent predictors of tanning dependence, reported Carolyn J. Heckman, Ph.D., of Fox Chase Cancer Center in Cheltenham, Pa., and her colleagues (Am. J. Health Behav. 2008;32:451–64).

The findings could assist clinicians in identifying individuals who are tanning dependent or who are at risk of becoming dependent, the investigators said.

In the article, which is now in press, the investigators stated that tanning dependence has a number of similarities to substance use, including higher prevalence among youth, an initial perception that the behavior is image enhancing, and high health risks and disregard for warnings about those risks. Although a primary motivation for tanning is appearance enhancement, tanners often report other benefits, such as mood enhancement, and socialization, commonly reported by individuals with other types of dependencies, Dr. Heckman and her associates noted.

Tanning dependence also has similarities to disorders such as obsessive compulsive disorder and eating disorders, thus the nickname "tanorexia," but it is unclear which comparisons are most applicable.

Prior studies have suggested that one possible mechanism for tanning dependence is endogenous opioid release during ultraviolet radiation (UVR) exposure: Blinded study participants demonstrated a preference for UVR vs. non-UVR tanning beds, and UVR exposure was associated with a more relaxed and less tense mood in those studies. Furthermore, in at least one other study, the preference for UVR tanning beds was reduced with increasing doses of the opioid antagonist naltrexone.

In the current study, which was sponsored by the National Cancer Institute, tanning dependence was assessed using measures developed to evaluate more traditional addictive behaviors such as substance use, which were adapted for the purpose of assessing tanning addiction. The scales used were the four-question CAGE alcohol evaluation and the American Psychiatric Association's Diagnostic and Statistics Manual IV-Text Revision substance dependence criteria.

Participants, who had a mean age of 21 years and were mostly women (75%), were asked questions about tanning behaviors such as "Do you think you need to spend more and more time in the sun to maintain your perfect tan?" and "Does your belief that tanning can cause skin cancer keep you from spending time in the sun or going to tanning beds?"

Of the 400 individuals surveyed, 106 (27%) were classified as tanning dependent by one or both of the two scales used, the investigators found.

Race was found to be predictive of tanning dependence, with white participants having 7.6-fold greater odds than African Americans. Also predictive was moderate skin type, compared with fair and dark skin. Those with Fitzpatrick type III and IV skin had the highest risk: Sixteen percent of those with type I, 21% with type II, 39% with type III, 32% with type IV, and 4% with type V skin were tanning dependent.

Several exposure and skin protection factors were found to predict tanning dependence:

▸ Those with highest level of summer sunbathing were more likely to be tanning dependent (odds ratio 7.5) than were those with the lowest level.

▸ Respondents who had the highest number of sunburns were more likely to be tanning dependent (OR 2.85).

▸ Those who used moderate (OR 0.27) or high levels (OR 0.36) of sun protection were less likely than were those who used low levels to be tanning dependent.

▸ Those who tanned indoors during warm weather were more likely to be tanning dependent (OR 2.99) than were those who did not use indoor tanning.

The use of chemical sunless tanners and the overall rates of indoor tanning did not predict tanning dependence in this study.

Health-related behaviors that were linked with tanning dependence included current smoking, with smokers having 1.81 greater odds of tanning dependence, and obesity, with those considered obese having lower likelihood of being dependent (odds ratio 0.34).

The findings may offer new avenues for research as well as skin protection and skin cancer prevention interventions, the investigators concluded, but they also noted that "not all tanning behavior or even frequent behavior should be seen as indicative of tanning dependence."

Nonetheless, they expressed concern regarding the finding that about 40% of respondents had used tanning beds, with a mean age of 17 years at first tanning and a mean number of lifetime uses of 57. This is alarming, considering the mean age of 21 in the respondents, they stated.

Tanning dependence bears similarities both to substance use disorder and to eating disorders, thus the nickname "tanorexia." ©Bora

CHICAGO — Topical therapy for 2 or 3 days with the investigational agent ingenol mebutate, also known as PEP005, provides substantial clearance of actinic keratosis lesions, according to findings from two phase II randomized studies.

"A comparison of efficacy outcomes with those of studies of diclofenac, 5-FU [fluorouracil], and imiquimod shows at least equivalent clearance of lesions over a much shorter period," Dr. Lawrence Anderson, one of the current study's lead investigators, reported at the American Academy of Dermatology's Academy 2008 meeting.

Ingenol mebutate gel has the potential to enhance compliance not only by its shorter course of therapy, but also by the truncated period of irritation in patients with actinic keratosis (AK), the investigators suggested.

PEP005 is a new class of compound derived from the sap of Euphorbia peplus, a readily available plant that has been used in Australia for centuries as a traditional treatment for skin conditions. The two current studies were sponsored by Peplin Ltd. of Brisbane, Australia, which is developing PEP005.

Dr. Anderson, who is in private dermatology practice in Tyler, Texas, and his associates randomized 222 patients with 4- 8 visible AK lesions on the arm, shoulder, chest, back, or scalp, to one of four treatment groups. The primary end point was partial clearance, defined as the proportion of patients at day 57 with 75% reduction in the number of AK lesions identified at baseline.

Treatment with PEP005 gel once daily for 2 or 3 days produced significantly greater lesion clearance in a dose-dependent manner by all measures and at all dosing regimens, compared with a control vehicle applied once daily for 3 days.

The partial clearance rate was 22% for vehicle, 56% for ingenol mebutate gel 0.025% for 3 days, 62% for ingenol mebutate gel 0.05% for 2 days, and 75.4% for ingenol mebutate 0.05% for 3 days.

The proportion of patients at day 57 with complete clearance, defined as no clinically visible AK lesions, was 12%, 40%, 44%, and 54.4%, respectively.

All three active treatments were well tolerated, according to the investigators, one of whom was a Peplin employee. The most common lesion-site reactions on day 57 were erythema, experienced by 34% of 162 actively treated patients; flaking or scaling (29%); and crusting (9%).

Because AK lesions on the trunk and extremities historically are more difficult to treat than scalp lesions, the investigators performed an ad hoc analysis to compare outcomes in patients with scalp and nonscalp lesions, Dr. Michael Freeman of the Skin Centre, Gold Coast, Australia, and his associates said in a separate poster.

Overall, scalp treatment areas had a higher complete clearance rate than nonscalp treatment areas (57% vs. 42.4%), although the gel was better tolerated when applied to nonscalp areas, regardless of concentration or dosing schedule, the investigators wrote.

The maximum tolerated dose (MTD) for face or face and scalp AK was determined to be once-daily ingenol mebutate gel 0.025% for 2 days, according to a second study that evaluated six formulation strengths ranging from 0.0025% to 0.025% in 86 patients with lesions limited to the face or face and scalp.

At the MTD, 26 of 36 patients (72%) achieved partial clearance and 14 of the 36 (39%) achieved complete clearance.

Ingenol mebutate gel was well tolerated across all strengths, with erythema the most common lesion site reaction. Three patients experienced four serious adverse events, none considered treatment related, according to the investigators, one of whom was also a Peplin employee.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Topical therapy for 2 or 3 days with the investigational agent ingenol mebutate, also known as PEP005, provides substantial clearance of actinic keratosis lesions, according to findings from two phase II randomized studies.

"A comparison of efficacy outcomes with those of studies of diclofenac, 5-FU [fluorouracil], and imiquimod shows at least equivalent clearance of lesions over a much shorter period," Dr. Lawrence Anderson, one of the current study's lead investigators, reported at the American Academy of Dermatology's Academy 2008 meeting.

Ingenol mebutate gel has the potential to enhance compliance not only by its shorter course of therapy, but also by the truncated period of irritation in patients with actinic keratosis (AK), the investigators suggested.

PEP005 is a new class of compound derived from the sap of Euphorbia peplus, a readily available plant that has been used in Australia for centuries as a traditional treatment for skin conditions. The two current studies were sponsored by Peplin Ltd. of Brisbane, Australia, which is developing PEP005.

Dr. Anderson, who is in private dermatology practice in Tyler, Texas, and his associates randomized 222 patients with 4- 8 visible AK lesions on the arm, shoulder, chest, back, or scalp, to one of four treatment groups. The primary end point was partial clearance, defined as the proportion of patients at day 57 with 75% reduction in the number of AK lesions identified at baseline.

Treatment with PEP005 gel once daily for 2 or 3 days produced significantly greater lesion clearance in a dose-dependent manner by all measures and at all dosing regimens, compared with a control vehicle applied once daily for 3 days.

The partial clearance rate was 22% for vehicle, 56% for ingenol mebutate gel 0.025% for 3 days, 62% for ingenol mebutate gel 0.05% for 2 days, and 75.4% for ingenol mebutate 0.05% for 3 days.

The proportion of patients at day 57 with complete clearance, defined as no clinically visible AK lesions, was 12%, 40%, 44%, and 54.4%, respectively.

All three active treatments were well tolerated, according to the investigators, one of whom was a Peplin employee. The most common lesion-site reactions on day 57 were erythema, experienced by 34% of 162 actively treated patients; flaking or scaling (29%); and crusting (9%).

Because AK lesions on the trunk and extremities historically are more difficult to treat than scalp lesions, the investigators performed an ad hoc analysis to compare outcomes in patients with scalp and nonscalp lesions, Dr. Michael Freeman of the Skin Centre, Gold Coast, Australia, and his associates said in a separate poster.

Overall, scalp treatment areas had a higher complete clearance rate than nonscalp treatment areas (57% vs. 42.4%), although the gel was better tolerated when applied to nonscalp areas, regardless of concentration or dosing schedule, the investigators wrote.

The maximum tolerated dose (MTD) for face or face and scalp AK was determined to be once-daily ingenol mebutate gel 0.025% for 2 days, according to a second study that evaluated six formulation strengths ranging from 0.0025% to 0.025% in 86 patients with lesions limited to the face or face and scalp.

At the MTD, 26 of 36 patients (72%) achieved partial clearance and 14 of the 36 (39%) achieved complete clearance.

Ingenol mebutate gel was well tolerated across all strengths, with erythema the most common lesion site reaction. Three patients experienced four serious adverse events, none considered treatment related, according to the investigators, one of whom was also a Peplin employee.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Topical therapy for 2 or 3 days with the investigational agent ingenol mebutate, also known as PEP005, provides substantial clearance of actinic keratosis lesions, according to findings from two phase II randomized studies.

"A comparison of efficacy outcomes with those of studies of diclofenac, 5-FU [fluorouracil], and imiquimod shows at least equivalent clearance of lesions over a much shorter period," Dr. Lawrence Anderson, one of the current study's lead investigators, reported at the American Academy of Dermatology's Academy 2008 meeting.

Ingenol mebutate gel has the potential to enhance compliance not only by its shorter course of therapy, but also by the truncated period of irritation in patients with actinic keratosis (AK), the investigators suggested.

PEP005 is a new class of compound derived from the sap of Euphorbia peplus, a readily available plant that has been used in Australia for centuries as a traditional treatment for skin conditions. The two current studies were sponsored by Peplin Ltd. of Brisbane, Australia, which is developing PEP005.

Dr. Anderson, who is in private dermatology practice in Tyler, Texas, and his associates randomized 222 patients with 4- 8 visible AK lesions on the arm, shoulder, chest, back, or scalp, to one of four treatment groups. The primary end point was partial clearance, defined as the proportion of patients at day 57 with 75% reduction in the number of AK lesions identified at baseline.

Treatment with PEP005 gel once daily for 2 or 3 days produced significantly greater lesion clearance in a dose-dependent manner by all measures and at all dosing regimens, compared with a control vehicle applied once daily for 3 days.

The partial clearance rate was 22% for vehicle, 56% for ingenol mebutate gel 0.025% for 3 days, 62% for ingenol mebutate gel 0.05% for 2 days, and 75.4% for ingenol mebutate 0.05% for 3 days.

The proportion of patients at day 57 with complete clearance, defined as no clinically visible AK lesions, was 12%, 40%, 44%, and 54.4%, respectively.

All three active treatments were well tolerated, according to the investigators, one of whom was a Peplin employee. The most common lesion-site reactions on day 57 were erythema, experienced by 34% of 162 actively treated patients; flaking or scaling (29%); and crusting (9%).

Because AK lesions on the trunk and extremities historically are more difficult to treat than scalp lesions, the investigators performed an ad hoc analysis to compare outcomes in patients with scalp and nonscalp lesions, Dr. Michael Freeman of the Skin Centre, Gold Coast, Australia, and his associates said in a separate poster.

Overall, scalp treatment areas had a higher complete clearance rate than nonscalp treatment areas (57% vs. 42.4%), although the gel was better tolerated when applied to nonscalp areas, regardless of concentration or dosing schedule, the investigators wrote.

The maximum tolerated dose (MTD) for face or face and scalp AK was determined to be once-daily ingenol mebutate gel 0.025% for 2 days, according to a second study that evaluated six formulation strengths ranging from 0.0025% to 0.025% in 86 patients with lesions limited to the face or face and scalp.

At the MTD, 26 of 36 patients (72%) achieved partial clearance and 14 of the 36 (39%) achieved complete clearance.

Ingenol mebutate gel was well tolerated across all strengths, with erythema the most common lesion site reaction. Three patients experienced four serious adverse events, none considered treatment related, according to the investigators, one of whom was also a Peplin employee.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

SAN FRANCISCO — Intestinal-type adenocarcinoma of the ethmoid sinus appears to be strongly related to long-term occupational exposure to wood dust or leather dust, Dr. Stefano Riccio reported at the Seventh International Conference on Head and Neck Cancer.

In a case series involving 706 patients with malignant tumors of the paranasal sinuses, 92.2% of the patients with histologically confirmed adenocarcinoma of the ethmoid sinus acknowledged substantial exposure to one of these dusts, said Dr. Riccio of the National Cancer Institute of Milan.

Most patients had been exposed to organic dusts for 25–58 years in their jobs as woodworkers or shoemakers. But 17 patients reported only early and relatively limited exposure to organic dusts: from 4 to 18 years followed by 28–46 years before the appearance of disease.

In patients with nasal obstruction or small or occasional epistaxis, physicians should determine whether the patient had been exposed to any oncogenic agents in the past, Dr. Riccio recommended at the conference, which was sponsored by the American Head and Neck Society. If such exposure can be confirmed, adenocarcinoma of the ethmoid sinus should be part of the differential diagnosis.

Dr. Riccio pointed out that epidemiologists first noticed an association between wood dust and nasal cancer in 1965. But epidemiological studies rarely make anatomical distinctions among the paranasal sinuses.

On the other hand, physicians are aware that intestinal-type adenocarcinoma is peculiar to the ethmoid sinus. For the most part, however, they are unaware of the epidemiological connection with occupational exposure.

All patients in the case series were treated between 1987 and 2007 at the National Cancer Institute of Milan. The cancer originated in the ethmoid sinus 57% of the time and in the maxillary sinus 43% of the time.

Forty-five percent of the patients in the ethmoid group reported occupational exposure to wood or leather dust, compared with just 1.3% of the maxillary group, a significant difference.

Intestinal-type adenocarcinoma was the predominant histologic type in the ethmoid group, and was seen in 44% of those patients.

In comparison, squamous cell carcinoma was the most common histologic type in the maxillary group, and was seen in 35% of those patients.

In his review of the literature, Dr. Riccio found that the rate of adenocarcinoma among patients with malignant ethmoid tumors appears to be much higher in Europe than in North America. In five European case series, the rate ranged from 27% to 74%, with the lowest rate in the United Kingdom. In five North American case series, the rate ranged from 6% to 17%.

Dr. Riccio suggested the three possible explanations for this discrepancy. First, while the commonly accepted danger threshold for wood dust in Europe is 5 mg/m

Dr. Riccio stated that he had no conflicts of interest related to his presentation.

SAN FRANCISCO — Intestinal-type adenocarcinoma of the ethmoid sinus appears to be strongly related to long-term occupational exposure to wood dust or leather dust, Dr. Stefano Riccio reported at the Seventh International Conference on Head and Neck Cancer.

In a case series involving 706 patients with malignant tumors of the paranasal sinuses, 92.2% of the patients with histologically confirmed adenocarcinoma of the ethmoid sinus acknowledged substantial exposure to one of these dusts, said Dr. Riccio of the National Cancer Institute of Milan.

Most patients had been exposed to organic dusts for 25–58 years in their jobs as woodworkers or shoemakers. But 17 patients reported only early and relatively limited exposure to organic dusts: from 4 to 18 years followed by 28–46 years before the appearance of disease.

In patients with nasal obstruction or small or occasional epistaxis, physicians should determine whether the patient had been exposed to any oncogenic agents in the past, Dr. Riccio recommended at the conference, which was sponsored by the American Head and Neck Society. If such exposure can be confirmed, adenocarcinoma of the ethmoid sinus should be part of the differential diagnosis.

Dr. Riccio pointed out that epidemiologists first noticed an association between wood dust and nasal cancer in 1965. But epidemiological studies rarely make anatomical distinctions among the paranasal sinuses.

On the other hand, physicians are aware that intestinal-type adenocarcinoma is peculiar to the ethmoid sinus. For the most part, however, they are unaware of the epidemiological connection with occupational exposure.

All patients in the case series were treated between 1987 and 2007 at the National Cancer Institute of Milan. The cancer originated in the ethmoid sinus 57% of the time and in the maxillary sinus 43% of the time.

Forty-five percent of the patients in the ethmoid group reported occupational exposure to wood or leather dust, compared with just 1.3% of the maxillary group, a significant difference.

Intestinal-type adenocarcinoma was the predominant histologic type in the ethmoid group, and was seen in 44% of those patients.

In comparison, squamous cell carcinoma was the most common histologic type in the maxillary group, and was seen in 35% of those patients.

In his review of the literature, Dr. Riccio found that the rate of adenocarcinoma among patients with malignant ethmoid tumors appears to be much higher in Europe than in North America. In five European case series, the rate ranged from 27% to 74%, with the lowest rate in the United Kingdom. In five North American case series, the rate ranged from 6% to 17%.

Dr. Riccio suggested the three possible explanations for this discrepancy. First, while the commonly accepted danger threshold for wood dust in Europe is 5 mg/m

Dr. Riccio stated that he had no conflicts of interest related to his presentation.

SAN FRANCISCO — Intestinal-type adenocarcinoma of the ethmoid sinus appears to be strongly related to long-term occupational exposure to wood dust or leather dust, Dr. Stefano Riccio reported at the Seventh International Conference on Head and Neck Cancer.

In a case series involving 706 patients with malignant tumors of the paranasal sinuses, 92.2% of the patients with histologically confirmed adenocarcinoma of the ethmoid sinus acknowledged substantial exposure to one of these dusts, said Dr. Riccio of the National Cancer Institute of Milan.

Most patients had been exposed to organic dusts for 25–58 years in their jobs as woodworkers or shoemakers. But 17 patients reported only early and relatively limited exposure to organic dusts: from 4 to 18 years followed by 28–46 years before the appearance of disease.

In patients with nasal obstruction or small or occasional epistaxis, physicians should determine whether the patient had been exposed to any oncogenic agents in the past, Dr. Riccio recommended at the conference, which was sponsored by the American Head and Neck Society. If such exposure can be confirmed, adenocarcinoma of the ethmoid sinus should be part of the differential diagnosis.

Dr. Riccio pointed out that epidemiologists first noticed an association between wood dust and nasal cancer in 1965. But epidemiological studies rarely make anatomical distinctions among the paranasal sinuses.

On the other hand, physicians are aware that intestinal-type adenocarcinoma is peculiar to the ethmoid sinus. For the most part, however, they are unaware of the epidemiological connection with occupational exposure.

All patients in the case series were treated between 1987 and 2007 at the National Cancer Institute of Milan. The cancer originated in the ethmoid sinus 57% of the time and in the maxillary sinus 43% of the time.

Forty-five percent of the patients in the ethmoid group reported occupational exposure to wood or leather dust, compared with just 1.3% of the maxillary group, a significant difference.

Intestinal-type adenocarcinoma was the predominant histologic type in the ethmoid group, and was seen in 44% of those patients.

In comparison, squamous cell carcinoma was the most common histologic type in the maxillary group, and was seen in 35% of those patients.

In his review of the literature, Dr. Riccio found that the rate of adenocarcinoma among patients with malignant ethmoid tumors appears to be much higher in Europe than in North America. In five European case series, the rate ranged from 27% to 74%, with the lowest rate in the United Kingdom. In five North American case series, the rate ranged from 6% to 17%.

Dr. Riccio suggested the three possible explanations for this discrepancy. First, while the commonly accepted danger threshold for wood dust in Europe is 5 mg/m

Dr. Riccio stated that he had no conflicts of interest related to his presentation.

CHICAGO — A specific pattern of X and Y chromosome losses—and in particular the loss of an important tumor-suppression gene—was shown in a recent study to be associated with melanoma progression.

This "very new and very unexpected finding" could help explain gender differences that are seen in melanoma, such as the increased risk of death in men with melanoma, compared with women with melanoma, Dr. Alan Spatz said at the American Society of Clinical Oncology annual meeting, where he presented the findings.

Frozen sections from 48 melanomas—taken from 32 women and 16 men with a median follow-up of 4 years—were analyzed as part of a European Organisation for Research and Treatment of Cancer (EORTC) study. Analyses of DNA and mRNA were conducted; the end point was distant metastasis-free survival.

A significant correlation was found between DNA copy number and mRNA level for 1,455 genes (P less than .05). In the women's samples, losses in the X chromosome were significantly associated with distant metastasis-free survival (P = .009), and the affected X chromosome was always the inactive X.

In the men, losses in the Y chromosome were significantly associated with distant metastasis-free survival (P = .015), reported Dr. Spatz of Institut Gustave Roussy in Villejuif, France.

Further investigation to identify any particular gene or genes that fulfilled the criteria of being located on the X chromosome in women and escaping inactivation of X chromosome, as well as being located on the Y chromosome in men, showed that only the PPP2R3B gene, also know as PR48, did so.

The normalized expression of the gene, which is located on Xp22 in women and on Yp11 in men was found to be associated with distant metastasis-free survival at a "totally unexpected level of significance," (P = .0007), after adjusting for clinical and pathologic prognostic variables, including gender, age, ulceration, and thickness, Dr. Spatz said.

PR48 is a lesser-known subunit of a well-known and very important gene (serine/threonine protein phosphatase 2A) which he described as "kind of a gatekeeper in cell biology," he said.

PR48 mediates the dephosphorylation of CDC6 by phosphatase 2A and controls initiation of DNA replication in human cancer cells, especially melanoma, he explained.

The findings, along with those from other ongoing studies that are designed to help improve understanding of PPP2R3B biology, could potentially provide biologic clues regarding gender differences in melanoma progression and survival; the gender effect in melanoma is strong—men have been shown to have a relative excess risk of death of 1.87, compared with women with melanoma.

"We can conclude that there is a very specific pattern of X and Y chromosome losses associated with melanoma progression … and that PPP2R3B appears from this study to be a very important tumor suppression gene whose loss is associated with tumor progression.

"Does this explain the gender effect? Maybe if indeed we show that there is a differential frequency of inactivated X chromosome in females, as compared with Y chromosome—but this is still an open question," Dr. Spatz said.

In a discussion of the findings, Elizabeth Grimm, Ph.D., a professor at the University of Texas M.D. Anderson Cancer Center, Houston, called these and other emerging data a "snapshot of finest biomarker work in melanoma at this time." Dr. Spatz's work is particularly provocative, she said.

She asked, however, how—given the findings—one would explain that the incidence of melanoma in young women is higher than that in young men. The increased incidence in men only begins to become evident around age 50 years, she noted, questioning whether other lifestyle parameters are in play.

"Just food for thought," she said.

Dr. Grimm also noted that it would be interesting, should the findings be validated in the ongoing studies that Dr. Spatz mentioned, to see how they might change the course of treatment or provide prognostic information, and to determine whether some form of gene therapy to redeliver the X and Y chromosome losses could be developed.

CHICAGO — A specific pattern of X and Y chromosome losses—and in particular the loss of an important tumor-suppression gene—was shown in a recent study to be associated with melanoma progression.

This "very new and very unexpected finding" could help explain gender differences that are seen in melanoma, such as the increased risk of death in men with melanoma, compared with women with melanoma, Dr. Alan Spatz said at the American Society of Clinical Oncology annual meeting, where he presented the findings.

Frozen sections from 48 melanomas—taken from 32 women and 16 men with a median follow-up of 4 years—were analyzed as part of a European Organisation for Research and Treatment of Cancer (EORTC) study. Analyses of DNA and mRNA were conducted; the end point was distant metastasis-free survival.

A significant correlation was found between DNA copy number and mRNA level for 1,455 genes (P less than .05). In the women's samples, losses in the X chromosome were significantly associated with distant metastasis-free survival (P = .009), and the affected X chromosome was always the inactive X.

In the men, losses in the Y chromosome were significantly associated with distant metastasis-free survival (P = .015), reported Dr. Spatz of Institut Gustave Roussy in Villejuif, France.

Further investigation to identify any particular gene or genes that fulfilled the criteria of being located on the X chromosome in women and escaping inactivation of X chromosome, as well as being located on the Y chromosome in men, showed that only the PPP2R3B gene, also know as PR48, did so.

The normalized expression of the gene, which is located on Xp22 in women and on Yp11 in men was found to be associated with distant metastasis-free survival at a "totally unexpected level of significance," (P = .0007), after adjusting for clinical and pathologic prognostic variables, including gender, age, ulceration, and thickness, Dr. Spatz said.

PR48 is a lesser-known subunit of a well-known and very important gene (serine/threonine protein phosphatase 2A) which he described as "kind of a gatekeeper in cell biology," he said.

PR48 mediates the dephosphorylation of CDC6 by phosphatase 2A and controls initiation of DNA replication in human cancer cells, especially melanoma, he explained.

The findings, along with those from other ongoing studies that are designed to help improve understanding of PPP2R3B biology, could potentially provide biologic clues regarding gender differences in melanoma progression and survival; the gender effect in melanoma is strong—men have been shown to have a relative excess risk of death of 1.87, compared with women with melanoma.

"We can conclude that there is a very specific pattern of X and Y chromosome losses associated with melanoma progression … and that PPP2R3B appears from this study to be a very important tumor suppression gene whose loss is associated with tumor progression.

"Does this explain the gender effect? Maybe if indeed we show that there is a differential frequency of inactivated X chromosome in females, as compared with Y chromosome—but this is still an open question," Dr. Spatz said.

In a discussion of the findings, Elizabeth Grimm, Ph.D., a professor at the University of Texas M.D. Anderson Cancer Center, Houston, called these and other emerging data a "snapshot of finest biomarker work in melanoma at this time." Dr. Spatz's work is particularly provocative, she said.

She asked, however, how—given the findings—one would explain that the incidence of melanoma in young women is higher than that in young men. The increased incidence in men only begins to become evident around age 50 years, she noted, questioning whether other lifestyle parameters are in play.

"Just food for thought," she said.

Dr. Grimm also noted that it would be interesting, should the findings be validated in the ongoing studies that Dr. Spatz mentioned, to see how they might change the course of treatment or provide prognostic information, and to determine whether some form of gene therapy to redeliver the X and Y chromosome losses could be developed.

CHICAGO — A specific pattern of X and Y chromosome losses—and in particular the loss of an important tumor-suppression gene—was shown in a recent study to be associated with melanoma progression.

This "very new and very unexpected finding" could help explain gender differences that are seen in melanoma, such as the increased risk of death in men with melanoma, compared with women with melanoma, Dr. Alan Spatz said at the American Society of Clinical Oncology annual meeting, where he presented the findings.

Frozen sections from 48 melanomas—taken from 32 women and 16 men with a median follow-up of 4 years—were analyzed as part of a European Organisation for Research and Treatment of Cancer (EORTC) study. Analyses of DNA and mRNA were conducted; the end point was distant metastasis-free survival.

A significant correlation was found between DNA copy number and mRNA level for 1,455 genes (P less than .05). In the women's samples, losses in the X chromosome were significantly associated with distant metastasis-free survival (P = .009), and the affected X chromosome was always the inactive X.

In the men, losses in the Y chromosome were significantly associated with distant metastasis-free survival (P = .015), reported Dr. Spatz of Institut Gustave Roussy in Villejuif, France.

Further investigation to identify any particular gene or genes that fulfilled the criteria of being located on the X chromosome in women and escaping inactivation of X chromosome, as well as being located on the Y chromosome in men, showed that only the PPP2R3B gene, also know as PR48, did so.

The normalized expression of the gene, which is located on Xp22 in women and on Yp11 in men was found to be associated with distant metastasis-free survival at a "totally unexpected level of significance," (P = .0007), after adjusting for clinical and pathologic prognostic variables, including gender, age, ulceration, and thickness, Dr. Spatz said.

PR48 is a lesser-known subunit of a well-known and very important gene (serine/threonine protein phosphatase 2A) which he described as "kind of a gatekeeper in cell biology," he said.

PR48 mediates the dephosphorylation of CDC6 by phosphatase 2A and controls initiation of DNA replication in human cancer cells, especially melanoma, he explained.

The findings, along with those from other ongoing studies that are designed to help improve understanding of PPP2R3B biology, could potentially provide biologic clues regarding gender differences in melanoma progression and survival; the gender effect in melanoma is strong—men have been shown to have a relative excess risk of death of 1.87, compared with women with melanoma.

"We can conclude that there is a very specific pattern of X and Y chromosome losses associated with melanoma progression … and that PPP2R3B appears from this study to be a very important tumor suppression gene whose loss is associated with tumor progression.

"Does this explain the gender effect? Maybe if indeed we show that there is a differential frequency of inactivated X chromosome in females, as compared with Y chromosome—but this is still an open question," Dr. Spatz said.

In a discussion of the findings, Elizabeth Grimm, Ph.D., a professor at the University of Texas M.D. Anderson Cancer Center, Houston, called these and other emerging data a "snapshot of finest biomarker work in melanoma at this time." Dr. Spatz's work is particularly provocative, she said.

She asked, however, how—given the findings—one would explain that the incidence of melanoma in young women is higher than that in young men. The increased incidence in men only begins to become evident around age 50 years, she noted, questioning whether other lifestyle parameters are in play.

"Just food for thought," she said.

Dr. Grimm also noted that it would be interesting, should the findings be validated in the ongoing studies that Dr. Spatz mentioned, to see how they might change the course of treatment or provide prognostic information, and to determine whether some form of gene therapy to redeliver the X and Y chromosome losses could be developed.

CHICAGO — Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi—and in indeterminate melanocytic lesions with an aggressive histological phenotype, according to data presented at the American Society of Clinical Oncology annual meeting.

Samples from eight dermal nevi, 28 malignant melanomas, and 49 pathologically indeterminate melanocytic lesions were evaluated using real-time polymerase chain reaction. Investigators found a mean 7.6-fold increase in micro-RNA-21 expression (P = .0001) and a mean 13.3-fold increase (P = .0001) in micro-RNA-155 expression, compared with the benign nevus samples, reported Gregory B. Lesinski, Ph.D., of Ohio State University, Columbus.

Another potential biomarker—micro-RNA-21b—showed a trend toward increased expression, but the difference did not reach statistical significance in this small sample size (P = .07). However, micro-RNA-21b remains of interest, Dr. Lesinski noted.

Micro-RNA-21 and micro-RNA-155 also appear to be expressed at higher levels in certain indeterminate melanocytic lesions. Indeterminate lesions, including deep penetrating nevi, dysplastic nevi, and Spitz nevi, pose a particular challenge in that diagnosis and determination of the appropriate course of action are uncertain.

A false-positive diagnosis could lead to unnecessary treatment; a false-negative diagnosis could lead to undertreatment and increased risk of melanoma development.

In this study, expression of micro-RNA-21 and micro-RNA-155 was analyzed in indeterminate lesions with more than one mitosis per 10x high-power field.

When they were compared with those with less than one mitosis per 10x high-power field, there was significantly higher expression of micro-RNA-21 (P = .0005) and micro-RNA-155 (P = .04).

Melanocytic lesions that were greater than 1 mm in depth, compared with thinner lesions, also had significantly higher levels of micro-RNA-155 (P = .01), suggesting these might have more malignant potential; micro-RNA-21 was higher in the thicker lesions as well, but the difference did not reach statistical significance, Dr. Lesinski said.

In a subset of 13 patients with indeterminate lesions whose lesions were considered suspicious enough that the patients were sent for sentinel node biopsy, micro-RNA-21 and micro-RNA-155 expression were compared with expression in benign nevi—in both those that proved node positive and those that proved node negative.

Micro-RNA expression was significantly higher in the lesions from node-positive patients, compared with expression in benign nevi (mean 6.5-fold increase), than in node-negative patients, compared with expression in benign nevi (1.3-fold increase).

"Surprisingly, we didn't find the same relationship for micro-RNA-155; the data were highly variable [for micro-RNA-155] regardless of whether the patients were node negative or node positive," said Dr. Lesinski, who reported he has no disclosures relevant to the data he presented.

These data are "very preliminary," he added, noting that the sample size for this portion of the study is being expanded to include at least 50 patients to make a more accurate statistical determination about the expression of these micro-RNAs.

"Nonetheless, these data are very enticing to us, and they suggest that micro-RNA-21, at least, may in fact be a relevant marker that can be used to complement the traditional histological analyses used to diagnose these lesions," he said.

The expression of micro-RNAs—a group of more than 200 recently identified noncoding molecules considered to be a new class of oncogenes—is altered in many types of tumors.

This study is among the first to explore this expression in melanoma. Studies to further assess the potential value of micro-RNAs as diagnostic and prognostic tools in melanoma are ongoing, Dr. Lesinski said.

During a discussion of Dr. Lesinski's findings and those from other melanoma biomarker studies, Elizabeth Grimm, Ph.D., said they are part of a "fabulous set of new data."

Dr. Lesinski's findings regarding indeterminate lesions are particularly important given the therapeutic dilemma they pose, she said.

She expressed concern, however, about difficulty in determining whether micro-RNA expression is increased in melanomas, compared with indeterminate lesions. Differences were marked between melanoma and benign nevi, but based on her review of the data, it appears there was little difference in expression between melanoma and indeterminate lesions, Dr. Grimm said, adding that research regarding other micro-RNAs should continue.

She also noted that she is curious about whether there is a micro-RNA signature that adds value to the current staging system and markers commonly used, and whether micro-RNAs can be used independently of common diagnostic markers used by pathologists, such as MAGE, MART, and S100B.

While many questions remain, she applauded the research effort, noting that there are valid markers in other tumor types; thus, the "noble" efforts to identify molecular markers for melanoma are worthwhile. "We're not just dreaming—we will have them for melanoma some day," said Dr. Grimm of M.D. Anderson Cancer Center, Houston.

CHICAGO — Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi—and in indeterminate melanocytic lesions with an aggressive histological phenotype, according to data presented at the American Society of Clinical Oncology annual meeting.

Samples from eight dermal nevi, 28 malignant melanomas, and 49 pathologically indeterminate melanocytic lesions were evaluated using real-time polymerase chain reaction. Investigators found a mean 7.6-fold increase in micro-RNA-21 expression (P = .0001) and a mean 13.3-fold increase (P = .0001) in micro-RNA-155 expression, compared with the benign nevus samples, reported Gregory B. Lesinski, Ph.D., of Ohio State University, Columbus.

Another potential biomarker—micro-RNA-21b—showed a trend toward increased expression, but the difference did not reach statistical significance in this small sample size (P = .07). However, micro-RNA-21b remains of interest, Dr. Lesinski noted.

Micro-RNA-21 and micro-RNA-155 also appear to be expressed at higher levels in certain indeterminate melanocytic lesions. Indeterminate lesions, including deep penetrating nevi, dysplastic nevi, and Spitz nevi, pose a particular challenge in that diagnosis and determination of the appropriate course of action are uncertain.

A false-positive diagnosis could lead to unnecessary treatment; a false-negative diagnosis could lead to undertreatment and increased risk of melanoma development.

In this study, expression of micro-RNA-21 and micro-RNA-155 was analyzed in indeterminate lesions with more than one mitosis per 10x high-power field.

When they were compared with those with less than one mitosis per 10x high-power field, there was significantly higher expression of micro-RNA-21 (P = .0005) and micro-RNA-155 (P = .04).

Melanocytic lesions that were greater than 1 mm in depth, compared with thinner lesions, also had significantly higher levels of micro-RNA-155 (P = .01), suggesting these might have more malignant potential; micro-RNA-21 was higher in the thicker lesions as well, but the difference did not reach statistical significance, Dr. Lesinski said.

In a subset of 13 patients with indeterminate lesions whose lesions were considered suspicious enough that the patients were sent for sentinel node biopsy, micro-RNA-21 and micro-RNA-155 expression were compared with expression in benign nevi—in both those that proved node positive and those that proved node negative.

Micro-RNA expression was significantly higher in the lesions from node-positive patients, compared with expression in benign nevi (mean 6.5-fold increase), than in node-negative patients, compared with expression in benign nevi (1.3-fold increase).

"Surprisingly, we didn't find the same relationship for micro-RNA-155; the data were highly variable [for micro-RNA-155] regardless of whether the patients were node negative or node positive," said Dr. Lesinski, who reported he has no disclosures relevant to the data he presented.

These data are "very preliminary," he added, noting that the sample size for this portion of the study is being expanded to include at least 50 patients to make a more accurate statistical determination about the expression of these micro-RNAs.

"Nonetheless, these data are very enticing to us, and they suggest that micro-RNA-21, at least, may in fact be a relevant marker that can be used to complement the traditional histological analyses used to diagnose these lesions," he said.

The expression of micro-RNAs—a group of more than 200 recently identified noncoding molecules considered to be a new class of oncogenes—is altered in many types of tumors.

This study is among the first to explore this expression in melanoma. Studies to further assess the potential value of micro-RNAs as diagnostic and prognostic tools in melanoma are ongoing, Dr. Lesinski said.

During a discussion of Dr. Lesinski's findings and those from other melanoma biomarker studies, Elizabeth Grimm, Ph.D., said they are part of a "fabulous set of new data."

Dr. Lesinski's findings regarding indeterminate lesions are particularly important given the therapeutic dilemma they pose, she said.

She expressed concern, however, about difficulty in determining whether micro-RNA expression is increased in melanomas, compared with indeterminate lesions. Differences were marked between melanoma and benign nevi, but based on her review of the data, it appears there was little difference in expression between melanoma and indeterminate lesions, Dr. Grimm said, adding that research regarding other micro-RNAs should continue.

She also noted that she is curious about whether there is a micro-RNA signature that adds value to the current staging system and markers commonly used, and whether micro-RNAs can be used independently of common diagnostic markers used by pathologists, such as MAGE, MART, and S100B.

While many questions remain, she applauded the research effort, noting that there are valid markers in other tumor types; thus, the "noble" efforts to identify molecular markers for melanoma are worthwhile. "We're not just dreaming—we will have them for melanoma some day," said Dr. Grimm of M.D. Anderson Cancer Center, Houston.

CHICAGO — Micro-RNA-21 and micro-RNA-155 are expressed at significantly higher levels in primary malignant melanoma tumor samples than in samples from benign nevi—and in indeterminate melanocytic lesions with an aggressive histological phenotype, according to data presented at the American Society of Clinical Oncology annual meeting.

Samples from eight dermal nevi, 28 malignant melanomas, and 49 pathologically indeterminate melanocytic lesions were evaluated using real-time polymerase chain reaction. Investigators found a mean 7.6-fold increase in micro-RNA-21 expression (P = .0001) and a mean 13.3-fold increase (P = .0001) in micro-RNA-155 expression, compared with the benign nevus samples, reported Gregory B. Lesinski, Ph.D., of Ohio State University, Columbus.

Another potential biomarker—micro-RNA-21b—showed a trend toward increased expression, but the difference did not reach statistical significance in this small sample size (P = .07). However, micro-RNA-21b remains of interest, Dr. Lesinski noted.

Micro-RNA-21 and micro-RNA-155 also appear to be expressed at higher levels in certain indeterminate melanocytic lesions. Indeterminate lesions, including deep penetrating nevi, dysplastic nevi, and Spitz nevi, pose a particular challenge in that diagnosis and determination of the appropriate course of action are uncertain.

A false-positive diagnosis could lead to unnecessary treatment; a false-negative diagnosis could lead to undertreatment and increased risk of melanoma development.

In this study, expression of micro-RNA-21 and micro-RNA-155 was analyzed in indeterminate lesions with more than one mitosis per 10x high-power field.

When they were compared with those with less than one mitosis per 10x high-power field, there was significantly higher expression of micro-RNA-21 (P = .0005) and micro-RNA-155 (P = .04).

Melanocytic lesions that were greater than 1 mm in depth, compared with thinner lesions, also had significantly higher levels of micro-RNA-155 (P = .01), suggesting these might have more malignant potential; micro-RNA-21 was higher in the thicker lesions as well, but the difference did not reach statistical significance, Dr. Lesinski said.

In a subset of 13 patients with indeterminate lesions whose lesions were considered suspicious enough that the patients were sent for sentinel node biopsy, micro-RNA-21 and micro-RNA-155 expression were compared with expression in benign nevi—in both those that proved node positive and those that proved node negative.

Micro-RNA expression was significantly higher in the lesions from node-positive patients, compared with expression in benign nevi (mean 6.5-fold increase), than in node-negative patients, compared with expression in benign nevi (1.3-fold increase).

"Surprisingly, we didn't find the same relationship for micro-RNA-155; the data were highly variable [for micro-RNA-155] regardless of whether the patients were node negative or node positive," said Dr. Lesinski, who reported he has no disclosures relevant to the data he presented.

These data are "very preliminary," he added, noting that the sample size for this portion of the study is being expanded to include at least 50 patients to make a more accurate statistical determination about the expression of these micro-RNAs.

"Nonetheless, these data are very enticing to us, and they suggest that micro-RNA-21, at least, may in fact be a relevant marker that can be used to complement the traditional histological analyses used to diagnose these lesions," he said.

The expression of micro-RNAs—a group of more than 200 recently identified noncoding molecules considered to be a new class of oncogenes—is altered in many types of tumors.

This study is among the first to explore this expression in melanoma. Studies to further assess the potential value of micro-RNAs as diagnostic and prognostic tools in melanoma are ongoing, Dr. Lesinski said.

During a discussion of Dr. Lesinski's findings and those from other melanoma biomarker studies, Elizabeth Grimm, Ph.D., said they are part of a "fabulous set of new data."

Dr. Lesinski's findings regarding indeterminate lesions are particularly important given the therapeutic dilemma they pose, she said.

She expressed concern, however, about difficulty in determining whether micro-RNA expression is increased in melanomas, compared with indeterminate lesions. Differences were marked between melanoma and benign nevi, but based on her review of the data, it appears there was little difference in expression between melanoma and indeterminate lesions, Dr. Grimm said, adding that research regarding other micro-RNAs should continue.

She also noted that she is curious about whether there is a micro-RNA signature that adds value to the current staging system and markers commonly used, and whether micro-RNAs can be used independently of common diagnostic markers used by pathologists, such as MAGE, MART, and S100B.

While many questions remain, she applauded the research effort, noting that there are valid markers in other tumor types; thus, the "noble" efforts to identify molecular markers for melanoma are worthwhile. "We're not just dreaming—we will have them for melanoma some day," said Dr. Grimm of M.D. Anderson Cancer Center, Houston.

SAN FRANCISCO — Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study.

The difference between median survival of 23 months with adjuvant radiotherapy and 10 months without the extra treatment was statistically significant, Dr. Babak Givi reported at the Seventh International Conference on Head and Neck Cancer.

Patients receiving adjuvant radiotherapy were more than 80% less likely to die than were those who did not receive this adjuvant treatment, said Dr. Givi of Oregon Health and Science University, Portland.

Surgery followed by radiotherapy has long been a standard treatment for metastatic squamous cell carcinoma of the head and neck, but Dr. Givi noted that there is a paucity of experimental data on its efficacy. Given the fact that this regimen is aggressive and carries a high degree of morbidity, he and his colleagues conducted a retrospective study involving 51 patients who received surgical treatment for metastatic squamous cell carcinoma between 1993 and 2008. Thirty of the patients received adjuvant radiotherapy.

The patients' median age was 73 years, and 47 patients were male. The disease was recurrent in 8 patients and previously untreated in 43. Those whose disease had recurred survived for a median of 14 months compared with 31 months among those who had not previously been treated.

After adjusting for age, immunosuppression, tumor characteristics, and recurrent disease in a multivariate analysis, the investigators found that patients with recurrent disease were almost three times as likely to die as were those without.

The conference was sponsored by the American Head and Neck Society.

SAN FRANCISCO — Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study.

The difference between median survival of 23 months with adjuvant radiotherapy and 10 months without the extra treatment was statistically significant, Dr. Babak Givi reported at the Seventh International Conference on Head and Neck Cancer.

Patients receiving adjuvant radiotherapy were more than 80% less likely to die than were those who did not receive this adjuvant treatment, said Dr. Givi of Oregon Health and Science University, Portland.

Surgery followed by radiotherapy has long been a standard treatment for metastatic squamous cell carcinoma of the head and neck, but Dr. Givi noted that there is a paucity of experimental data on its efficacy. Given the fact that this regimen is aggressive and carries a high degree of morbidity, he and his colleagues conducted a retrospective study involving 51 patients who received surgical treatment for metastatic squamous cell carcinoma between 1993 and 2008. Thirty of the patients received adjuvant radiotherapy.

The patients' median age was 73 years, and 47 patients were male. The disease was recurrent in 8 patients and previously untreated in 43. Those whose disease had recurred survived for a median of 14 months compared with 31 months among those who had not previously been treated.

After adjusting for age, immunosuppression, tumor characteristics, and recurrent disease in a multivariate analysis, the investigators found that patients with recurrent disease were almost three times as likely to die as were those without.

The conference was sponsored by the American Head and Neck Society.

SAN FRANCISCO — Patients who received adjuvant radiotherapy following surgery for metastatic cutaneous squamous cell carcinoma survived more than twice as long as did those who did not receive radiotherapy in a small retrospective study.

The difference between median survival of 23 months with adjuvant radiotherapy and 10 months without the extra treatment was statistically significant, Dr. Babak Givi reported at the Seventh International Conference on Head and Neck Cancer.

Patients receiving adjuvant radiotherapy were more than 80% less likely to die than were those who did not receive this adjuvant treatment, said Dr. Givi of Oregon Health and Science University, Portland.

Surgery followed by radiotherapy has long been a standard treatment for metastatic squamous cell carcinoma of the head and neck, but Dr. Givi noted that there is a paucity of experimental data on its efficacy. Given the fact that this regimen is aggressive and carries a high degree of morbidity, he and his colleagues conducted a retrospective study involving 51 patients who received surgical treatment for metastatic squamous cell carcinoma between 1993 and 2008. Thirty of the patients received adjuvant radiotherapy.

The patients' median age was 73 years, and 47 patients were male. The disease was recurrent in 8 patients and previously untreated in 43. Those whose disease had recurred survived for a median of 14 months compared with 31 months among those who had not previously been treated.

After adjusting for age, immunosuppression, tumor characteristics, and recurrent disease in a multivariate analysis, the investigators found that patients with recurrent disease were almost three times as likely to die as were those without.

The conference was sponsored by the American Head and Neck Society.

SAN FRANCISCO — A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.

When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.

While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.

The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.

The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.

Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.

In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.

Dr. Liao said the investigators had no conflicts of interest regarding the study.

SAN FRANCISCO — A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.

When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.

While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.

The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.

The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.

Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.

In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.

Dr. Liao said the investigators had no conflicts of interest regarding the study.

SAN FRANCISCO — A 5-year local control rate is possible with or without skin excision in squamous cell carcinoma of the buccal mucosa, according to a retrospective study of 331 patients.

When patients are properly selected for skin preservation or sacrifice on the basis of surgical margins more or less than 1 cm, there are no statistically significant differences in survival, Dr. Chun-Ta Liao and colleagues reported. In patients treated with surgery alone, the 5-year survival rate was 94% with skin excision and 91% without skin excision. In patients treated with surgery plus adjuvant radiotherapy or chemotherapy, the 5-year survival rate was 82% with skin excision and 85% without skin excision.

While it's generally accepted that bone excisions are often indicated in this form of cancer, controversy remains, said Dr. Liao. Skin excision significantly affects the patient's appearance and may contribute to oral incompetence, so physicians prefer to preserve the cheek skin if doing so would not increase mortality.

The study, by Dr. Liao of Chang Gung University, Taoyuan, Taiwan, and colleagues, was presented at the Seventh International Conference on Head and Neck Cancer.

The investigators examined records from 331 patients with squamous cell carcinoma of the buccal mucosa. Of those, 149 received surgery alone and 182 received surgery followed by adjuvant radiotherapy or radiotherapy plus chemotherapy.

Patients received skin-preserving procedures when the distance between the tumor and the skin was 13 mm or greater. This was possible for 69.5% of the patients, Dr. Liao reported at the meeting sponsored by the American Head and Neck Society.

In another part of the study, the investigators determined that a surgical margin of 4 mm or below was an independent predictor of adverse outcome, leading to an 81% increase in the risk of local recurrence in patients receiving surgery alone and a 33% increase in risk in patients receiving surgery plus adjuvant therapy.

Dr. Liao said the investigators had no conflicts of interest regarding the study.