Melanoma

An intervention consisting of text-message reminders, read-along books, and swim shirts achieved significant improvements in sun protection behaviors in children, compared with information about sun protection alone, according to the results of a randomized controlled trial.

The study, published online Feb. 8 in JAMA Pediatrics, enrolled 300 caregiver-child pairs (children aged 2-6 years), randomizing 153 to receive a read-along book emphasizing sun protection behaviors, a swim shirt, and weekly text messages asking about sun protection measures undertaken and 147 to the usual information about sun protection given at a well-child visit.

©Vesna Andjic/iStockphoto.com

After 4 weeks, the intervention group showed significantly higher scores for sunscreen use both on sunny and cloudy days, significantly higher scores relating to wearing a shirt on sunny days, and significantly lower increases in skin melanin indices on the sun-protected upper arm, compared with the control group (JAMA Pediatr. 2016 Feb 8. doi: 10.1001/jamapediatrics.2015.4373).

“Pediatricians’ seasonal age-specific sun protection recommendations will be more effective if supported by an effective, easily accessible, multicomponent program that can be reinforced at home,” said Byron K. Ho of Northwestern University, Chicago, and his coauthors.

The study was funded by the Pediatric Sun Protection Foundation. No conflicts of interest were declared.

An intervention consisting of text-message reminders, read-along books, and swim shirts achieved significant improvements in sun protection behaviors in children, compared with information about sun protection alone, according to the results of a randomized controlled trial.

The study, published online Feb. 8 in JAMA Pediatrics, enrolled 300 caregiver-child pairs (children aged 2-6 years), randomizing 153 to receive a read-along book emphasizing sun protection behaviors, a swim shirt, and weekly text messages asking about sun protection measures undertaken and 147 to the usual information about sun protection given at a well-child visit.

©Vesna Andjic/iStockphoto.com

After 4 weeks, the intervention group showed significantly higher scores for sunscreen use both on sunny and cloudy days, significantly higher scores relating to wearing a shirt on sunny days, and significantly lower increases in skin melanin indices on the sun-protected upper arm, compared with the control group (JAMA Pediatr. 2016 Feb 8. doi: 10.1001/jamapediatrics.2015.4373).

“Pediatricians’ seasonal age-specific sun protection recommendations will be more effective if supported by an effective, easily accessible, multicomponent program that can be reinforced at home,” said Byron K. Ho of Northwestern University, Chicago, and his coauthors.

The study was funded by the Pediatric Sun Protection Foundation. No conflicts of interest were declared.

An intervention consisting of text-message reminders, read-along books, and swim shirts achieved significant improvements in sun protection behaviors in children, compared with information about sun protection alone, according to the results of a randomized controlled trial.

The study, published online Feb. 8 in JAMA Pediatrics, enrolled 300 caregiver-child pairs (children aged 2-6 years), randomizing 153 to receive a read-along book emphasizing sun protection behaviors, a swim shirt, and weekly text messages asking about sun protection measures undertaken and 147 to the usual information about sun protection given at a well-child visit.

©Vesna Andjic/iStockphoto.com

After 4 weeks, the intervention group showed significantly higher scores for sunscreen use both on sunny and cloudy days, significantly higher scores relating to wearing a shirt on sunny days, and significantly lower increases in skin melanin indices on the sun-protected upper arm, compared with the control group (JAMA Pediatr. 2016 Feb 8. doi: 10.1001/jamapediatrics.2015.4373).

“Pediatricians’ seasonal age-specific sun protection recommendations will be more effective if supported by an effective, easily accessible, multicomponent program that can be reinforced at home,” said Byron K. Ho of Northwestern University, Chicago, and his coauthors.

The study was funded by the Pediatric Sun Protection Foundation. No conflicts of interest were declared.

Treatment with vemurafenib may result in severe skin toxicity, and dabrafenib appears to be useful in patients who discontinue vemurafenib due to such toxicity, according to a retrospective analysis of the cohort.

About a quarter (26%) of 131 melanoma patients treated in real life conditions with the BRAF inhibitor vemurafenib developed grade 3-4 skin toxicity, and 44% (34) of those patients permanently discontinued treatment, corresponding to 11% of the overall cohort, Dr. Lucie Peuvrel of Nantes (France) University Hospital and colleagues reported in Journal of the European Academy of Dermatology and Venereology.

©The National Cancer Institute

Discontinuations were mainly due to rash and classic adverse skin reactions, including Stevens-Johnson syndrome, drug reaction with eosinophilia, and systemic symptoms, whereas reactions involving only photosensitivity or cutaneous carcinomas rarely resulted in treatment adjustment; 14 of the remaining 19 patients with grade 3-4 toxicity who continued treatment had no dose adjustment, and 5 had a dose reduction.

Clinical or biological abnormalities occurred in 94% of those with grade 3-4 rashes, the investigators noted (J Eur Acad Dermatol Venereol. 2016 Feb;30[2]:250-7).

Study subjects were patients with a mean age of 60 years who were treated with vemurafenib for melanoma between November 2010 and December 2014. Grade 3-4 skin toxicity that emerged within the first 4-8 weeks of treatment was significantly associated with prolonged overall survival; severe skin rashes also were associated with prolonged median overall survival. Of seven patients who switched to dabrafenib due to their skin reaction, only one experienced recurrence of the reaction.

Vemurafenib, which is approved for the treatment of unresectable stage III-IV BRAF mutant melanoma, is commonly associated with skin toxicity, with severe cases occurring only rarely; the impact of severe forms of toxicity on treatment and patient outcomes was unknown, the investigators said.

The current findings reaffirm that vemurafenib is commonly associated with skin toxicity, but rarely with severe cases. Severe skin adverse reactions permanently preclude use of vemurafenib, but dabrafenib – the only other BRAF inhibitor with market authorization for unresectable stage III-IV BRAF mutant melanoma – “seems to be beneficial in case of vemurafenib-induced skin intolerance,” they noted, adding that for other skin toxicities, including photosensitivity and cutaneous carcinoma, treatment adjustment is generally not required, and that treatment resumption at a reduced dose should be considered after skin improvement in patients with rashes.

The finding of increased survival in cases involving severe skin toxicity that emerges within 4-8 weeks of treatment initiation should be confirmed in other studies, Dr. Peuvrel and associates said.

The authors reported having no conflicts of interest.

[email protected]

Treatment with vemurafenib may result in severe skin toxicity, and dabrafenib appears to be useful in patients who discontinue vemurafenib due to such toxicity, according to a retrospective analysis of the cohort.

About a quarter (26%) of 131 melanoma patients treated in real life conditions with the BRAF inhibitor vemurafenib developed grade 3-4 skin toxicity, and 44% (34) of those patients permanently discontinued treatment, corresponding to 11% of the overall cohort, Dr. Lucie Peuvrel of Nantes (France) University Hospital and colleagues reported in Journal of the European Academy of Dermatology and Venereology.

©The National Cancer Institute

Discontinuations were mainly due to rash and classic adverse skin reactions, including Stevens-Johnson syndrome, drug reaction with eosinophilia, and systemic symptoms, whereas reactions involving only photosensitivity or cutaneous carcinomas rarely resulted in treatment adjustment; 14 of the remaining 19 patients with grade 3-4 toxicity who continued treatment had no dose adjustment, and 5 had a dose reduction.

Clinical or biological abnormalities occurred in 94% of those with grade 3-4 rashes, the investigators noted (J Eur Acad Dermatol Venereol. 2016 Feb;30[2]:250-7).

Study subjects were patients with a mean age of 60 years who were treated with vemurafenib for melanoma between November 2010 and December 2014. Grade 3-4 skin toxicity that emerged within the first 4-8 weeks of treatment was significantly associated with prolonged overall survival; severe skin rashes also were associated with prolonged median overall survival. Of seven patients who switched to dabrafenib due to their skin reaction, only one experienced recurrence of the reaction.

Vemurafenib, which is approved for the treatment of unresectable stage III-IV BRAF mutant melanoma, is commonly associated with skin toxicity, with severe cases occurring only rarely; the impact of severe forms of toxicity on treatment and patient outcomes was unknown, the investigators said.

The current findings reaffirm that vemurafenib is commonly associated with skin toxicity, but rarely with severe cases. Severe skin adverse reactions permanently preclude use of vemurafenib, but dabrafenib – the only other BRAF inhibitor with market authorization for unresectable stage III-IV BRAF mutant melanoma – “seems to be beneficial in case of vemurafenib-induced skin intolerance,” they noted, adding that for other skin toxicities, including photosensitivity and cutaneous carcinoma, treatment adjustment is generally not required, and that treatment resumption at a reduced dose should be considered after skin improvement in patients with rashes.

The finding of increased survival in cases involving severe skin toxicity that emerges within 4-8 weeks of treatment initiation should be confirmed in other studies, Dr. Peuvrel and associates said.

The authors reported having no conflicts of interest.

[email protected]

Treatment with vemurafenib may result in severe skin toxicity, and dabrafenib appears to be useful in patients who discontinue vemurafenib due to such toxicity, according to a retrospective analysis of the cohort.

About a quarter (26%) of 131 melanoma patients treated in real life conditions with the BRAF inhibitor vemurafenib developed grade 3-4 skin toxicity, and 44% (34) of those patients permanently discontinued treatment, corresponding to 11% of the overall cohort, Dr. Lucie Peuvrel of Nantes (France) University Hospital and colleagues reported in Journal of the European Academy of Dermatology and Venereology.

©The National Cancer Institute

Discontinuations were mainly due to rash and classic adverse skin reactions, including Stevens-Johnson syndrome, drug reaction with eosinophilia, and systemic symptoms, whereas reactions involving only photosensitivity or cutaneous carcinomas rarely resulted in treatment adjustment; 14 of the remaining 19 patients with grade 3-4 toxicity who continued treatment had no dose adjustment, and 5 had a dose reduction.

Clinical or biological abnormalities occurred in 94% of those with grade 3-4 rashes, the investigators noted (J Eur Acad Dermatol Venereol. 2016 Feb;30[2]:250-7).

Study subjects were patients with a mean age of 60 years who were treated with vemurafenib for melanoma between November 2010 and December 2014. Grade 3-4 skin toxicity that emerged within the first 4-8 weeks of treatment was significantly associated with prolonged overall survival; severe skin rashes also were associated with prolonged median overall survival. Of seven patients who switched to dabrafenib due to their skin reaction, only one experienced recurrence of the reaction.

Vemurafenib, which is approved for the treatment of unresectable stage III-IV BRAF mutant melanoma, is commonly associated with skin toxicity, with severe cases occurring only rarely; the impact of severe forms of toxicity on treatment and patient outcomes was unknown, the investigators said.

The current findings reaffirm that vemurafenib is commonly associated with skin toxicity, but rarely with severe cases. Severe skin adverse reactions permanently preclude use of vemurafenib, but dabrafenib – the only other BRAF inhibitor with market authorization for unresectable stage III-IV BRAF mutant melanoma – “seems to be beneficial in case of vemurafenib-induced skin intolerance,” they noted, adding that for other skin toxicities, including photosensitivity and cutaneous carcinoma, treatment adjustment is generally not required, and that treatment resumption at a reduced dose should be considered after skin improvement in patients with rashes.

The finding of increased survival in cases involving severe skin toxicity that emerges within 4-8 weeks of treatment initiation should be confirmed in other studies, Dr. Peuvrel and associates said.

The authors reported having no conflicts of interest.

[email protected]

GRAND CAYMAN – Are your patients noncompliant about sun protection? Do they want to use photoprotection but aren’t sure what is best for them? Perhaps they are confused by the multitude of sunscreen manufacturer’s claims or even some claims by consumer and environmental advocates.

Patients are often confused by how much sun protection factor they actually need and marketing hype often makes things worse, according to Dr. Vincent DeLeoof the department of dermatology at the University of Southern California, Los Angeles. “The use of the words ‘babies, natural, hypoallergenic, or organic’ all mean absolutely nothing when it comes to an SPF’s actual efficacy,” he said at the meeting provided by Global Academy of Medical Education.

The degree of confusion surrounding these products was illustrated in a survey of 114 patients at Chicago dermatology clinic. Of those surveyed, 80% said they purchased a sunscreen product to prevent sunburn (75%) and to prevent skin cancer (66%); having the highest SPF, a sensitive skin formulation, or being water resistant were reasons the products were chosen. But 62% could not identify information explaining its role in cancer prevention, and 77% could not identify how well the product would prevent sunburn. And nearly all participants were unsure how products prevented photoaging (JAMA Dermatol. 2015 Sep;151[9]:1028-30).

Adding to the confusion, Dr. DeLeo said, are warnings issued by some consumer advocacy groups about sunscreens that are not based on actual clinical or animal studies, but from data simulation. For example, he said there are no data to substantiate claims from such groups that oxybenzone has estrogenic effects in humans.

Consumer advocacy groups who say that sunscreens interfere with vitamin D levels may have a point, however, Dr. DeLeo noted, adding that it is time public health officials look into this issue, particularly with regards to revising recommended levels of vitamin D upward for the elderly, dark-skinned persons, and breastfed babies.

Although the Food and Drug Administration does not directly test sunscreens, it issued a 2014 guidance to manufacturers regarding which ingredients can be used and at what concentrations. Based on the FDA’s 2011 final rule on Labeling and Effectiveness Testing of OTC sunscreen products, the highest SPF currently allowed is “50+” without specifying actual numbers above 50, although Dr. DeLeo said this could be revised if industry is able to demonstrate efficacy at higher SPF values.

In an interview, however, he said that this is not likely to happen anytime soon. Citing a recent study of 40 commercially available sunscreens, including top brand names, professional skincare lines, and eponymously labeled products sold at drug store chains, more than half failed to reach the SPF level they purported to have and nine did not provide adequate broad spectrum protection.

“The takeaway is that the FDA is probably correct. Sunscreens should not be labeled higher than 50,” he said.

With the Sunscreen Innovation Act passed in 2014, the FDA is now evaluating data on new sunscreen agents that have proven effective overseas. So far, these agents have not been approved, Dr. DeLeo said in the interview.

With regards to the currently available products, “what patients really need to know is pretty simple,” Dr. DeLeo said during his presentation. An important point is that sunscreens – which work by forming a film on the stratum corneum, preventing the penetration of radiation – are effective only if used properly, he said.

©Vesna Andjic/iStockphoto.com

A concept that is helpful for patients to understand is that while an SPF 30 product allows a person to stay in the sun twice as long as an SPF 15 product, with the same amount of protection from burning, it does not block twice as many burn rays, he noted. “When you combine them, it’s not additive, it dilutes” he said. For example, if an SPF 10 product is mixed with an SPF 20 product, the SPF is 15.

According to Dr. DeLeo, other important messages about sunscreen for patients are as follows:

• Use SPF 30 or higher.

• Apply 20-30 minutes before exposure to give the product a chance to create an effective barrier on the skin; and reapply every 2 hours or after going in the water or sweating outside.

• Use lotions or sprays, based on patient preference.

• For pregnant women or parents who don’t want to use chemical sunscreens, inorganic physical screens can be considered, although they will likely be less effective.

• Babies younger than 6 months of age can tolerate very small amounts of sunscreens.

Still, Dr. DeLeo said that the most foolproof form of photoprotection is to stay out of the sun, particularly between 10 a.m. and 4 p.m.

He disclosed being a consultant to LaRoche-Posay and Estée Lauder. Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN – Are your patients noncompliant about sun protection? Do they want to use photoprotection but aren’t sure what is best for them? Perhaps they are confused by the multitude of sunscreen manufacturer’s claims or even some claims by consumer and environmental advocates.

Patients are often confused by how much sun protection factor they actually need and marketing hype often makes things worse, according to Dr. Vincent DeLeoof the department of dermatology at the University of Southern California, Los Angeles. “The use of the words ‘babies, natural, hypoallergenic, or organic’ all mean absolutely nothing when it comes to an SPF’s actual efficacy,” he said at the meeting provided by Global Academy of Medical Education.

The degree of confusion surrounding these products was illustrated in a survey of 114 patients at Chicago dermatology clinic. Of those surveyed, 80% said they purchased a sunscreen product to prevent sunburn (75%) and to prevent skin cancer (66%); having the highest SPF, a sensitive skin formulation, or being water resistant were reasons the products were chosen. But 62% could not identify information explaining its role in cancer prevention, and 77% could not identify how well the product would prevent sunburn. And nearly all participants were unsure how products prevented photoaging (JAMA Dermatol. 2015 Sep;151[9]:1028-30).

Adding to the confusion, Dr. DeLeo said, are warnings issued by some consumer advocacy groups about sunscreens that are not based on actual clinical or animal studies, but from data simulation. For example, he said there are no data to substantiate claims from such groups that oxybenzone has estrogenic effects in humans.

Consumer advocacy groups who say that sunscreens interfere with vitamin D levels may have a point, however, Dr. DeLeo noted, adding that it is time public health officials look into this issue, particularly with regards to revising recommended levels of vitamin D upward for the elderly, dark-skinned persons, and breastfed babies.

Although the Food and Drug Administration does not directly test sunscreens, it issued a 2014 guidance to manufacturers regarding which ingredients can be used and at what concentrations. Based on the FDA’s 2011 final rule on Labeling and Effectiveness Testing of OTC sunscreen products, the highest SPF currently allowed is “50+” without specifying actual numbers above 50, although Dr. DeLeo said this could be revised if industry is able to demonstrate efficacy at higher SPF values.

In an interview, however, he said that this is not likely to happen anytime soon. Citing a recent study of 40 commercially available sunscreens, including top brand names, professional skincare lines, and eponymously labeled products sold at drug store chains, more than half failed to reach the SPF level they purported to have and nine did not provide adequate broad spectrum protection.

“The takeaway is that the FDA is probably correct. Sunscreens should not be labeled higher than 50,” he said.

With the Sunscreen Innovation Act passed in 2014, the FDA is now evaluating data on new sunscreen agents that have proven effective overseas. So far, these agents have not been approved, Dr. DeLeo said in the interview.

With regards to the currently available products, “what patients really need to know is pretty simple,” Dr. DeLeo said during his presentation. An important point is that sunscreens – which work by forming a film on the stratum corneum, preventing the penetration of radiation – are effective only if used properly, he said.

©Vesna Andjic/iStockphoto.com

A concept that is helpful for patients to understand is that while an SPF 30 product allows a person to stay in the sun twice as long as an SPF 15 product, with the same amount of protection from burning, it does not block twice as many burn rays, he noted. “When you combine them, it’s not additive, it dilutes” he said. For example, if an SPF 10 product is mixed with an SPF 20 product, the SPF is 15.

According to Dr. DeLeo, other important messages about sunscreen for patients are as follows:

• Use SPF 30 or higher.

• Apply 20-30 minutes before exposure to give the product a chance to create an effective barrier on the skin; and reapply every 2 hours or after going in the water or sweating outside.

• Use lotions or sprays, based on patient preference.

• For pregnant women or parents who don’t want to use chemical sunscreens, inorganic physical screens can be considered, although they will likely be less effective.

• Babies younger than 6 months of age can tolerate very small amounts of sunscreens.

Still, Dr. DeLeo said that the most foolproof form of photoprotection is to stay out of the sun, particularly between 10 a.m. and 4 p.m.

He disclosed being a consultant to LaRoche-Posay and Estée Lauder. Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN – Are your patients noncompliant about sun protection? Do they want to use photoprotection but aren’t sure what is best for them? Perhaps they are confused by the multitude of sunscreen manufacturer’s claims or even some claims by consumer and environmental advocates.

Patients are often confused by how much sun protection factor they actually need and marketing hype often makes things worse, according to Dr. Vincent DeLeoof the department of dermatology at the University of Southern California, Los Angeles. “The use of the words ‘babies, natural, hypoallergenic, or organic’ all mean absolutely nothing when it comes to an SPF’s actual efficacy,” he said at the meeting provided by Global Academy of Medical Education.

The degree of confusion surrounding these products was illustrated in a survey of 114 patients at Chicago dermatology clinic. Of those surveyed, 80% said they purchased a sunscreen product to prevent sunburn (75%) and to prevent skin cancer (66%); having the highest SPF, a sensitive skin formulation, or being water resistant were reasons the products were chosen. But 62% could not identify information explaining its role in cancer prevention, and 77% could not identify how well the product would prevent sunburn. And nearly all participants were unsure how products prevented photoaging (JAMA Dermatol. 2015 Sep;151[9]:1028-30).

Adding to the confusion, Dr. DeLeo said, are warnings issued by some consumer advocacy groups about sunscreens that are not based on actual clinical or animal studies, but from data simulation. For example, he said there are no data to substantiate claims from such groups that oxybenzone has estrogenic effects in humans.

Consumer advocacy groups who say that sunscreens interfere with vitamin D levels may have a point, however, Dr. DeLeo noted, adding that it is time public health officials look into this issue, particularly with regards to revising recommended levels of vitamin D upward for the elderly, dark-skinned persons, and breastfed babies.

Although the Food and Drug Administration does not directly test sunscreens, it issued a 2014 guidance to manufacturers regarding which ingredients can be used and at what concentrations. Based on the FDA’s 2011 final rule on Labeling and Effectiveness Testing of OTC sunscreen products, the highest SPF currently allowed is “50+” without specifying actual numbers above 50, although Dr. DeLeo said this could be revised if industry is able to demonstrate efficacy at higher SPF values.

In an interview, however, he said that this is not likely to happen anytime soon. Citing a recent study of 40 commercially available sunscreens, including top brand names, professional skincare lines, and eponymously labeled products sold at drug store chains, more than half failed to reach the SPF level they purported to have and nine did not provide adequate broad spectrum protection.

“The takeaway is that the FDA is probably correct. Sunscreens should not be labeled higher than 50,” he said.

With the Sunscreen Innovation Act passed in 2014, the FDA is now evaluating data on new sunscreen agents that have proven effective overseas. So far, these agents have not been approved, Dr. DeLeo said in the interview.

With regards to the currently available products, “what patients really need to know is pretty simple,” Dr. DeLeo said during his presentation. An important point is that sunscreens – which work by forming a film on the stratum corneum, preventing the penetration of radiation – are effective only if used properly, he said.

©Vesna Andjic/iStockphoto.com

A concept that is helpful for patients to understand is that while an SPF 30 product allows a person to stay in the sun twice as long as an SPF 15 product, with the same amount of protection from burning, it does not block twice as many burn rays, he noted. “When you combine them, it’s not additive, it dilutes” he said. For example, if an SPF 10 product is mixed with an SPF 20 product, the SPF is 15.

According to Dr. DeLeo, other important messages about sunscreen for patients are as follows:

• Use SPF 30 or higher.

• Apply 20-30 minutes before exposure to give the product a chance to create an effective barrier on the skin; and reapply every 2 hours or after going in the water or sweating outside.

• Use lotions or sprays, based on patient preference.

• For pregnant women or parents who don’t want to use chemical sunscreens, inorganic physical screens can be considered, although they will likely be less effective.

• Babies younger than 6 months of age can tolerate very small amounts of sunscreens.

Still, Dr. DeLeo said that the most foolproof form of photoprotection is to stay out of the sun, particularly between 10 a.m. and 4 p.m.

He disclosed being a consultant to LaRoche-Posay and Estée Lauder. Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN ISLAND – Smartphones and other digital technologies could provide clinicians – and patients – the tools to greatly improve melanoma and other dermatology outcomes, but how might they change actual practice?

“Ten years from now, what is going to distinguish the app world from the dermatology community?” That was the question Dr. Allan C. Halpern, chief of the dermatology service at Memorial Sloan Kettering Cancer Center, New York, posed at the meeting, sponsored by Global Academy for Medical Education.

Many clinicians already use dermatoscopes, which Dr. Halpern said “significantly improves diagnostic accuracy for melanoma by making available to us visual cues that would not be available through routine naked-eye examination.” However, he said, a rapid digital evolution in dermoscopy is already underway, allowing clinicians to use mobile devices that store images and perform short term monitoring of any areas of concern.

“For suspicious lesions, rather than do a biopsy, one of the options is that you can take a dermoscopic image of it, then do so again in another couple of months. If it hasn’t changed, then the data are very convincing that you’re dealing with something other than melanoma,” Dr. Halpern said.

What gives him pause is that there are an increasing number of consumer-based smartphone medical products, including more than 250 for dermatology alone.

“For about 100 dollars or less, patients can purchase their own dermatoscope and attach it to their smartphone” and take images of their own lesions, Dr. Halpern said.

As a result, he believes that the field has reached the “tipping point” for successful teledermatology, where companies can accept and interpret these data.

Because of the exponential growth of mobile medical applications, the Food and Drug Administration issued guidance for their use in 2015, he noted.

Although he said that the FDA is overwhelmed by the task – and that the medical app marketplace is akin to the Wild West – medical apps are here to stay and will continue to develop quickly.

“For one thing, big players are now entering the field,” he said, alluding to a recent Apple initiativeto collect data uploaded by consumers to the Cloud, which can then be parsed by medical researchers. In addition to melanoma, Apple is currently focusing on autism and epilepsy.

“Apple is trying to make the iPhone a conduit for medical research,” Dr. Halpern said.

Over the next 5-10 years, there will be a race to see who can perfect this kind of data analysis. There is even an ongoing competition that pits melanoma researchers around the world against one another to see who can most accurately interpret images uploaded to the archives. The hope, he said, is that it will help dermatologists to develop and agree upon international standards for melanoma diagnosis.

With this kind of standardization, medical apps can help both consumers and practitioners triage care.

“I don’t know when it will happen, but there is no doubt we’re going to reach a point at which these apps are going to be as good as the average dermatologist is today when it comes to looking at a single spot,” Dr. Halpern said.

Aside from some cancer centers’ ability to create three-dimensional images of lesions, another distinguishing technology for dermatologists could be reflectance confocal microscopy.

“As dermatologists, we are trained well enough in pathology that we can use this technology, we will be able to do even better than with dermoscopy alone,” he said. This kind of technology captures images at the cellular level similar to histological examinations, but without the actual biopsy.

In an interview, Dr. Halpern said that while dermatologists have nothing to fear from apps in daily practice, there are some issues to be aware of. “The first is the one we’re most concerned about – automated diagnosis, before we know for certain that the apps work.”

Another issue is that these apps raise awareness among consumers about their individual risk for melanoma, which will “invariably help drive more people in the door,” but there may not be enough clinicians to manage these patients.

The group Dr. Halpern expects will be the most frequent users of personal dermatology technologies initially are “ultra–tech savvy young people motivated to avoid melanoma,” although he expects that over time, this could change as technologies become easier to use.

He disclosed financial relationships with Quintiles, Canfield Scientific, DermTech, SciBase, and Caliber ID.

Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN ISLAND – Smartphones and other digital technologies could provide clinicians – and patients – the tools to greatly improve melanoma and other dermatology outcomes, but how might they change actual practice?

“Ten years from now, what is going to distinguish the app world from the dermatology community?” That was the question Dr. Allan C. Halpern, chief of the dermatology service at Memorial Sloan Kettering Cancer Center, New York, posed at the meeting, sponsored by Global Academy for Medical Education.

Many clinicians already use dermatoscopes, which Dr. Halpern said “significantly improves diagnostic accuracy for melanoma by making available to us visual cues that would not be available through routine naked-eye examination.” However, he said, a rapid digital evolution in dermoscopy is already underway, allowing clinicians to use mobile devices that store images and perform short term monitoring of any areas of concern.

“For suspicious lesions, rather than do a biopsy, one of the options is that you can take a dermoscopic image of it, then do so again in another couple of months. If it hasn’t changed, then the data are very convincing that you’re dealing with something other than melanoma,” Dr. Halpern said.

What gives him pause is that there are an increasing number of consumer-based smartphone medical products, including more than 250 for dermatology alone.

“For about 100 dollars or less, patients can purchase their own dermatoscope and attach it to their smartphone” and take images of their own lesions, Dr. Halpern said.

As a result, he believes that the field has reached the “tipping point” for successful teledermatology, where companies can accept and interpret these data.

Because of the exponential growth of mobile medical applications, the Food and Drug Administration issued guidance for their use in 2015, he noted.

Although he said that the FDA is overwhelmed by the task – and that the medical app marketplace is akin to the Wild West – medical apps are here to stay and will continue to develop quickly.

“For one thing, big players are now entering the field,” he said, alluding to a recent Apple initiativeto collect data uploaded by consumers to the Cloud, which can then be parsed by medical researchers. In addition to melanoma, Apple is currently focusing on autism and epilepsy.

“Apple is trying to make the iPhone a conduit for medical research,” Dr. Halpern said.

Over the next 5-10 years, there will be a race to see who can perfect this kind of data analysis. There is even an ongoing competition that pits melanoma researchers around the world against one another to see who can most accurately interpret images uploaded to the archives. The hope, he said, is that it will help dermatologists to develop and agree upon international standards for melanoma diagnosis.

With this kind of standardization, medical apps can help both consumers and practitioners triage care.

“I don’t know when it will happen, but there is no doubt we’re going to reach a point at which these apps are going to be as good as the average dermatologist is today when it comes to looking at a single spot,” Dr. Halpern said.

Aside from some cancer centers’ ability to create three-dimensional images of lesions, another distinguishing technology for dermatologists could be reflectance confocal microscopy.

“As dermatologists, we are trained well enough in pathology that we can use this technology, we will be able to do even better than with dermoscopy alone,” he said. This kind of technology captures images at the cellular level similar to histological examinations, but without the actual biopsy.

In an interview, Dr. Halpern said that while dermatologists have nothing to fear from apps in daily practice, there are some issues to be aware of. “The first is the one we’re most concerned about – automated diagnosis, before we know for certain that the apps work.”

Another issue is that these apps raise awareness among consumers about their individual risk for melanoma, which will “invariably help drive more people in the door,” but there may not be enough clinicians to manage these patients.

The group Dr. Halpern expects will be the most frequent users of personal dermatology technologies initially are “ultra–tech savvy young people motivated to avoid melanoma,” although he expects that over time, this could change as technologies become easier to use.

He disclosed financial relationships with Quintiles, Canfield Scientific, DermTech, SciBase, and Caliber ID.

Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

GRAND CAYMAN ISLAND – Smartphones and other digital technologies could provide clinicians – and patients – the tools to greatly improve melanoma and other dermatology outcomes, but how might they change actual practice?

“Ten years from now, what is going to distinguish the app world from the dermatology community?” That was the question Dr. Allan C. Halpern, chief of the dermatology service at Memorial Sloan Kettering Cancer Center, New York, posed at the meeting, sponsored by Global Academy for Medical Education.

Many clinicians already use dermatoscopes, which Dr. Halpern said “significantly improves diagnostic accuracy for melanoma by making available to us visual cues that would not be available through routine naked-eye examination.” However, he said, a rapid digital evolution in dermoscopy is already underway, allowing clinicians to use mobile devices that store images and perform short term monitoring of any areas of concern.

“For suspicious lesions, rather than do a biopsy, one of the options is that you can take a dermoscopic image of it, then do so again in another couple of months. If it hasn’t changed, then the data are very convincing that you’re dealing with something other than melanoma,” Dr. Halpern said.

What gives him pause is that there are an increasing number of consumer-based smartphone medical products, including more than 250 for dermatology alone.

“For about 100 dollars or less, patients can purchase their own dermatoscope and attach it to their smartphone” and take images of their own lesions, Dr. Halpern said.

As a result, he believes that the field has reached the “tipping point” for successful teledermatology, where companies can accept and interpret these data.

Because of the exponential growth of mobile medical applications, the Food and Drug Administration issued guidance for their use in 2015, he noted.

Although he said that the FDA is overwhelmed by the task – and that the medical app marketplace is akin to the Wild West – medical apps are here to stay and will continue to develop quickly.

“For one thing, big players are now entering the field,” he said, alluding to a recent Apple initiativeto collect data uploaded by consumers to the Cloud, which can then be parsed by medical researchers. In addition to melanoma, Apple is currently focusing on autism and epilepsy.

“Apple is trying to make the iPhone a conduit for medical research,” Dr. Halpern said.

Over the next 5-10 years, there will be a race to see who can perfect this kind of data analysis. There is even an ongoing competition that pits melanoma researchers around the world against one another to see who can most accurately interpret images uploaded to the archives. The hope, he said, is that it will help dermatologists to develop and agree upon international standards for melanoma diagnosis.

With this kind of standardization, medical apps can help both consumers and practitioners triage care.

“I don’t know when it will happen, but there is no doubt we’re going to reach a point at which these apps are going to be as good as the average dermatologist is today when it comes to looking at a single spot,” Dr. Halpern said.

Aside from some cancer centers’ ability to create three-dimensional images of lesions, another distinguishing technology for dermatologists could be reflectance confocal microscopy.

“As dermatologists, we are trained well enough in pathology that we can use this technology, we will be able to do even better than with dermoscopy alone,” he said. This kind of technology captures images at the cellular level similar to histological examinations, but without the actual biopsy.

In an interview, Dr. Halpern said that while dermatologists have nothing to fear from apps in daily practice, there are some issues to be aware of. “The first is the one we’re most concerned about – automated diagnosis, before we know for certain that the apps work.”

Another issue is that these apps raise awareness among consumers about their individual risk for melanoma, which will “invariably help drive more people in the door,” but there may not be enough clinicians to manage these patients.

The group Dr. Halpern expects will be the most frequent users of personal dermatology technologies initially are “ultra–tech savvy young people motivated to avoid melanoma,” although he expects that over time, this could change as technologies become easier to use.

He disclosed financial relationships with Quintiles, Canfield Scientific, DermTech, SciBase, and Caliber ID.

Global Academy and this news organization are owned by the same parent company.

[email protected]

On Twitter @whitneymcknight

Combination therapy to inhibit the MAP kinase pathway is associated with a median overall survival of more than 2 years for patients with metastatic melanoma positive for the BRAF V600 mutation who have not previously received a BRAF inhibitor.

An analysis of data from a phase I and II trial of the BRAF inhibitor dabrafenib (Tafinlar), 150 mg twice daily, and the MEK inhibitor trametinib (Mekinist), 2 mg once daily, in 78 BRAF inhibitor–naïve patients with metastatic melanoma showed that in a non-randomized cohort (part B) the median overall survival (OS) was 27.4 months. In a cohort randomized to the same doses (part C), the median OS was 25 months, reported Dr. Georgina V. Long and her colleagues from the Melanoma Institute Australia and the University of Sydney in the Journal of Clinical Oncology.

Among 24 patients treated in part B, progression-free survival (PFS) was 18% at 3 years.

“The combination has an acceptable long-term safety profile and is a standard of care for patients with BRAF mutation–positive metastatic melanoma, particularly given the recent publications demonstrating a significant improvement in the PFS and OS in phase III trials of combination versus single-agent BRAF inhibitors,” the investigators wrote (J Clin Oncol. 2016 Jan 25. doi: 10.1200/JCO.2015.62.9345).

The investigators conducted the analysis to determine which patients were the most likely to benefit from combination therapy of the MAP (mitogen-active protein) kinase pathway.

They observed that in the part B, non-randomized cohort, OS was 72% at 1 year, 60% at 2 tears, and 47% at 3 years. In the part C, randomized cohort, OS was 80%, 51%, and 38%, respectively.

Factors associated with better OS in Cox proportional hazards regression models included metastases to fewer than three organs sites, and lower levels of lactate dehydrogenase (LDH) at baseline. Not surprisingly, a complete response to therapy was also associated with better survival. Three-year OS rates were 62% for patients with normal baseline LDH levels, and 63% for patients who had a complete response.

Combination therapy to inhibit the MAP kinase pathway is associated with a median overall survival of more than 2 years for patients with metastatic melanoma positive for the BRAF V600 mutation who have not previously received a BRAF inhibitor.

An analysis of data from a phase I and II trial of the BRAF inhibitor dabrafenib (Tafinlar), 150 mg twice daily, and the MEK inhibitor trametinib (Mekinist), 2 mg once daily, in 78 BRAF inhibitor–naïve patients with metastatic melanoma showed that in a non-randomized cohort (part B) the median overall survival (OS) was 27.4 months. In a cohort randomized to the same doses (part C), the median OS was 25 months, reported Dr. Georgina V. Long and her colleagues from the Melanoma Institute Australia and the University of Sydney in the Journal of Clinical Oncology.

Among 24 patients treated in part B, progression-free survival (PFS) was 18% at 3 years.

“The combination has an acceptable long-term safety profile and is a standard of care for patients with BRAF mutation–positive metastatic melanoma, particularly given the recent publications demonstrating a significant improvement in the PFS and OS in phase III trials of combination versus single-agent BRAF inhibitors,” the investigators wrote (J Clin Oncol. 2016 Jan 25. doi: 10.1200/JCO.2015.62.9345).

The investigators conducted the analysis to determine which patients were the most likely to benefit from combination therapy of the MAP (mitogen-active protein) kinase pathway.

They observed that in the part B, non-randomized cohort, OS was 72% at 1 year, 60% at 2 tears, and 47% at 3 years. In the part C, randomized cohort, OS was 80%, 51%, and 38%, respectively.

Factors associated with better OS in Cox proportional hazards regression models included metastases to fewer than three organs sites, and lower levels of lactate dehydrogenase (LDH) at baseline. Not surprisingly, a complete response to therapy was also associated with better survival. Three-year OS rates were 62% for patients with normal baseline LDH levels, and 63% for patients who had a complete response.

Combination therapy to inhibit the MAP kinase pathway is associated with a median overall survival of more than 2 years for patients with metastatic melanoma positive for the BRAF V600 mutation who have not previously received a BRAF inhibitor.

An analysis of data from a phase I and II trial of the BRAF inhibitor dabrafenib (Tafinlar), 150 mg twice daily, and the MEK inhibitor trametinib (Mekinist), 2 mg once daily, in 78 BRAF inhibitor–naïve patients with metastatic melanoma showed that in a non-randomized cohort (part B) the median overall survival (OS) was 27.4 months. In a cohort randomized to the same doses (part C), the median OS was 25 months, reported Dr. Georgina V. Long and her colleagues from the Melanoma Institute Australia and the University of Sydney in the Journal of Clinical Oncology.

Among 24 patients treated in part B, progression-free survival (PFS) was 18% at 3 years.

“The combination has an acceptable long-term safety profile and is a standard of care for patients with BRAF mutation–positive metastatic melanoma, particularly given the recent publications demonstrating a significant improvement in the PFS and OS in phase III trials of combination versus single-agent BRAF inhibitors,” the investigators wrote (J Clin Oncol. 2016 Jan 25. doi: 10.1200/JCO.2015.62.9345).

The investigators conducted the analysis to determine which patients were the most likely to benefit from combination therapy of the MAP (mitogen-active protein) kinase pathway.

They observed that in the part B, non-randomized cohort, OS was 72% at 1 year, 60% at 2 tears, and 47% at 3 years. In the part C, randomized cohort, OS was 80%, 51%, and 38%, respectively.

Factors associated with better OS in Cox proportional hazards regression models included metastases to fewer than three organs sites, and lower levels of lactate dehydrogenase (LDH) at baseline. Not surprisingly, a complete response to therapy was also associated with better survival. Three-year OS rates were 62% for patients with normal baseline LDH levels, and 63% for patients who had a complete response.

Rates of anorectal melanoma rose substantially in the United States from 1992 to 2011, according to a study published in Dermatologic Surgery.

The increases affected men and women, said Dr. Adrienne Callahan of the department of dermatology, University Hospitals Case Medical Center, Cleveland, and her associates. Anorectal carcinoma was significantly more common among Hispanic whites than non-Hispanic whites (P = .02), “suggesting that this population may be targeted for screening interventions,” they added. (Dermatol Surg. 2016;42[1]:94-9). The highest rates were in Hispanic white elderly women.

Anorectal melanoma accounts for 1.3% of all melanomas and 16.5% of mucosal melanomas, and is most common among older women. The prognosis is often poor because the cancer tends to be asymptomatic until its late stages. To study the epidemiology of anorectal melanoma, the researchers analyzed data from the Surveillance, Epidemiology, and End Results 13 (SEER 13) Registries Database for 1992 through 2011.

The SEER database listed 260 cases for the study period. Most involved the rectum, 58% affected adults aged 65 years and older, and almost two-thirds occurred in women – a finding that dovetails with other studies, the researchers said. Notably, the estimated annual change in age-standardized incidence rates increased in both men (5.08%) and women (3.02%), which were statistically significant increases (P less than .05 for both trends).

Anorectal melanoma rates were significantly higher among Hispanic whites, compared with non-Hispanic whites. “Other studies have indicated that Hispanics are underscreened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population,” said the researchers. “Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.”

As far as they know, this is the first study that has analyzed anorectal melanoma incidence in Hispanic whites and non-Hispanic whites, they added.

Ethnicity did not affect survival, which was generally poor. Anorectal melanoma is very rare, so the number of cases was relatively small and rates might have been unstable, the investigators noted. They added that it was not known whether the increases they found were related to improved detection.

The study was funded by the Char and Chuck Fowler Family Foundation, the Dermatology Foundation, and the National Cancer Institute. The researchers had no disclosures.

Rates of anorectal melanoma rose substantially in the United States from 1992 to 2011, according to a study published in Dermatologic Surgery.

The increases affected men and women, said Dr. Adrienne Callahan of the department of dermatology, University Hospitals Case Medical Center, Cleveland, and her associates. Anorectal carcinoma was significantly more common among Hispanic whites than non-Hispanic whites (P = .02), “suggesting that this population may be targeted for screening interventions,” they added. (Dermatol Surg. 2016;42[1]:94-9). The highest rates were in Hispanic white elderly women.

Anorectal melanoma accounts for 1.3% of all melanomas and 16.5% of mucosal melanomas, and is most common among older women. The prognosis is often poor because the cancer tends to be asymptomatic until its late stages. To study the epidemiology of anorectal melanoma, the researchers analyzed data from the Surveillance, Epidemiology, and End Results 13 (SEER 13) Registries Database for 1992 through 2011.

The SEER database listed 260 cases for the study period. Most involved the rectum, 58% affected adults aged 65 years and older, and almost two-thirds occurred in women – a finding that dovetails with other studies, the researchers said. Notably, the estimated annual change in age-standardized incidence rates increased in both men (5.08%) and women (3.02%), which were statistically significant increases (P less than .05 for both trends).

Anorectal melanoma rates were significantly higher among Hispanic whites, compared with non-Hispanic whites. “Other studies have indicated that Hispanics are underscreened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population,” said the researchers. “Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.”

As far as they know, this is the first study that has analyzed anorectal melanoma incidence in Hispanic whites and non-Hispanic whites, they added.

Ethnicity did not affect survival, which was generally poor. Anorectal melanoma is very rare, so the number of cases was relatively small and rates might have been unstable, the investigators noted. They added that it was not known whether the increases they found were related to improved detection.

The study was funded by the Char and Chuck Fowler Family Foundation, the Dermatology Foundation, and the National Cancer Institute. The researchers had no disclosures.

Rates of anorectal melanoma rose substantially in the United States from 1992 to 2011, according to a study published in Dermatologic Surgery.

The increases affected men and women, said Dr. Adrienne Callahan of the department of dermatology, University Hospitals Case Medical Center, Cleveland, and her associates. Anorectal carcinoma was significantly more common among Hispanic whites than non-Hispanic whites (P = .02), “suggesting that this population may be targeted for screening interventions,” they added. (Dermatol Surg. 2016;42[1]:94-9). The highest rates were in Hispanic white elderly women.

Anorectal melanoma accounts for 1.3% of all melanomas and 16.5% of mucosal melanomas, and is most common among older women. The prognosis is often poor because the cancer tends to be asymptomatic until its late stages. To study the epidemiology of anorectal melanoma, the researchers analyzed data from the Surveillance, Epidemiology, and End Results 13 (SEER 13) Registries Database for 1992 through 2011.

The SEER database listed 260 cases for the study period. Most involved the rectum, 58% affected adults aged 65 years and older, and almost two-thirds occurred in women – a finding that dovetails with other studies, the researchers said. Notably, the estimated annual change in age-standardized incidence rates increased in both men (5.08%) and women (3.02%), which were statistically significant increases (P less than .05 for both trends).

Anorectal melanoma rates were significantly higher among Hispanic whites, compared with non-Hispanic whites. “Other studies have indicated that Hispanics are underscreened for skin cancer compared to other ethnic groups despite the increasing incidence of melanoma in this population,” said the researchers. “Although this may suggest a role for improved screening among those with Hispanic ethnicity, additional studies must be done to corroborate these results and further elucidate the association of Hispanic ethnicity with anorectal melanoma.”

As far as they know, this is the first study that has analyzed anorectal melanoma incidence in Hispanic whites and non-Hispanic whites, they added.

Ethnicity did not affect survival, which was generally poor. Anorectal melanoma is very rare, so the number of cases was relatively small and rates might have been unstable, the investigators noted. They added that it was not known whether the increases they found were related to improved detection.

The study was funded by the Char and Chuck Fowler Family Foundation, the Dermatology Foundation, and the National Cancer Institute. The researchers had no disclosures.

Mohs micrographic surgery (MMS) to remove digital melanomas of less than 2 mm Breslow thickness spared patients from amputation without undermining survival, according to a single-center retrospective study published in Dermatologic Surgery.

The overall recurrence rate was 8%, and there were no recurrences with use of the MART-1 (melanoma antigen recognized by T-cells 1 staining) immunostain, said Dr. Vitaly Terushkin of the Zitelli and Brodland Skin Cancer Center in Pittsburgh and his associates. “The use of MART-1 has revolutionized the value of MMS,” the researchers said, while cautioning that the sample size was too small to draw reliable conclusions about thicker tumors.

Digital melanoma historically eluded diagnosis until it was advanced and was treated with amputation. Amputation and wide local excision remain common, and particularly erode function and balance when the tumor involves the thumb or big toe, the researchers noted. In 35 years at their center, 62 patients underwent MMS for digital melanoma, two-thirds of which involved the nail unit. About 92% of tumors were primary, 8% were recurrent, 53% involved the fingers, and 47% involved the toes. About half of patients were women, and the average age at treatment was about 63 years (Dermatol Surg. 2016;42:83-93).

Nearly 97% of patients avoided amputation over an average of 6.5 years of follow-up, the investigators reported. Five-year and 10-year local recurrence-free survival rates for the primary melanomas were about 92% and 83%, respectively. Of the five local recurrences, three were salvaged with additional MMS and two were treated with an amputation; all five recurrences involved the nail unit. Failing to remove the entire nail unit apparatus probably led to false-negative MMS layers and subsequent recurrence in at least two cases, they pointed out.

This is only the fifth published study to describe the treatment of digital melanoma with MMS, according to Dr. Terushkin and his associates. Although the study lacked a comparison group, it suggested that MART-1 improved outcomes and that most recurrences could be retreated with MMS without amputation or negative effects on survival. These findings will hopefully help inform future melanoma guidelines, said the researchers.

The investigators reported no funding sources and had no disclosures.

Mohs micrographic surgery (MMS) to remove digital melanomas of less than 2 mm Breslow thickness spared patients from amputation without undermining survival, according to a single-center retrospective study published in Dermatologic Surgery.

The overall recurrence rate was 8%, and there were no recurrences with use of the MART-1 (melanoma antigen recognized by T-cells 1 staining) immunostain, said Dr. Vitaly Terushkin of the Zitelli and Brodland Skin Cancer Center in Pittsburgh and his associates. “The use of MART-1 has revolutionized the value of MMS,” the researchers said, while cautioning that the sample size was too small to draw reliable conclusions about thicker tumors.

Digital melanoma historically eluded diagnosis until it was advanced and was treated with amputation. Amputation and wide local excision remain common, and particularly erode function and balance when the tumor involves the thumb or big toe, the researchers noted. In 35 years at their center, 62 patients underwent MMS for digital melanoma, two-thirds of which involved the nail unit. About 92% of tumors were primary, 8% were recurrent, 53% involved the fingers, and 47% involved the toes. About half of patients were women, and the average age at treatment was about 63 years (Dermatol Surg. 2016;42:83-93).

Nearly 97% of patients avoided amputation over an average of 6.5 years of follow-up, the investigators reported. Five-year and 10-year local recurrence-free survival rates for the primary melanomas were about 92% and 83%, respectively. Of the five local recurrences, three were salvaged with additional MMS and two were treated with an amputation; all five recurrences involved the nail unit. Failing to remove the entire nail unit apparatus probably led to false-negative MMS layers and subsequent recurrence in at least two cases, they pointed out.

This is only the fifth published study to describe the treatment of digital melanoma with MMS, according to Dr. Terushkin and his associates. Although the study lacked a comparison group, it suggested that MART-1 improved outcomes and that most recurrences could be retreated with MMS without amputation or negative effects on survival. These findings will hopefully help inform future melanoma guidelines, said the researchers.

The investigators reported no funding sources and had no disclosures.

Mohs micrographic surgery (MMS) to remove digital melanomas of less than 2 mm Breslow thickness spared patients from amputation without undermining survival, according to a single-center retrospective study published in Dermatologic Surgery.

The overall recurrence rate was 8%, and there were no recurrences with use of the MART-1 (melanoma antigen recognized by T-cells 1 staining) immunostain, said Dr. Vitaly Terushkin of the Zitelli and Brodland Skin Cancer Center in Pittsburgh and his associates. “The use of MART-1 has revolutionized the value of MMS,” the researchers said, while cautioning that the sample size was too small to draw reliable conclusions about thicker tumors.

Digital melanoma historically eluded diagnosis until it was advanced and was treated with amputation. Amputation and wide local excision remain common, and particularly erode function and balance when the tumor involves the thumb or big toe, the researchers noted. In 35 years at their center, 62 patients underwent MMS for digital melanoma, two-thirds of which involved the nail unit. About 92% of tumors were primary, 8% were recurrent, 53% involved the fingers, and 47% involved the toes. About half of patients were women, and the average age at treatment was about 63 years (Dermatol Surg. 2016;42:83-93).

Nearly 97% of patients avoided amputation over an average of 6.5 years of follow-up, the investigators reported. Five-year and 10-year local recurrence-free survival rates for the primary melanomas were about 92% and 83%, respectively. Of the five local recurrences, three were salvaged with additional MMS and two were treated with an amputation; all five recurrences involved the nail unit. Failing to remove the entire nail unit apparatus probably led to false-negative MMS layers and subsequent recurrence in at least two cases, they pointed out.

This is only the fifth published study to describe the treatment of digital melanoma with MMS, according to Dr. Terushkin and his associates. Although the study lacked a comparison group, it suggested that MART-1 improved outcomes and that most recurrences could be retreated with MMS without amputation or negative effects on survival. These findings will hopefully help inform future melanoma guidelines, said the researchers.

The investigators reported no funding sources and had no disclosures.