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Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006
Randomized Controlled Trial Testing the Impact Of High-Protection Sunscreens on Sun-Exposure Behavior
Objective: High-protection sunscreens have been suspected to prompt people to increase sun exposure, and thus to increase skin cancer risk. We tested the influence of both the actual protection (sun protection factor [SPF]) and the information about protection (label) on sun-exposure behavior.
Design: Randomized controlled trial.
Setting: Four French seaside resorts during summer 2001.
Participants: A total of 367 healthy subjects during their 1-week holiday. Outcome was assessable in 98% of them.
Intervention: Subjects were offered free sunscreens, with randomization into the following study arms: (1) SPF 40 labeled as “high protection”; (2) SPF 40 labeled as “basic protection”; and (3) SPF 12 labeled as “basic protection.” Arm 4, ie, SPF 12 labeled as “high protection,” was not implemented for ethical reasons. Subjects were not aware of the real target of the study and were blinded to the SPF value.
Main Outcome Measure: Duration of sunbathing exposure during 1 week. Secondary outcomes were occurrence of sunburns and amount of sunscreen used. Influences of SPF and label were assessed separately.
Results: Compared with the low-SPF group, the high-SPF group did not have longer sunbathing exposure (12.9 ± 7.2 hours/wk for high SPF vs 14.6 ± 6.7 hours/wk for low SPF; P = .06), experienced fewer sunburns (14% vs 24%; P = .049), and used less sunscreen (median, 30 g vs 109 g; P<.001). The label “high protection” or “basic protection” had no influence on these end points.
Conclusions: In this adult population, higher SPF had no influence on duration of sun exposure and offered better protection against sunburns. Although higher SPF may increase sun exposure duration in specific populations, this effect cannot be viewed as a universal side effect of high-SPF sunscreens.
Dupuy A, Dunant A, Grob JJ; Reseau d'Epidemiologie en Dermatologie
Incidence of New and Changed Nevi and Melanomas Detected Using Baseline Images and Dermoscopy in Patients at High Risk for Melanoma
Objective: To determine the incidence of new, changed, and regressed nevi and melanomas in a cohort of patients at high risk for melanoma using baseline total body photography and dermatoscopy.
Design: Cohort study of patients at high risk for melanoma who underwent baseline cutaneous photography between January 1, 1992, and December 31, 1997, and had at least 1 follow-up visit by December 31, 1998.
Setting: Private practice rooms of 1 dermatologist in conjunction with a public hospital-based, multidisciplinary melanoma clinic in Victoria, Australia.
Patients: A total of 309 patients who had at least 1 of the following risk factors for melanoma: personal history, family history, 100 or more nevi, or 4 or more dysplastic nevi.
Main Outcome Measures: Number of new, changed, and regressed nevi and melanomas detected and excised during the study interval.
Results: The incidence of new, changed, and regressed nevi decreased with increasing age (P<.001), whereas the incidence of melanomas increased (P = .05). The number of dysplastic nevi at baseline was positively associated with the incidence of changed nevi (P<.001) and melanomas (P = .03). The use of baseline photography and dermatoscopy was associated with low biopsy rates and early detection of melanomas. The development of melanoma in association with a preexisting nevus was not directly correlated with a change in a preexisting lesion monitored by baseline photography.
Conclusions: Nevi are dynamic, and only a small percentage of all new and changed melanocytic lesions are melanomas. Patients younger than 50 years had a lower incidence of melanomas and a higher rate of new, changed, and regressed nevi when compared with patients older than 50 years. A new or changed pigmented lesion is more likely to be a melanoma in patients older than 50 years.
Banky JP, Kelly JW, English DR, Yeatman JM, Dowling JP
Primary Closure vs Second-Intention Treatment of Skin Punch Biopsy Sites: A Randomized Trial
Objective: To determine if healing of punch biopsy wounds by second intention is equivalent to healing with primary closure.
Design: Prospective, randomized, method comparison equivalence study.
Setting: Tertiary academic medical center.
Participants: Study volunteers were recruited from the general population and enrolled between January 7, 2002, and August 20, 2002. Patients with immunodeficiency, peripheral vascular disease, or history of keloid formation and those receiving anticoagulation therapy or systemic corticosteroids were excluded. Intervention Study volunteers had two 4-mm or two 8-mm punch biopsies performed on the upper outer arms, midlateral aspect of the thighs, or upper back. One biopsy site was closed with interrupted 4-0 nylon suture, and the contralateral biopsy site was allowed to heal by second intention.
Main Outcome Measures: At 9 months, scar appearance was evaluated blindly and independently by 3 physicians using a visual analog scale (0 indicating poor and 100 indicating best).
Results: Seventy-seven of 82 enrolled volunteers completed the study. Mean (SD) visual analog scale score was 57.1 (19.5) for biopsy sites allowed to heal by second intention and 58.9 (19.7) for biopsy sites that healed with primary closure. The median surface area of the biopsy scars at 9 months was 32 mm2 for second intention and 33 mm2 for primary closure. For the 8-mm biopsies, the volunteers preferred the appearance of the sites that healed with primary closure; however, for the 4-mm biopsies, volunteers had no significant preference for either biopsy method. Costs were lower for second intention, and complications were equivalent.
Conclusions: Punch biopsy sites allowed to heal by second intention appear at least as good as biopsy sites closed primarily with suture. Although volunteers preferred suturing at larger biopsy sites, elimination of suturing of punch biopsy wounds would result in personnel efficiency and economic savings for both patients and medical institutions.
Christenson LJ, Phillips PK, Weaver AL, Otley CC
Melanoma Recurrence Patterns After Negative Sentinel Lymphadenectomy
Hypothesis: A tumor-negative sentinel node (SN) does not eliminate the chance of melanoma recurrence. Patterns of metastasis can be identified and characterized in patients with tumor-negative SNs.
Design: Retrospective review.
Setting: Melanoma referral center.
Patients: Patients who underwent lymphatic mapping and sentinel lymphadenectomy between 1995 and 2002 and whose SNs were negative for metastasis by hematoxylin-eosin and immunohistochemistry staining were included in the study. The SN specimens from patients with recurrent disease were reexamined for missed metastasis.
Main Outcome Measures: Differences in survival related to sites of recurrence and the rate of false-negative histopathologic SN diagnosis were determined.
Results: At a median follow-up of 36.7 months, 69 (8.9%) of 773 patients with tumor-negative SNs had recurrent disease. Three-year survival after first recurrence was 17.1% in the 37 patients with distant recurrence, 48.7% in the 19 patients with local or in-transit recurrence, and 63.5% in the 13 patients with regional basin recurrence; the difference in survival between patients with local or regional and distant recurrences was statistically significant (P<.001). Histopathologic reexamination of SNs from the 69 patients identified 9 patients with false-negative SNs; 2 of these had same-basin recurrences.
Conclusions: The SN is a valuable prognostic indicator because only 8.9% of patients with tumor-negative SNs will develop recurrence. The low incidence (1.7%) of regional basin recurrence in patients with negative SNs supports the accuracy of our current method of lymphatic mapping and sentinel lymphadenectomy to identify occult regional nodal basin metastasis.
Zogakis TG, Essner R, Wang HJ, Turner RR, Takasumi YT, Gaffney RL, Lee JH, Morton DL
Abstracts: In Other Archives Journals. Arch Facial Plast Surg. 2006;8(1):70–71. doi:
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