Faculty Bibliography

OBJECTIVE: To examine and compare the temporal trends in melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida from 1990 to 2004. DESIGN: Cross-sectional and retrospective analysis. SETTING: Florida Cancer Data System. PATIENTS: Melanoma cases with known stage and race/ethnicity reported from 1990 to 2004. MAIN OUTCOME MEASURES: Age-adjusted melanoma incidence and stage at diagnosis. RESULTS: Of 41 072 cases of melanoma, 39 670 cases were reported for white non-Hispanics (WNHs), 1148 for white Hispanics (WHs), and 254 for blacks. Melanoma incidence rates increased by 3.0% per year among WNH men (P < .001), 3.6% among WNH women (P < .001), 3.4% among WH women (P = .01), and 0.9% among WH men (P = .52), while remaining relatively stable among black men and women. Both WHs and blacks had significantly more advanced melanoma at presentation: 18% of WH and 26% of black patients had either regional or distant-stage melanoma at diagnosis compared with 12% of WNH patients. The proportion of distant-stage melanoma diagnosed among WHs and blacks changed little from 1990 to 2004, compared with a steady decrease in the percentage of melanoma cases diagnosed at distant stage among WNHs (P < .001). Such differences in the time trends of the proportion of distant-stage melanoma remained after excluding in situ cases. CONCLUSIONS: The rising melanoma incidence among WNHs and WHs emphasizes the need for primary prevention. The persistence of disparity in melanoma stage at diagnosis among WHs, blacks, and WNHs warrants closer examination of secondary prevention efforts in minority groups.

Objective. To assess knowledge base and practice habits of dermatological surgeons regarding surgery-related allergic contact dermatitis. Design. Cross-sectional study. Setting. The Florida Society of Dermatologic Surgery served as the study group. Participants. Cohort of dermatological surgeons. Measurements. An anonymous, close-ended survey instrument eliciting common surgical practices as well as allergic contact dermatitis knowledge. Results. Among the 45 respondents, 87 percent reported performing surgery more than 10 times per week and only 14 percent of respondents reported using latex-free gloves in their practice. Nearly two-thirds (66%) of respondents reported diagnosing allergic contact dermatitis either among themselves, their surgical staff, and/or patients. Surgeons were noted to use the TRUE Test((R)) to screen for adhesive allergy. While colophony can be found both in adhesive products and on the TRUE Test, the main adhesives found in perisurgical products, acrylates, cannot. Similarly, the TRUE Test does not screen for antiseptics, yet this group of respondents suspected antiseptics nearly one-fourth of the time and used the TRUE Test to screen for them. Lastly, six dermatological surgeons used the TRUE Test to screen for suture allergy. While only two used chromated cat gut (the TRUE Test screens for chromium), the other surgical components are not screened. Conclusion. Education among dermatological surgeons is needed regarding exposure to a potential allergen in the surgical setting and risk of developing allergic contact dermatitis.

The aim of this study was to assess baseline knowledge of skin cancer, sun protection practices, and perceptions of tanning among third through fifth grade elementary students in Florida. A total of 4,002 students in nineteen elementary schools in Palm Beach County, Florida were surveyed. SunSmart America curriculum pretest responses were the main outcome measures. Overall students' knowledge using a students' mean knowledge scale scores of skin cancer and sun protection were low (<40% of questions answered correctly) and was found to increase with increasing grade level (p < 0.01). Boys more frequently reported spending greater than 2 hours in the sun when compared with girls (p < 0.01). Girls, however, were more likely to try and get a tan most of the time or always when compared with boys (p = 0.02). Non-Hispanic White students (51.3%) more frequently reported use of SPF 15 or greater sunscreen "most of the time or always" compared with Hispanic (35.3%) and non-Hispanic Black (13.4%) students (p < 0.01). Elementary aged students in south Florida have limited knowledge about sun safety, despite spending considerable amount of time in the sun. Sun safe behavior is associated with gender and ethnicity. The findings provide empirical support for the need of a school-based educational intervention.

BACKGROUND: Allergic contact dermatitis from condoms is a problem that carries significant morbidity and that has been increasingly reported due to the use of condoms to prevent sexually transmitted diseases as well as for birth control. OBJECTIVE: The purpose of the study is to evaluate the process by which condom manufacturing companies divulge product allergen information to health care professionals. METHODS: An interviewer-administered telephone questionnaire eliciting the staff member's knowledge of condom allergens was utilized. Eligible respondents were condom manufacturers' service staff over 18 years of age. RESULTS: Complete surveys were obtained regarding 36 (85.7%) of the 42 subtypes of condoms. Telephoning was the primary (75%) method of obtaining allergen information. The majority (63.9%) of the information was obtained within minutes to hours of the initial contact. Nearly two-thirds of the interviews evaluated the condom manufacturers' service staff as good and effective in their knowledge base and in providing product information. CONCLUSION: The study determined that the extent of knowledge, helpfulness, and effectiveness of the customer service personnel in relaying product allergen information to clinicians were generally good. The study additionally generated a reference table outlining the common allergens in major manufactured condoms.

BACKGROUND: Cutaneous soft tissue sarcomas (CSTS) are a heterogeneous group of mesenchymal neoplasms. To the authors' knowledge, no prior large, population-based study has focused on CSTS. METHODS: Surveillance, Epidemiology, and End Results (SEER) Program incidence and relative survival rates of CSTS were analyzed according to race, sex, and histologic type using the 2002 criteria of the World Health Organization classification. RESULTS: Among residents of the 13 SEER registries, 12,114 CSTS were diagnosed from 1992 through 2004. Overall age-adjusted CSTS incidence rates were highest among blacks (30.8 per 1,000,000 person-years) followed by whites (25 per 1,000,000 person-years), and American Indians/Alaska Natives (11.2 per 1,000,000 person-years) and were lowest among Asian/Pacific Islanders (7.7 per 1,000,000 person-years). Kaposi sarcoma (KS) accounted for 71.1% of cases, and the rates were similarly ranked. Dermatofibrosarcoma protuberans (DFSP) rates also were highest among blacks, whereas leiomyosarcoma (LS) and angiosarcoma (AS) rates were highest among whites. The rate ratio of men to women was 25.5 for KS, 4.7 for malignant fibrous histiocytoma (MFH), 3.7 for LS, 2.0 for AS, and 0.9 for DFSP. The 5-year relative survival rates were 99% for patients with DFSP, 89% for patients with MFH, 92% for patients with LS, and 45% for patients with AS. KS rates among men in the original 9 SEER registries increased more than 30-fold during the 1980s before they peaked around 1991 and subsequently declined rapidly because of human immunodeficiency virus-associated KS and highly active antiretroviral therapy. This KS pattern was evident not only among those ages 20 to 59 years but also among those ages 60 to 69 years. From 1978 through 2004, LS and AS rates among whites increased exponentially. CONCLUSIONS: CSTS rates varied markedly over time and by race, sex, and histologic type, supporting the notion that these histologic variants of CSTS areetiologically distinct.

BACKGROUND: Although age-adjusted incidence rates (per 100,000) for melanoma are lower among Hispanics and blacks (4.5 and 1.0, respectively) compared with white non-Hispanics (21.6), melanomas among minority populations in the United States are more likely to metastasize and have poorer outcomes. METHODS: A review of the literature was conducted on melanomas affecting Hispanic and black Americans. RESULTS: Because of the low index of suspicion in both the medical community and these ethnic populations, diagnosis is often delayed, resulting in advanced presentation and a poorer prognosis. CONCLUSIONS: More comprehensive medical training, expanded public educational campaigns, and increased awareness among patients of all skin types to perform self skin checks are recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are warranted.

BACKGROUND: Early detection of skin cancer by skin examination may reduce its associated morbidity and mortality, in particular for workers routinely exposed to sun. OBJECTIVES: We sought to describe the proportion of US workers reporting skin cancer screening examination in a representative sample of the US worker population in the National Health Interview Survey. METHODS: Report of skin cancer examination in the 2000 and 2005 National Health Interview Survey cancer control supplements were examined by a range of variables. RESULTS: Lifetime and 12-month reported clinical skin examination prevalence was 15% and 8%, respectively. Workers with elevated occupational exposure to ultraviolet light were less likely to have ever received a skin examination than the average US worker. Logistic regression analysis identified occupational category and age, sex, race, education level, health insurance, and sun-protective behavior as significant independent correlates of skin cancer examination. LIMITATIONS: A limitation is potential healthy worker effect and underestimation of skin cancer screening with self-reported data. CONCLUSIONS: Routine examination by primary care physicians frequently does not include a thorough skin examination. Physicians should be even more vigilant with patients at increased risk of excessive occupational sun exposure, as early detection of skin cancer by periodic skin examination decreases morbidity and can improve survival.

BACKGROUND: Physician visits provide invaluable opportunities to screen patients for skin cancer, yielding earlier detection and improved survival. OBJECTIVE: We sought to assess frequency of skin cancer screening by full body skin examinations (FBSE) by primary care physicians, patient attitudes toward FBSE, and risk factors for cutaneous malignancy. METHODS: Questionnaires were distributed to patients at primary care and dermatology clinics. RESULTS: A total of 426 participants were surveyed. Overall, 20% of patients reported having undergone regular FBSE by their primary care physician. Sex, race, personal skin cancer history, and Fitzpatrick skin type were predictive of whether a FBSE was performed by a patient's primary care physician. Men were more likely to report having undergone a FBSE (22% vs 19%; P < .01); women were more likely to report feeling embarrassed by a FBSE (15% vs 4%; P < .01). LIMITATIONS: This study was conducted at a single site academic center. CONCLUSION: Although low rates of skin cancer screening are reported by patients, those at higher risk are being screened more frequently. Sex disparity exists, and as both male and female patients have a strong preference to undergo FBSE, unmet opportunities for skin cancer prevention should be maximized.