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Melanoma Epidemiology: Analytical Studies, Systematic Reviews and Meta-Analyses Addressing Environmental Risk Factors and Preventive Measures

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 15963

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Prof. Dr. Olaf Gefeller

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Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
Interests: epidemiology; biostatistics; melanoma; ultraviolet radiation; UV index; prevention of sun exposure
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Marit B. Veierød

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Guest Editor

Oslo Centre of Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo
Interests: epidemiology; biostatistics; bias; melanoma; ultraviolet radiation; lifestyle

Special Issue Information

Dear Colleagues,

Studying the epidemiology of melanoma is a tricky endeavour as the risk of developing melanoma depends on environmental factors, host factors, lifestyle factors, genetic factors and their interactions. Among the environmental factors, exposure to ultraviolet radiation from the sun plays the most prominent role, but also other environmental factors, such as chemical exposures, may increase melanoma risk. Host factors like the skin phenotype and the number as well as the type of nevi are well established as risk factors for melanoma, but other factors are also discussed for which the evidence is less clear. Lifestyle factors such as exposure to artificial ultraviolet radiation when using sunbeds have been shown to be associated with melanoma risk. A variety of genetic factors including high-penetrant genes, moderate-risk genes, and low-risk genetic polymorphisms have been linked to melanoma development. The effects of the complex interplay between all these factors are an evolving area of current research. In addition, the effect of preventive measures to reduce the risk of melanoma is also a topic of specific interest in the current research. This Special Issue invites papers on all these aspects of melanoma epidemiology. The focus lies on environmental factors and their prevention, but other related topics may also be considered. Not only papers reporting original data from epidemiologic studies, but also systematic reviews and meta-analyses are welcome.

Prof. Dr. Olaf Gefeller
Prof. Dr. Marit B. Veierød
Guest Editors

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Keywords

melanoma
epidemiology
prevention
environmental exposure
ultraviolet radiation

Published Papers (5 papers)

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Research

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13 pages, 316 KiB

Open AccessArticle

Clinical Characteristics in Early Childhood Associated with a Nevus-Prone Phenotype in Adults from Tropical Australia: Two Decades of Follow-Up of the Townsville Preschool Cohort Study

by Ramez Barsoum and Simone L. Harrison

Int. J. Environ. Res. Public Health 2020, 17(22), 8680; https://doi.org/10.3390/ijerph17228680 - 23 Nov 2020

Cited by 3 | Viewed by 2379

Abstract

Having numerous melanocytic nevi increases melanoma risk. Few studies have enumerated nevi in children and re-examined them as adults. We aimed to determine if childhood nevus-counts predict nevus-prone adults, and further explore the relevance of host-factors and sun-exposure. Fifty-one Caucasian residents of Townsville (19.16° S, Queensland, Australia) had full-body nevus-counts aged 1–6 and 21–31 years-old. Sun-exposure was determined from questionnaires. Children in the upper-quartile of nevus-counts acquired nevi more rapidly than those in the bottom-quartile (13.3 versus 4.7 nevi/year; p < 0.0005). Children sunburnt before 7 years-old acquired more incident nevi by adulthood (238 versus 126, p = 0.003) particularly if sunburn was severe (321 versus 157.5, p = 0.003) or erythema occurred annually (380 versus 132, p = 0.008). Fair-skinned, freckled children with some nevi ≥ 3 mm, solar lentigines, or a family history of melanoma acquired more incident nevi than children without these attributes. Nevus-prone adults exhibit distinguishing features earlier in life (<7 years-old in Queensland) than has been shown previously. In addition to intervening with sun-protection counselling early enough to reduce risk, being able to reliably triage children into high- and low melanoma-risk groups may inform more efficacious and cost-effective targeted-screening in melanoma-prone populations. Further longitudinal research is needed to confirm that these attributes can reliably separate risk-groups. Full article

(This article belongs to the Special Issue Melanoma Epidemiology: Analytical Studies, Systematic Reviews and Meta-Analyses Addressing Environmental Risk Factors and Preventive Measures)

9 pages, 309 KiB

Open AccessArticle

Validation of SEPI in German—A German Translation of the Sun Exposure and Protection Index

by Elias Karlsson, Inga-Marie Hübner, Daniela Haluza and Magnus Falk

Int. J. Environ. Res. Public Health 2020, 17(17), 6172; https://doi.org/10.3390/ijerph17176172 - 25 Aug 2020

Cited by 4 | Viewed by 2295

Abstract

The Sun Exposure and Protection Index (SEPI) is a brief instrument for scoring of sun exposure habits and propensity to increase sun protection, previously validated in English and in Swedish, as well as in two different outdoor sun intensity environments (Australia and Northern Europe). The aim of the present study was to study reliability and validity of a German translated version of the SEPI to be used in German-speaking populations. Data was collected at University of Flensburg and at Hamburg University of Applied Sciences from November 2018 to April 2019. Participants (n = 205) filled out the SEPI and also a selection of corresponding questions from the Austrian Vienna UV Questionnaire in German. After three weeks, the participants filled out the SEPI once again in order to assess test–retest stability. Of the 205 participants completing the baseline questionnaire, 135 participants completed it once again after three weeks. Internal consistency, by Cronbach’s alpha, for the baseline responses was 0.70 (95% C.I: 0.63–0.76) for SEPI part 1 (sun exposure habits) and 0.72 (95% C.I: 0.66–0.78) for part 2 (propensity to increase sun protection). Test–retest stability was high, with weighted Kappa >0.6 for all items but one, and the instrument correlated well with the previously validated German-language UV Skin Risk Survey Questionnaire. In conclusion, the German version of SEPI can reliably be used for mapping of individual sun exposure patterns. Full article

(This article belongs to the Special Issue Melanoma Epidemiology: Analytical Studies, Systematic Reviews and Meta-Analyses Addressing Environmental Risk Factors and Preventive Measures)

11 pages, 1251 KiB

Open AccessArticle

Trends in Tanning Bed Use, Motivation, and Risk Awareness in Germany: Findings from Four Waves of the National Cancer Aid Monitoring (NCAM)

by Katharina Diehl, Tatiana Görig, Rüdiger Greinert, Eckhard W. Breitbart and Sven Schneider

Int. J. Environ. Res. Public Health 2019, 16(20), 3913; https://doi.org/10.3390/ijerph16203913 - 15 Oct 2019

Cited by 16 | Viewed by 3652

Abstract

Indoor tanning is an important risk factor for the development of melanoma and non-melanoma skin cancer. With our nationally representative monitoring, we aimed at describing tanning bed use, user characteristics, reasons for use, and risk awareness over time. In the framework of the National Cancer Aid Monitoring (NCAM), we collected representative data on 12,000 individuals aged 14 to 45 years in annual waves of n = 3,000 participants in Germany between 2015 and 2018. We used descriptive statistics and chi²-tests to uncover group differences. To compare data from the different waves, we calculated confidence intervals. The use of tanning beds decreased from 2015 (11.0%, 95%-CI: 9.9%–12.1%) to 2018 (8.8%, 95%-CI: 7.8%–9.8%). However, this decrease did not affect all subgroups. For instance, there was an (non-significant) increase in minors and the prevalence remained stable for individuals with immigrant background and males. Attractiveness was an important reason for tanning bed use in each wave. Over time, there was an increase in medical-related reasons for use. Furthermore, monitoring showed a decrease in risk awareness regarding tanning bed use and ultraviolet (UV) radiation. While it is a positive development that the overall use of tanning beds in Germany has decreased over time, the increasing use by minors despite the legal ban is alarming. Due to the declining risk awareness it is necessary to implement prevention and education campaigns specifically targeted at this group. Full article

(This article belongs to the Special Issue Melanoma Epidemiology: Analytical Studies, Systematic Reviews and Meta-Analyses Addressing Environmental Risk Factors and Preventive Measures)

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Review

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17 pages, 1717 KiB

Open AccessReview

The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review

by Annkathrin Hornung, Theresa Steeb, Anja Wessely, Titus J. Brinker, Thomas Breakell, Michael Erdmann, Carola Berking and Markus V. Heppt

Int. J. Environ. Res. Public Health 2021, 18(4), 1726; https://doi.org/10.3390/ijerph18041726 - 10 Feb 2021

Cited by 26 | Viewed by 3648

Abstract

Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow’s index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of n = 12,082 (range 100–4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow’s thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains “flow and timing” and “reference standard”. The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma. Full article

(This article belongs to the Special Issue Melanoma Epidemiology: Analytical Studies, Systematic Reviews and Meta-Analyses Addressing Environmental Risk Factors and Preventive Measures)

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24 pages, 2112 KiB

Open AccessReview

Risk Prediction Models for Melanoma: A Systematic Review on the Heterogeneity in Model Development and Validation

by Isabelle Kaiser, Annette B. Pfahlberg, Wolfgang Uter, Markus V. Heppt, Marit B. Veierød and Olaf Gefeller

Int. J. Environ. Res. Public Health 2020, 17(21), 7919; https://doi.org/10.3390/ijerph17217919 - 28 Oct 2020

Cited by 15 | Viewed by 3112

Abstract

The rising incidence of cutaneous melanoma over the past few decades has prompted substantial efforts to develop risk prediction models identifying people at high risk of developing melanoma to facilitate targeted screening programs. We review these models, regarding study characteristics, differences in risk factor selection and assessment, evaluation, and validation methods. Our systematic literature search revealed 40 studies comprising 46 different risk prediction models eligible for the review. Altogether, 35 different risk factors were part of the models with nevi being the most common one (n = 35, 78%); little consistency in other risk factors was observed. Results of an internal validation were reported for less than half of the studies (n = 18, 45%), and only 6 performed external validation. In terms of model performance, 29 studies assessed the discriminative ability of their models; other performance measures, e.g., regarding calibration or clinical usefulness, were rarely reported. Due to the substantial heterogeneity in risk factor selection and assessment as well as methodologic aspects of model development, direct comparisons between models are hardly possible. Uniform methodologic standards for the development and validation of risk prediction models for melanoma and reporting standards for the accompanying publications are necessary and need to be obligatory for that reason. Full article

(This article belongs to the Special Issue Melanoma Epidemiology: Analytical Studies, Systematic Reviews and Meta-Analyses Addressing Environmental Risk Factors and Preventive Measures)

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