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New Study Identifies Five Risk Factors Linked to Melanoma Detection

Since its inception in 1985, the American Academy of Dermatology’s (Academy) National Melanoma/Skin Cancer Screening Program has screened more than 1.7 million people and detected more than 171,200 suspicious lesions. More than 20,000 of these lesions were suspected melanomas – the most serious form of skin cancer. Now, a new study published online today in the Journal of the American Academy of Dermatology suggests criteria to help gauge a person’s melanoma risk and identify those that may be most in “HARMM’s” way. The full text of the article can be found at http://www.eblue.org.

Dermatologist Darrell S. Rigel, MD, FAAD, clinical professor of dermatology at New York University Medical Center in New York, NY, and his colleagues analyzed the Academy’s screening data from 2001-2005 in order to identify factors associated with melanoma detection in patients where melanoma was suspected. The study, entitled “Risk Factors for Presumptive Melanoma in Skin Cancer Screening: American Academy of Dermatology National Melanoma/Skin Cancer Screening Program Experience 2001-2005,” discovered five factors that independently increased the likelihood of suspected melanomas.

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Dr. Rigel suggested the use of the acronym HARMM to identify the following five factors associated with increased melanoma detection: History of previous melanoma; Age over 50; Regular dermatologist absent; Mole changing; and Male gender.

“In examining the data collected from the Academy’s skin cancer screening enrollment form and the suspected lesions identified during the skin exam, we found that individuals at highest risk for melanoma – who had four or five of our identified risk factors – comprised only 5.8 percent of the total population, yet they accounted for 13.6 percent of the program’s probable melanoma findings,” said Dr. Rigel. “Interestingly, these people also were 4.4 times more likely to be diagnosed with suspected melanomas than individuals at lowest risk, with zero or only one risk factor.”

Data from a total of 364,804 individuals between the ages of 18 and 100 were included in Dr. Rigel’s review of the Academy’s skin cancer screening program over the five-year period. All individuals participating in the free screenings were required to complete a one-page form with basic demographic and melanoma risk-related questions before being examined by a dermatologist. Of those screened, melanomas were suspected upon initial clinical diagnosis in 0.9 percent of patients.

Although women made up the majority (61.8 percent) of people attending screenings, they only accounted for 53.9 percent of the total suspected melanomas identified. However, men over 50 comprised only 23.4 percent of the screening population, yet accounted for 31.6 percent of the total suspected melanomas identified.

The data for the suspected melanoma diagnoses were categorized into sub-groups based on the number of risk factors identified – from zero to one, two, three, or four to five. When the data was re-analyzed to evaluate the association between the number of risk factors present and suspected melanoma, 98 percent of the study population had at least one risk factor, 75.4 percent had two or more risk factors, 32.7 percent had three or more risk factors, and 5.8 percent had four or five risk factors. The data demonstrated that having additional risk factors corresponded to a significantly increased likelihood of suspected melanoma.

In addition, individuals who received a total skin examination during the screening were more likely to be diagnosed with suspected melanoma than those who received a specific lesion examination or a face and arms examination. However, there was a decrease in the proportion of total skin examinations given to each group of subsequently higher risk patients, as only 53.7 percent of those with four or five risk factors received total skin examinations – compared with 62.5 percent of those with zero or only one risk factor.

“The inverse relationship observed between the rate of total skin examinations and the level of individual melanoma risk is troubling, and indicates an area that should be addressed in improving melanoma detection in future skin cancer screenings,” added Dr. Rigel. “The total skin examination is an integral part of this equation and should be strongly encouraged for those individuals who have multiple melanoma risk factors.”

Early detection of melanoma is critical to effectively treat this potentially fatal disease that accounts for nearly 75 percent of all skin cancer deaths. In 2007, there will be about 108,230 new cases of melanoma – 48,290 in situ (noninvasive) and 59,940 invasive (33,910 men and 26,030 women). At current rates, a person has a one in 33 chance of developing melanoma (both in situ and invasive).

The Academy urges everyone to examine their skin regularly. This means looking over your entire body including your back, your scalp, the soles of your feet, between your toes and the palms of your hands. If there are any changes in the size, color, shape or texture of a mole, the development of a new mole, or any other unusual changes in the skin, see your dermatologist immediately.

“One of the key findings of our study demonstrates that not having a regular dermatologist independently increases the likelihood of suspected melanoma,” said Dr. Rigel. “While studies have shown that physicians diagnose thinner lesions better than their patients alone can, it also has been demonstrated that dermatologists can more accurately diagnosis pigmented lesions than primary care physicians and that involving dermatologists in melanoma patient management led to significantly improved survival rates.”

In addition to performing self-examinations, the Academy encourages people to be screened for skin cancer. Through the Academy’s National Melanoma/Skin Cancer Screening Program, volunteer dermatologists provide free skin cancer screenings in their communities. The public can visit http://www.aad.org to find a free skin cancer screening in their area.

“This study reaffirms that men over 50 are at an increased risk of melanoma,” stated Dr. Rigel. “If they have a changing mole, it’s important that they see a dermatologist.”

May is Melanoma Monday® and the official launch of Melanoma/Skin Cancer Detection and Prevention Month®. For more information about skin cancer, please visit www.skincarephysicians.com and click on “SkinCancerNet.”

The American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or http://www.aad.org.

(SOURCES: David Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Larry Deeb, M.D., president, Medicine & Science, American Diabetes Association, Alexandria, Va.; May 5, 2007, presentation, Pediatric Academic Societies annual meeting, Toronto)

SATURDAY, May 5 (HealthDay News) -- In another sign of the alarming childhood obesity epidemic in the United States, researchers report a 200 percent increase in the number of children hospitalized for type 2 diabetes.

Type 2 diabetes, which used to be called adult onset diabetes because it was rarely seen in children, is typically diagnosed in patients who are overweight. Left untreated, it can lead to such complications as heart disease, blindness, nerve damage and kidney damage.

The dramatic increase in pediatric type 2 diabetes occurred nationwide between 1997 and 2003, according to the study by researchers at New York University School of Medicine.

"The rapid rise in childhood obesity is now common knowledge," said Dr. David Katz, director of Yale University School of Medicine's Prevention Research Center, who was not involved in the study. "Increasingly, so is the concurrent rise in type 2 diabetes in children -- a generation ago, this condition did not exist. What is now called type 2 diabetes was called adult onset diabetes until quite recently."

"Epidemic childhood obesity has transformed a chronic disease of mid-life into a pediatric scourge," Katz added.

For the study, Dr. Rhonda Graves, a pediatrician, and her colleagues used data from nationwide hospital discharge records from 1997, 2000 and 2003. They compared the trends in hospitalization rates, length of stay and costs for children with type 2 diabetes and type 1 diabetes.

They found that rates of hospitalization for type 1 diabetes increased 15 percent between 1997 and 2003, while rates of hospitalizations for type 2 diabetes increased 200 percent.

"These findings, based on hospital records of a nationally representative sample of hospitals in the U.S.A., indicate that type 2 diabetes is increasingly becoming a pediatric illness that results in hospitalizations. It is associated with a very serious number of co-morbidities and complications which may have profound health implications both in childhood and in adulthood," Graves said in a prepared statement.

Graves' team also found that hospitalizations for type 2 diabetes were 1.3 times more likely for boys than girls. Children 9 to 12 years old had the highest rates of hospitalization.

The researchers also found that black, Hispanic and Native American children were at greatest risks of increasing hospitalizations.

The researchers also found that children hospitalized for type 2 diabetes were hospitalized longer than children with type 1 diabetes. Type 1 diabetes is a disease caused by the body's inability to produce insulin, and it's not related to obesity. Insulin is a hormone that converts blood sugar to energy for cells.

The findings were expected to be presented Saturday at the annual meeting of the Pediatric Academic Societies, in Toronto.

"The dramatic increase in hospitalizations for type 2 diabetes in children reported here confirms this trend and further demonstrates that it affects ethnic minorities disproportionately," Katz said.

The National Cholesterol Education Program considers diabetes such a potent risk factor for heart disease that, in adults, treatment guidelines essentially equate the two, Katz noted.

"There is no reason to think this will be any different in children. If 7- and 8-year-olds can get adult onset diabetes, 17- and 18-year-olds can start getting heart disease. I personally know of a 17-year-old boy, with early onset obesity and type 2 diabetes, who has already had a triple coronary bypass. If current trends persist, cases like his could become the rule rather than the rare and terrible exception," Katz said.

Graves thinks much more needs to be done prevent obesity in children.

"As pediatricians, we must learn to recognize the signs and symptoms of type 2 diabetes, and, in turn, educate the next generation of young physicians to be aware of this ever-growing epidemic and how best to prevent and treat it," she said. "Equally important is our duty to further explore the mechanisms causing health disparities in this new and profoundly serious child health problem."

One expert, however, thinks that this striking increase in hospitalization for children with type 2 diabetes needs to be viewed with some skepticism.

"There is a side of me that wonders if these children were diagnosed correctly," said Dr. Larry Deeb, the president for medicine and science at the American Diabetes Association. "Type 2 diabetes is rare in 9- to 12-year-olds. That's the age group that has the highest incidence of type 1 diabetes."

Deeb, a pediatric endocrinologist, noted that type 2 diabetes wasn't recognized until 1997. "The increase in type 2 diabetes seen here may be a function of more recognition rather than more of it," he said.

More information

For more information on type 2 diabetes, visit the American Diabetes Association.

Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:

• Right away, your cells may be starved for energy.
• Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.

Finding out you have diabetes is scary. But don't panic. Type 2 diabetes is serious, but people with diabetes can live long, healthy, happy lives.

While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.Your Body's Well Being
Make it a priority to take good care of your body. The time you spend now on eye care, foot care and skin care, as well as your heart health and oral health, could delay or prevent the onset of dangerous type 2 diabetes complications later in life. Plus, some of the best things you can do for your body are to stop smoking, and reduce the amount of alcohol you drink.

Common Concerns
This section addresses various areas to help you live with type 2 diabetes. What do you do when you're sick? What do you do when you travel? Can you get a flu shot with diabetes? How do you cope with having type 2 diabetes? Are you being discriminated against because you have diabetes? You'll find answers to these questions, and more in this section.

Ask the Pharmacist
The American Diabetes Association and Rite Aid "Ask the Pharmacist" area is where you can ask a pharmacist a question to help you manage your diabetes. Rite Aid and the ADA have partnered to allow you to access to Rite Aid's Drug Information Center from our Web site.

Women and Diabetes
Learn how to ensure your own health and well-being.

Health Information For Men
Learn how to ensure your own health and well-being.

Related Links

• Want to learn more about diabetes? Visit the Healthy Body Healthy Mind Web site and click on the link for "diabetes."  Dr. Nathaniel Clark, Vice President of Clinical Affairs for the Association, and Dr. James Gavin, former president of the Association, joined other diabetes experts to share their insight on diabetes.
  
  
• Physician Recognition Program
  This Recognized Physician Directory helps individuals find doctors who have demonstrated they meet important standards of care.
  
  
• Education Recognition Program
  The following diabetes education programs in your area are Recognized by the American Diabetes Association. These Recognized programs meet the National Standards for excellence in diabetes education.