PracticeUpdate: Dermatology & Rheumatology

AMERICAN ACADEMY OF DERMATOLOGY 73RD ANNUAL MEETING 12

Melanoma diagnosed earlier from 2001 through 2011 Early detection of melanoma improved significantly, as measured by stage at diagnosis, over the decade 2001–2011, report results of a crossover registry study.

G iselle Prado, BS, of the Herbert Wertheim College of Medicine, Florida International University, Miami, explained that it is estimated that over 73,000 new cases of melanoma will be diagnosed in the US this year. While melanoma accounts for less than 2% of skin cancer cases, it will account for most skin cancer related deaths. Early detection of this highly aggressive cancer is the cor- nerstone of treatment. “We undertook this study,” said Ms Prado, “because we know that melanoma incidence has been increasing. It’s important to implement public health programs that help increase early detection. Excising a superficial melanoma is much simpler than dealing with the morbidity and mortality associated with higher stages of melanoma. In addition, rising healthcare costs are another important reason to detect melanomas at an early stage.” Ms Prado and colleagues employed data from 18 registries reporting to the Surveillance, Epidemiology, and End Re- sults (SEER) program from 2001–2011. They performed multivariate logistic regression to obtain unadjusted and adjusted associations between year of diagnosis and stage at the time of diagnosis (in situ/localised vs regional/distant). Demographic traits, age at diagnosis, primary site, laterality, histologic subtype, and tumour size were used as predictors. A total of 115,913 cases of melanoma were identified from 2001–2011. Men constituted 56.6%. Age at diagnosis was evenly split between persons 40-64 years of age (45.4%) and those >65 years of age (43.4%). Primary site was distributed as follows: head and face 28.1%, trunk 29.8%, upper limb 25.0%, and lower limb 17.0%. More primary melanomas were located on the left side (51.8%).

Most cases were in situ or localised (92.5%) versus regional and distant (7.5%). A significant unadjusted association was observed be- tween year and stage of diagnosis (odds ratio 0.95, 95% CI 0.95–0.96). After adjusting for sex, age at diagnosis, primary site, and histology code subtype, the significant association between year of diagnosis and stage remained (odds ratio 0.94, 95% CI 0.93–0.95). Adjusted analysis also demonstrated that females were less likely to be diagnosed at a higher stage than men (odds ratio 0.69, 95% CI 0.65–0.73). Persons >65 years of age were more likely to be diagnosed with regional and distant cancer (odds ratio 1.24, 95% CI 1.13–1.35) than those age 18–39 years. Melanomas located on the trunk (odds ratio 0.77, 95% CI 0.71 - 0.82) and upper limb (odds ratio 0.64, 95% CI 0.60–0.69) were less likely to be a higher stage than those located on the face and head. Nodular melanoma was more likely to be widespread at diag- nosis than superficial spreading melanoma (odds ratio 10.63, 95% CI 9.77–11.57). Acral lentiginous melanoma was more likely to be staged higher (odds ratio 6.75, 95% CI 5.70–8.00). Ms Prado said that early detection improved significantly as measured by stage at diagnosis. Men and older patients were more likely to be diagnosed at a higher stage. Education and interventions aimed at early detection are critical to reduce the incidence of regional and distant melanoma. “In the future,” she said, “we need more studies detailing exactly why earlier detection occurred over this time period, whether it was increased awareness, increased surveillance by dermatologists, or other factors.”

Over a third of emergency department patients admitted for cellulitis are misdiagnosed Over a third of patients admitted through the emergency department with a diagnosis of cellulitis were misdiagnosed, outcome of a retrospective chart review performed in a large urban hospital show. A dam B. Raff, MD, PhD, of Harvard Medical School, Boston, Massa- chusetts, explained that cellulitis is

emergency department costs. Cellulitis is frequently misdiagnosed due to numerous clinical entities with similar pres- entations, so-called pseudocellulitis, such as chronic venous stasis. Thirty to ninety percent of patients referred to an inpatient dermatologist for presumed severe lower limb cellulitis were misdiagnosed in a study. In an effort to better characterise the overall

impact of misdiagnosis, Dr Raff and col- leagues analysed of the healthcare burden of pseudocellulitis, including delay of effective care, inappropriate use of antibiotics, unnec- essary hospital admissions, complications, and increased medical costs. Dr Raff said, “I was challenged by patients I was seeing as an inpatient dermatologist. Many patients referred to me for cellulitis

a common diagnosis, with 2.3 million visits annually to the emergency department and an estimated at 15.2% admission rate. Cel- lulitis accounts for 10% of infectious disease – related US hospitalisations. Cellulitis ac- counted for US$3.7 billion in outpatient and

PRACTICEUPDATE RHEUMATOLOGY & DERMATOLOGY