Skin in the game: The cost consequences of skin cancer diagnosis, treatment and care in Northern Ireland.

Background: Skin cancer is a prevalent cancer in the UK. Its rising incidence and mortality rates are expected to result in substantial financial implications, particularly on diagnostic and treatment services for skin cancer management in Northern Ireland (NI). Such anticipated disease increases underscore the need for prevention and control measures that should help guide policymaking and planning efforts.

Improving descriptive terminology using a descriptive algorithm as an educational intervention to improve referral accuracy.

The accuracy of clinical communication in referrals to dermatology has not been fully explored. Baseline analysis of inpatient ward referral to a dermatology service revealed that only 37% of referrals used accurate descriptive terminology. Theme analysis of individual descriptive terms used was performed to assess knowledge deficits and develop a novel intervention to improve descriptive accuracy.

Beta-blocker usage after malignant melanoma diagnosis and survival: a population-based nested case-control study.

Background: Beta-blockers have potential antiangiogenic and antimigratory activity. Studies have demonstrated a survival benefit in patients with malignant melanoma treated with beta-blockers.

Objectives: To investigate the association between postdiagnostic beta-blocker usage and risk of melanoma-specific mortality in a population-based cohort of patients with malignant melanoma.

A family with Fabry disease diagnosed by a single angiokeratoma.

This case presents a 39-year-old gentleman with a single angiokeratoma on the abdomen. Because of a family history of early onset cardiac disease, testing for Fabry disease was performed and a mis-sense mutation (A143T) in the Fabry gene confirmed the diagnosis. The unusual aspect of this case is that the patient otherwise had normal health.

Second primary cancers in patients with skin cancer: a population-based study in Northern Ireland.

Among all 14,500 incident cases of basal cell carcinoma (BCC), 6405 squamous cell carcinomas (SCC) and 1839 melanomas reported to the Northern Ireland Cancer Registry between 1993 and 2002, compared with the general population, risk of new primaries after BCC or SCC was increased by 9 and 57%, respectively. The subsequent risk of cancer, overall, was more than double after melanoma.

Aminolaevulinic acid diffusion characteristics in 'in vitro' normal human skin and actinic keratosis: implications for topical photodynamic therapy.

Background: The response rate of aminolaevulinic acid (ALA)-based photodynamic therapy (PDT) in certain subtypes of actinic keratosis (AK), such as hypertrophic and hyperkeratotic lesions, is variable, an effect attributable to a supposed lack of ALA penetration. A detailed and depth-related profile of spatial ALA permeation in AK following drug administration would lead to a greater understanding of concentrations achievable before protoporphyrin IX biosynthesis and subsequent PDT.

Methods: ALA penetration through excised normal human skin (NS) and AK lesions was evaluated using a cryostatic sectioning technique and radio-isotope counting following drug delivery using a novel, bioadhesive patch, loaded with 19, 38 or 50 mg/cm(2) ALA.

Reliability testing of a sun exposure questionnaire for the Northern Ireland population.

Background: Sunbathing and other types of exposure to ultraviolet radiation are the major preventable risk factors for skin cancer. Due to the continued increase in incidence of melanoma in Northern Ireland, we have conducted a questionnaire survey in an attempt to gather information about sunbathing habits and other forms of ultraviolet light exposure amongst the Northern Ireland population.

Aim: The aim of this study was to examine the test-retest reliability of a questionnaire used in a large-scale cross-sectional population survey pertaining to sunbathing habits, use of sun screen, skin types, and frequencies of sunburn and to assess the responses given by the subjects to determine the nature of their sun-related behaviour.

Skin cancer trends in Northern Ireland and consequences for provision of dermatology services.

Background: The incidence of skin cancer, both melanoma and nonmelanoma skin cancer (NMSC), is rising throughout the world. The evaluation of trends in skin cancer will allow better planning of the future development of skin cancer services.

Objectives: Using data collected from the Northern Ireland Cancer Registry (NICR), the incidence of the three major cutaneous cancers, basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM), was determined and the workload associated with their management assessed.

Follow-up of basal cell carcinomas: an audit of current practice.

Background: Follow-up of patients after treatment of basal cell carcinoma (BCC) allows for monitoring of recurrence and detection of new tumours, but adds a significant burden to outpatient clinics. At the skin tumour clinic in the dermatology department, the Royal Hospitals, Belfast, all patients are reviewed for 2 years after surgical excision of a low-risk primary BCC.

Objectives: An audit was undertaken to determine the quality of data set recorded relating to prognostic factors for BCCs to determine the rate of recurrence and number of new primary tumours detected and to determine the completeness of follow-up by patients.

Knowledge, attitudes and behaviour in the sun: the barriers to behavioural change in Northern Ireland.

To inform future health promotion programmes, we studied the knowledge, attitudes and behaviour of the Northern Ireland population to sun care. An interviewer-administered questionnaire was applied to one adult per household from a random sample of 1242 addresses. Lower levels of knowledge were found among respondents who were male, aged under 25 years or over 65 years, in a manual occupation or living in the west where health promotion activity on this topic was less active than in the east.

Improved survival for melanoma in Northern Ireland: a comparison of two 5-year periods (1984-88 and 1994-98).

Background: The incidence of cutaneous malignant melanoma has been rising steadily in Caucasian populations for several decades, with a doubling time of 10-14 years. An increase in incidence of about 5% per year has been reported in most Caucasian populations since the early 1960s.

Objectives: This study was designed to determine the changing incidence of primary cutaneous malignant melanoma in Northern Ireland and to examine changes in survival rates from cutaneous malignant melanoma in two 5-year periods, 1984-88 and 1994-98.

Association between long-term acitretin therapy and osteoporosis: no evidence of increased risk.

Osteoporosis has been observed with chronic hypervitaminosis A, leading some authors to hypothesize that systemic retinoids may have an effect on bone mineral density. Two previous small studies identified osteoporosis in patients who received long-term therapy with etretinate. Etretinate has now been superceeded by acitretin in clinical use.

Clinical and histologic trends of melanoma.

Background: Several changing clinical and histopathologic melanoma trends occurred from the 1950s to the 1980s.

Objective: The purpose of this study was to evaluate melanoma trends during the past decade and to compare present trends to those documented during the past four decades.

Methods: Sex, age at diagnosis, location, tumor thickness, stage, and histologic subtypes were evaluated from 1984 to 1995 and compared with trends during the past four decades.

Pyoderma gangrenosum of the breast treated with low-dose cyclosporin A.

Pyoderma gangrenosum (PG) is a painful chronic ulcerative skin disorder often occurring in association with systemic disease. It typically affects the lower limbs, but may also involve other sites, or sometimes develop after trauma of surgical procedures. We report the case of a woman with rheumatoid arthritis who developed disfiguring and severe PG of the right breast, a rare site, following biopsy for a benign breast lesion, and who was subsequently successfully treated with low-dose cyclosporin A.