Archive for October, 2012
This article, although quite obvious really, has just been published. The interesting thing is how naevi on the back were not associated with increased risk.
J Eur Acad Dermatol Venereol. 2012 Sep;26(9):1092-6. doi: 10.1111/j.1468-3083.2011.04213.x. Epub 2011 Aug 16.
Melanocytic naevi and basal cell carcinoma: is there an association?
Cancer and Population Studies Unit, Queensland Institute of Medical Research School of Life Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Melanoma and basal cell carcinoma (BCC) affect similar body sites and share a complex relationship with sun exposure.
To establish the existence and magnitude of association between melanocytic naevi, the strongest predictors of melanoma, and BCC to give possible insights into shared pathways of solar ultraviolet tumourigenesis.
In a community-based longitudinal Australian study, detailed information was collected about sun sensitivity, and dermatologists assessed skin colour and counted naevi on the forearms (1986) and back (1992). The BCC frequency and sites were prospectively monitored until 2007. Multivariate logistic regression was used to assess the association of naevi on the forearms or on the back with the development of BCC, adjusting for other risk factors.
Of 1621 study participants in 1992, 1339 (average age 49) had complete follow-up and 401 (30%) of these had 1202 histologically confirmed BCCs until 2007. After adjustment for age, gender, skin colour, naevi on the back and sun exposure, overall BCC risk increased significantly in those with forearm naevi (odds ratio: 1.5; 95% confidence intervals: 1.1-1.9). Risk of BCC specifically on the back was doubled in those with many (11 or more) forearm naevi compared with no forearm naevi (odds ratio: 2.4; 95% confidence interval: 1.1-4.8). Naevi on the back were not associated with subsequent basal cell carcinoma.
High naevus prevalence on the arms is associated with future BCC development.
I had previously heard of this but have never really come across a lot of patients with both Parkinson’s and melanoma. Has anyone?
Parkinson Disease and Melanoma May Share a Genetic Link
Reciprocal predispositions of parkinsonism and cancer demonstrate a strong association between these conditions.
Persons with Parkinson disease (PD) have a lower than expected prevalence of most cancers, but melanoma is an exception. Several studies have found an elevated risk for malignant melanoma in PD patients. A reciprocal increased risk for PD has been reported in melanoma patients and their first-degree relatives, suggesting a common genetic or environmental link. Researchers used the Utah Cancer Registry and the Utah Population Database, which contains birth, death, and family relationship data of more than 2 million individuals, dating back in some instances 15 generations, to assess associations between PD and cancer subtypes.
Among 388,221 individuals with a recorded cause of death and at least three generations of genealogic data, 2998 had PD as a cause of death, and 48 of these had melanoma, versus an expected rate of 24.6 (relative risk, 1.95; 95% confidence interval, 1.44–2.59). Statistically significant excess risk for melanoma was found in the first- and second-degree relatives of those with PD-related deaths. Among 7841 individuals with a melanoma diagnosis and at least three generations of genealogy, the researchers found significantly increased risk for PD-related death in the melanoma cases (RR, 1.65; 95% CI, 1.22–2.19) and in their first-, second-, and third-degree relatives. Prostate cancer was the only other cancer observed in excess in those with PD-related death. Among those with PD-related deaths, men had significantly fewer than expected lung, pancreas, and stomach cancers, and colon cancers were significantly decreased in women. The authors conclude that the findings in this study strongly support the hypothesis of a common genetic link between PD and melanoma.
Comment: This study adds further genetic evidence of a link between Parkinson disease and melanoma. The strength of this association is indicated by the finding of an increased risk in both directions: an increased risk for melanoma among PD patients and vice versa. I personally have several patients who have been diagnosed with both conditions, and the question of Sinemet treatment invariably surfaces at some point. Because PD patients tend to be older, quality of life becomes a real issue for them. I typically balance the risk of their melanoma with disability if Sinemet is discontinued. If they remain on the drug, careful melanoma follow-up is certainly indicated.
Published in Journal Watch Dermatology September 28, 2012
Kareus SA et al. Shared predispositions of parkinsonism and cancer: A population-based pedigree-linked study. Arch Neurol2012 Sep 3; [e-pub ahead of print]. (http://dx.doi.org/10.1001/archneurol.2012.2261)