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Biomedical subjects

Martin A Weinstock

Publications and source records attributed to Martin A Weinstock.

At least 37 records · Page 2Linked to original sources
PubMed2004

The Framingham school nevus study: a pilot study.

OBJECTIVES: To (1). describe nevus patterns using digital photography and dermoscopy; (2). evaluate the relationship between host and environmental factors and prevalence of nevi in schoolchildren; and (3). demonstrate the feasibility of conducting a longitudinal study. DESIGN: Cross-sectional survey and 1-year prospective follow-up study. PARTICIPANTS: Students from 2 classrooms, grades 6 and 7, in the Framingham, Mass, school system (N = 52). MAIN OUTCOME MEASURES: A survey was completed by students and 1 of their parents that included questions on demographic and phenotypic characteristics, family history of skin cancer, and sun exposure and protection practices. An examination of nevi on the back was performed that included digital photography and digital dermoscopy. Follow-up child and parent surveys and examinations were conducted at 1-year follow-up. RESULTS: At baseline, the median number of back nevi was 15 (mean [SD], 21.9 [15.3]). Older age, male sex, fair skin, belief that a tan is healthier, tendency to burn, and sporadic use of sunscreen were positively associated with mole count, although age was the only statistically significant factor. Predominant dermoscopic patterns for the index nevus were as follows: 38% globular, 14% reticulated, 38% structureless, and 10% combinations of the above patterns with no predominant characteristic. The overall participation rate from baseline to follow-up was 81% (42/52) for the skin examination process. At the 1-year follow-up examination, new nevi were identified in 36% of students (n = 15), while 9.6% of baseline index nevi had changes in the dermoscopic pattern. Dominant dermoscopic pattern was related to nevus size: smaller nevi tended to be structureless, while larger nevi were of mixed pattern. CONCLUSION: This study supports the feasibility and utility of digital photography and dermoscopy for the longitudinal study of nevus evolution in early adolescence.

Adolescent↗
PubMed2004

Nonmelanoma skin cancer mortality (1988-2000): the Rhode Island follow-back study.

OBJECTIVES: To estimate (1) the magnitude of and the components and factors associated with nonmelanoma skin cancer (NMSC) mortality and (2) the proportion of deaths misclassified as NMSC. DESIGN: Population-based follow-back study. SETTING AND PATIENTS: All Rhode Island residents whose deaths between 1988 and 2000 were attributed to NMSC. MAIN OUTCOME MEASURES: Distribution of diagnoses, verification of the causes of death, and characterization of associated factors. RESULTS: The proportion of misclassified deaths was significantly higher for nongenital NMSC (57%) than for genital NMSC (18%; P<.001). Most of the deaths misclassified as nongenital NMSC were caused by squamous cell carcinoma of mucosal surfaces. The age-adjusted NMSC mortality rate was 0.91 (per 100 000 persons per year), of which almost half (0.45) were due to genital carcinoma. Nonmelanoma skin cancer mortality increased sharply with age. The mortality rate from nongenital NMSC in men was more than twice that in women, but for genital NMSC this ratio was reversed. Skin cancers originating on the ear were responsible for more than a quarter of all deaths caused by nongenital NMSC. No cases of NMSC mortality occurred in organ transplant recipients. Many individuals had comorbid psychiatric conditions or evidence of unreasonable delay in seeking medical care for their lesions. CONCLUSIONS: Misclassifying the cause of death as nongenital NMSC accounts for a large source of error on death certificates in Rhode Island. Overall, nongenital squamous cell carcinoma and basal cell carcinoma death rates have declined, and mortality due to genital carcinoma was about half of total NMSC deaths. The dermatology community should emphasize prevention of mortality from genital skin cancer, while continuing to stress the importance of reducing excessive exposure to UV light and prompt treatment of NMSC.

Adolescent↗
PubMed2004

Sun-safe practices in U.S. youth and their parents: role of caregiver on youth sunscreen use.

BACKGROUND: There is a limited understanding of the social influences, such as the role of parents on youth sun-safe practices, that may reduce the risk of developing skin cancer later in life. METHODS: This study examined the degree of correlation in sun-safe practices between youth and their parents and assessed independent parental factors of youth sunscreen use in a 1998 cross-sectional, population-based telephone survey of U.S. youth (11- to 18-year-olds) and their parents/caregivers (N=1192 pairs of youth and parents). RESULTS: Sunscreen-use practices between youth and their parents were significantly correlated, albeit small. Youth were significantly more likely to use sunscreen frequently if their parents applied it frequently on themselves. Multivariate analysis revealed three independent parental factors associated with frequent youth sunscreen use: Their parent reported to insist frequently that the child uses sunscreen (adjusted prevalence odds ratio [aPOR]=2.4, 95% confidence interval [CI], 1.6-3.8); parent reported no difficulty with protecting their child from the sun (aPOR=1.4, 95% CI, 1.1-1.9); and parent's own frequency of sunscreen use (aPOR=1.3, 95% CI, 0.9-1.8). CONCLUSIONS: Sun-safe practices were correlated between parent-child pairs and parental factors exerted a positive role on youth sunscreen-use frequency. These data may guide further sociobehavioral and intervention research for the design of skin cancer prevention programs in schools and communities to improve levels of sun-safe practices.

Adolescent↗
PubMed2004

Addition of dermoscopy to conventional naked-eye examination in melanoma screening: a randomized study.

OBJECTIVE: We sought to assess the difference in lesion management between combined examination (naked-eye and dermoscopy) and conventional naked-eye examination in evaluations for melanoma; and to assess the impact on patient treatment of facilities for digital follow-up of diagnostically equivocal lesions. METHODS: We conducted a randomized, controlled trial at a pigmented lesion clinic in a university hospital. A total of 938 consecutive subjects presenting between November 1, 2001, and March 31, 2002, were eligible and 25 were excluded because they were younger than 12 years of age; hence 913 subjects were enrolled. Participants were randomized to combined examination with mandatory excision of equivocal lesion (arm B) and with possibility of digital follow-up according to the clinician's decision (arm C), or to conventional naked-eye examination (mandatory excision of equivocal lesion) (arm A). The same pigmented lesion clinic staff examined all subjects. RESULTS: Combined examination determined a significant reduction in the percentage of patients referred for operation (9.0% vs 15.6%) (P =.013). When facilities for digital follow-up of equivocal lesions were available, the percentage of patients classified as harboring lesions difficult to diagnose increased (group C, 35.8%; group B, 17.8%; P <.01). About half of them were immediately referred for operation whereas the remainder submitted to second examination (digital follow-up). Two melanomas (1 in situ and 1 invasive, 0.40-mm thick) were diagnosed after second examination performed 6 months later. The number of melanomas eventually excised within the study were similar among the 3 allocation groups (3, 2, and 3, respectively). CONCLUSIONS: the addition of dermoscopy to conventional naked-eye examination is associated with a significant reduction of number of pigmented skin lesions excised for diagnostic verification. The possibility of digital follow-up of equivocal lesions is associated with a not negligible occurrence of initial melanomas left unexcised until the second consultation.

Adult↗
PubMed2004

Reliability of assessment and circumstances of performance of thorough skin self-examination for the early detection of melanoma in the Check-It-Out Project.

BACKGROUND: Thorough skin self-examination (TSSE) has substantial potential to reduce melanoma mortality by early detection. METHODS: We interviewed 2,126 patients before a scheduled routine visit with a primary care physician, at which participation in a randomized trial was offered as part of the Check-It-Out Project. We asked about skin examination behavior and related issues. RESULTS: By our a priori definition of TSSE, 18% of participants performed this activity, but other definitions led to widely varying estimates of 12% to 38%. Using a partner to assist in the examination was strongly associated with TSSE. That partner was generally the spouse, and wives were more likely to assist their husbands in these examinations than the reverse. The availability of a wall mirror was a particularly important predictor of TSSE performance. Visual impairment also affected performance. CONCLUSIONS: Estimates of TSSE performance vary substantially with the questions used to elicit this information. Partners, particularly spouses, appear to play a critical role in the conduct of TSSE, and wives appear more often and more effectively engaged in this process. Appropriate circumstances, such as availability of a wall mirror, are also important factors. These findings can be used to design interventions to increase TSSE performance with the ultimate aim of reducing melanoma mortality.

Female↗
PubMed2003

Development and reliability of a brief skin cancer risk assessment tool.

This study aimed to develop and pilot test a brief skin cancer risk assessment tool (BRAT), a self-administered instrument that can be reliably used to assess skin cancer risk. To develop the BRAT, we critically reviewed published literature on risk factors; formulated a draft questionnaire; pilot tested the questionnaire; and retested 1 month later. The BRAT items address the key risk factors for melanoma and other keratinocyte skin cancers: ethnicity, personal and family history of skin cancer, mole count, freckles, childhood residence, sunburn history, and sun sensitivity factors (skin color, natural hair color, ease of sunburning and tanning). One hundred sixty-five persons completed the initial BRAT pilot study, and 52 additional people at moderate- or high-risk completed a second BRAT pilot study. Results were as follows: using a dichotomous risk measure, about 90% of subjects would be correctly classified at baseline and follow-up. Weighted kappa for the total BRAT score (0.41-0.68) and for individual items (0.57-0.99) were fair to good, as were correlation coefficients. The BRAT has acceptable to good reproducibility. Reliability statistics compared favorably with those reported in the literature for similar measures.

Adult↗
PubMed2003

The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985-1999.

BACKGROUND: In response to the precipitous increase of melanoma, the American Academy of Dermatology (AAD) has coupled melanoma/skin cancer education with free skin cancer screening programs throughout the United States since 1985. The purpose of this analysis is to investigate the risk factors, access to dermatologic services, and screening results of participants in AAD-sponsored programs during the first 15 years that this service was available to the US public. METHODS: Before screening, participants completed a standardized AAD screening form. Screening forms were counted in the AAD central office and recorded in annual summaries. Forms were sent for keypunching and returned to the AAD on a computer disk annually. In 1999, disks were sent to Boston University and a master file was created. RESULTS: Computerized records were available for 819,019 screening forms and 639,835 individuals. In all, 65% of screenees had at least 1 risk factor and 33% had at least 2 risk factors. Of screenees, 33% reported a changing mole and 37% had skin type I or II. Among all screenees, nearly 80% did not have a regular dermatologist, 78% reported no prior AAD skin cancer screening, 60% had never had their skin checked by any doctor, and 51% would not have seen a doctor for skin cancer without the free screening. Nearly 30% of screenees had a presumptive diagnosis of skin cancer or a precursor lesion. Melanomas confirmed by postscreening biopsy were more likely than those in population-based registries to be less than 1.50 mm in thickness. CONCLUSIONS: AAD national screening and educational programs have expanded to all 50 states, provided educational messages about sun protection and early detection to millions, and served many US citizens with an above average risk for skin cancer and suboptimal access to dermatologic care. Screenees had a disturbingly high point prevalence of malignant and premalignant skin lesions. Sustained commitment by the AAD leadership and membership to the screening program is critical to reducing the morbidity and mortality of skin cancer.

Adolescent↗
PubMed2002

Use of tanning devices and risk of basal cell and squamous cell skin cancers.

Use of artificial tanning devices that emit UV radiation, such as tanning lamps and tanning beds, has become increasingly popular in the United States. Although an excess risk of nonmelanoma skin cancers might be predicted from this exposure, little epidemiologic data exist. We conducted a population-based, case-control study that included 603 basal cell carcinoma (BCC) case patients, 293 squamous cell carcinoma (SCC) case patients, and 540 control subjects. Study participants were interviewed in person to obtain information on tanning device use, sun exposure history, sun sensitivity, and other risk factors for skin cancer. Overall, any use of tanning devices was associated with odds ratios of 2.5 (95% confidence interval [CI] = 1.7 to 3.8) for SCC and 1.5 (95% CI = 1.1 to 2.1) for BCC. Adjustment for history of sunburns, sunbathing, and sun exposure did not affect our results. Our findings suggest that the use of tanning devices may contribute to the incidence of nonmelanoma skin cancers. They highlight the need to further evaluate the potential risks of BCC and SCC that are associated with tanning lamp exposure and the appropriate public health response.

Adult↗
PubMed2002

The impact of the basic skin cancer triage curriculum on providers' skills, confidence, and knowledge in skin cancer control.

BACKGROUND: Primary care providers (PCPs) are in the unique position of being able to deliver preventive health care services to the majority of the general population. Early detection of skin cancer may reduce mortality, but many PCPs do not participate in skin cancer control activities due to lack of training and confidence. We sought to evaluate the effect of a 2-h, Basic Skin Cancer Triage (BSCT) curriculum in overcoming these barriers. METHODS: A convenience sample of 28 primary care providers participated in a 2-h training curriculum. Assessments included skills (evaluated by a 20-item slide quiz), confidence, knowledge, and attitudes measured pre- and post training. RESULTS: Provider ability to accurately diagnose and triage lesions significantly improved (46 to 64%, P < 0.0001, and 61 to 71%, P < 0.0001, respectively). The greatest improvement in triage ability occurred in providers ability to appropriately reassure patients about lesions (49 to 70%, P < 0.0001). There were also significant improvements in both knowledge of skin cancer control practices (68 to 74% correct answers, P = 0.026) and confidence in ability to provide skin cancer preventive services (2.95 to 4.13 on a 1 to 5 scale, P < 0.0001). CONCLUSIONS: Participation in the BSCT curriculum may improve providers' diagnostic and triage accuracy of skin cancer as well as increase their knowledge of skin cancer and confidence in their provision of skin cancer control activities. Defining the full potential impact of this curriculum requires further evaluation.

Adult↗
PubMed2002

Randomized controlled community trial of the efficacy of a multicomponent stage-matched intervention to increase sun protection among beachgoers.

BACKGROUND: Skin cancer is about as common as all other cancers combined and is preventable by sun protection. The most intense sun exposures often occur on the beach, so we chose this setting to test an intervention to affect sun protection behaviors. METHODS: We developed a multicomponent stage-matched intervention for beachgoers and evaluated its efficacy in a randomized trial for influencing stage of change and self-reported behavior. RESULTS: We randomized 2,324 persons ages 16 to 65 on the beach (83% of those approached). The intervention was effective in increasing self-reported sun protective behaviors. Effects were similar across gender and age groups. CONCLUSIONS; The beach is a good site for recruitment and intervention to prevent skin cancer in high-risk populations. Our stage-matched intervention package was effective for increasing sun protective behaviors.

Adolescent↗
PubMed2002

Patient and referring provider satisfaction with teledermatology.

BACKGROUND: Teledermatology has become more widely used, but its impact has not been clearly elucidated. We developed a teledermatology program in response to clinical need, based on the store-and-forward approach. OBJECTIVE AND METHODS: Our purpose was to evaluate the satisfaction of patient and referring physician by using telephone interview. RESULTS: Both patients and providers considered this a useful program and would recommend it to a friend or colleague. The patients were split in their overall rating of the program and its ability to treat their skin conditions. Their greatest concern was their lack of direct contact with their dermatologist. Other common concerns were waiting time and follow-up. Privacy concerns were not commonly mentioned. Providers expressed greater satisfaction than their patients. Their greatest concerns involved the inability of the program to handle the demand. CONCLUSION: The program provided a service that was valued by both patients and providers. The most common concern was the impact on the physician-patient relationship.

Dermatology↗