Study Points To Increase Of Melanoma Among Young Women

Melanoma incidence has been on the rise in Caucasians, especially women, according to a recent study published in the Journal of Investigative Dermatology. Researchers speculate that this may be due to increasing ultraviolet ray exposure.
   The authors analyzed Caucasian patients in the Surveillance, Epidemiology and End Results (SEER) Program between 1973 and 2004. Researchers calculated annual age-adjusted incidence and mortality rates of invasive cutaneous melanoma among men and women ages 15 to 39.

   Overall, the study found that the age-adjusted annual incidence of melanoma among young women increased from 5.5 per 100,000 people in 1973 to 13.9 per 100,000 in 2004. Among men, the melanoma incidence increased from 4.7 cases per 100,000 people in 1973 to 7.7 per 100,000 in 2004.
   Furthermore, the melanoma incidence among women from the 1990s onward increased both for thinner and thicker melanomas, and was greater for regional and distant tumors in comparison with localized lesions, according to the study. The study authors also found that melanoma mortality rates for men and women started declining in 1981.
   The increasing incidence of melanoma in young women parallels reported trends in exposure to ultraviolet rays, which the authors note is the primary environmental cause of melanoma. They add that sunburn incidence has increased in both genders. The authors conclude that additional studies should determine whether the increase in melanoma and non-melanoma skin cancer is due to exposure to UV rays.

Has There Been An Increase Of Lower Extremity Melanoma?

M. Joel Morse, DPM, has not seen an increase in lower extremity melanoma in his practice. However, he has heard that the increased use of open shoes such as flip-flops increases the sun exposure to the foot. Dr. Morse, the President of the American Society of Podiatric Dermatology, notes that people do not usually put sunscreen on the tops of their feet.
   Bradley Bakotic, DPM, DO, likewise has not seen the same incidence of melanoma on the distal lower extremities of women as researchers have shown recently in alternate anatomic locations.
   He attributes the discrepancy to the fact that the forms of melanoma that seem to be affecting women at an increasing rate are largely those related to sun exposure or tanning salons. Acral melanoma does not show as close of an association with these mechanisms of development, according to Dr. Bakotic, the Director of the Institute for Podiatric Pathology in Pompano Beach, Fla.
   Dr. Morse says the incidence of melanoma is reportedly 15 times higher in Caucasians than African-Americans. He says this is due mostly to UV exposure.
   In non-Caucasians, Dr. Morse says melanoma is most common in body parts (such as the palms, soles and subungual locations) that are not regularly exposed to the sun. Dr. Morse adds that several studies have noted that melanoma in acrolentiginous sites (feet and hands) is more prevalent in African-Americans followed by Asians, Hispanics and Caucasians.

NPWT And HBO: A Good Combination For Wound Healing?

By Brian McCurdy, Senior Editor

Negative pressure wound therapy (NPWT) and hyperbaric oxygen therapy (HBO) each has clinical evidence to back their efficacy in treating wounds. Combining those modalities can also have a noticeable effect on wound reduction, according to a study presented as a poster at the American Podiatric Medical Association Annual Scientific Meeting.
   The study compared the healing of diabetic foot ulcers (DFUs) treated with hyperbaric oxygen therapy (HBO) with that of ulcers treated with a combination of HBO and negative pressure wound therapy (NPWT) with reticulated open cell foam (ROCF). Researchers analyzed Intellicure consortium data from patients treated between 2001 and 2006. They identified 1,580 diabetic foot ulcers from 878 patients with varying degrees of Wagner grades I, II and III ulcerations.
   The study authors found that the combination of HBO and NPWT/ROCF resulted in a larger overall mean maximum volume closure of Wagner grade II DFUs (6.98 cm3) than the use of HBO (2.22 cm3). When it came to Wagner grade III DFUs, the difference was even greater. According to the study, the use of HBO and NPWT/ROCF facilitated a 26.81 cm3 overall mean maximum volume closure whereas the use of HBO resulted in a 3.27 cm3 overall mean maximum volume closure.

A Closer Look At The Synergistic Activities Of HBO And NPWT

Study co-author Caroline Fife, MD, says in theory, HBO and NPWT have many synergistic activities. As she explains, HBO reduces bacterial load via oxidative stress and NPWT physically removes bacteria. Hyperbaric oxygen enhances growth factor receptors while NPWT increases growth factor production so both increase angiogenesis, according to Dr. Fife. She notes that both modalities reduce edema: HBO by vasoconstriction and NPWT by physically removing fluid. Finally, research has shown that both HBO and NPWT increase tissue PO2, according to Dr. Fife.
   Dr. Fife, the Director of Clinical Research at Memorial Hermann Center for Wound Healing and Hyperbaric Medicine, cannot point to any contraindications for the combined use of HBO and NPWT.
   In her review of the wound healing literature, Dr. Fife says patients with vascular disease were excluded from every clinical trial involving wound healing from 1996 to 2006, with the exception of the HBO trials. She notes that only HBO trials included ischemic patients although recently researchers have utilized VAC therapy for ischemic leg ulcers.
   “Until and unless the gene studies (trials on vascular endothelial growth factors (VEGFs) and other trials to grow new blood vessels) bear fruit, ischemic leg ulcer patients have no options on the horizon,” says Dr. Fife. “However, it might be that with the combination of HBO and the VAC, some of these limbs can be saved.”

Can Heel Stiffness Help Determine Osteoporosis Risk?

By Brian McCurdy, Senior Editor

A recent study in Radiology concludes that using ultrasound to determine heel stiffness can reveal those at risk for osteoporotic fractures.
   As part of the three-year prospective multicenter study, Swiss researchers surveyed 6,174 women between the ages 70 and 85. Using an ultrasound device, they calculated the patients’ heel stiffness index and used that index to formulate a predictive rule for osteoporotic fracture.
   The study notes five risk factors for the incidence of osteoporotic fracture: an age of 75 and over, a heel quantitative ultrasound stiffness index of less than 78 percent, a history of fracture, recent falls and a failed chair test. Researchers determined that 1,464 women were at lower risk and 4,710 were at higher risk for fractures. Among the higher risk women, the study notes 6.1 percent had an osteoporotic fracture in comparison to 1.8 percent of women at lower risk. Of the women who had a hip fracture, 90 percent were in the higher risk group, according to the study.

What Are The Test’s Advantages?

Martin Wendelken, DPM, says the use of heel-bone quantitative ultrasound appears to have adjunctive promise as a tool for identifying osteoporosis in women. He notes the advantages that ultrasound is both noninvasive and painless. Dr. Wendelken cites a 2000 study in the Journal of Clinical Densitometry that shows ultrasound has an 80 percent sensitivity and 74 percent specificity in diagnosing osteoporosis. Dr. Wendelken concedes that the test’s high false positive rate makes the test limited in regard to using quantitative ultrasound alone.
   However, using the heel-bone ultrasound test along with the evaluation of other risk factors, as demonstrated in the Radiology study, may greatly improve the predictive value, according to Dr. Wendelken, who is affiliated with the Calvary Hospital Center for Palliative Wound Care in New York City.

In Brief

• Merz Pharmaceuticals has recently become a Corporate Partner of the American Podiatric Medical Association (APMA) and is the exclusive sponsor of the 2009 APMA Coding Resource Center. The company says its sponsorship of the Resource Center will help fund an upgraded, Web-based program that will allow podiatrists to access coding information online.
• Ortho-McNeil has announced the launch of the nation’s first prospective, multi-center registry of complicated skin and soft tissue infections (cSSTIs). The company says the Skin and Soft Tissue Infection Hospital Registry (SSTIR) will provide data to help physicians improve the outcomes of patients suffering from four major types of cSSTIs, including diabetic foot infections, surgical site infections, deep soft tissue abscesses and cellulitis.

Clarification

In the sidebar, “A Guide To The University Of Texas Puncture Wound Scoring System,” to the July 2008 continuing education feature, “How To Address Puncture Wounds,” the two point score for the age of the wound should have read “More than six hours but less than 24 hours.” We regret the error.