JAMA dermatology最新文献

Importance: While mortality from melanoma has decreased in non-Hispanic White individuals over the last decade due to new and effective therapies, disparities in survival remain for Latino populations. Latino patients have lower overall incidence of melanoma than non-Hispanic White patients but are more likely to be diagnosed with thicker, more advanced tumors, leading to higher mortality.

Objective: To identify the facilitators and barriers Latino patients face prior to melanoma diagnosis and treatment and to inform strategies that expedite care and improve survival rates in this population.

Design, setting, and participants: This qualitative study used reflexive thematic analysis of interviews with Latino patients with melanoma of any stage at diagnosis conducted in Los Angeles County, California, between May and November 2023. Patients were identified from the California Cancer Registry, part of the Surveillance, Epidemiology, and End Results Program.

Main outcomes and measures: A semistructured interview guide designed to explore multiple themes related to potential barriers and facilitators to timely diagnosis of melanoma among Latino patients.

Results: Of 20 included Latino patients with melanoma, 13 (65%) were female, and the median (range) age was 56.5 (41-79) years. Half of the interviews were conducted in Spanish, and 15 participants (75%) were diagnosed at an early stage (in situ or regional). A total of 6 themes were identified: 2 facilitators, including patients as advocates for their health care and linguistically appropriate care, and 4 barriers, including barriers to timely care due to health insurance procedures, delays in accessing specialty referral, low awareness of melanoma prior to diagnosis, and a lack of linguistically appropriate care.

Conclusions and relevance: This qualitative study identified multifaceted challenges faced by Latino patients as they seek both diagnosis and treatment of melanoma. Findings suggest several recommendations to accelerate time to diagnosis and prompt initiation of treatment to reduce disparities experienced by this patient population.

Importance: The cardiovascular impact of biologics used in psoriasis is not fully understood. Several studies have suggested that the inhibition of the T-helper 17 cell pathway could lead to the destabilization of atherosclerotic plaques, leading to major adverse cardiovascular events (MACEs).

Objective: To assess whether the initiation of interleukin (IL)-17(R)A inhibitors triggers MACEs.

Design, setting, and participants: In this case-time-control study using the French National Health Insurance database, all individuals who received IL-17(R)A inhibitors (secukinumab, ixekizumab, and brodalumab) from 2016 to 2021, were included and classified according to their cardiovascular risk level. The risk period was defined as the 6 months before the MACE, and the reference period as the 6 months before the risk period. The same design for patients who received tumor necrosis factor (TNF)-α inhibitors (adalimumab or etanercept) for similar indications (psoriasis, psoriatic arthritis, ankylosing spondylitis, or juvenile arthritis), as an active comparator. The data analysis was conducted between April 2023 and August 2024.

Exposure: The initiation of the biologic was screened in both periods.

Main outcomes and measures: The odds ratios (ORs) for the risk of MACEs were assessed following the initiation of IL-17(R)A inhibitors and TNF-α inhibitors independently. Subsequently, the OR for the risk of MACE associated with IL-17(R)A inhibitors was estimated using TNF-α inhibitors as the comparator.

Results: Among the 34 241 individuals who received an IL-17(R)A inhibitor, 381 MACEs were analyzed, including 176 acute coronary syndromes and 84 ischemic strokes in the main analysis. Initiation of IL-17(R)A inhibitors was not significantly associated with MACEs (OR, 1.25 [95% CI, 0.75-2.08] vs TNF-α inhibitor initiation and MACEs: OR, 0.90 [95% CI, 0.65-1.24]). Overall, the initiation of an IL-17(R)A inhibitor was not significantly associated with MACEs in the following 6 months, using TNF-α inhibitor as a comparator (OR, 1.40 [95% CI, 0.77-2.54]), regardless of the individual cardiovascular risk (P for homogeneity = .29). The definition of MACE was broadened in a first sensitivity analysis, and the risk period was shortened to 3 months in a second sensitivity analysis. The results did not change.

Conclusions: In this case-time-control study based on a national insurance database, there was no evidence of a significant association between MACEs and the initiation of IL-17(R)A inhibitors, regardless of the individual cardiovascular risk of the patient. However, a modest risk increase cannot be entirely excluded.

Importance: Increasingly, strategies to systematically detect melanomas invoke targeted approaches, whereby those at highest risk are prioritized for skin screening. Many tools exist to predict future melanoma risk, but most have limited accuracy and are potentially biased.

Objectives: To develop an improved melanoma risk prediction tool for invasive melanoma.

Design, setting, and participants: This population-based prospective cohort study (the QSkin Study) in Queensland, Australia, involved 10 years of follow-up from the baseline survey in 2011 and included individuals aged between 40 to 69 years who were melanoma-free at baseline and completed a comprehensive risk factor survey at recruitment. The data analysis was conducted from October 2024 to April 2025.

Exposures: Thirty-one candidate variables collected at baseline were identified a priori as potential predictors of future risk of invasive melanoma.

Main outcomes and measures: Histologically confirmed invasive melanomas newly diagnosed from baseline through to December 31, 2021, captured by data linkage to the Queensland Cancer Register. Follow-up was censored on diagnosis of melanoma in situ or death. Cox proportional hazards models with forward and backward selection approaches were used to identify the best-fitting model.

Results: Of 41 919 eligible participants, 55% were female, and the mean (SD) age at baseline was 55.4 (8.2) years. A total of 706 new invasive melanomas were identified during 401 356 person-years of follow-up. The best-fitting model retained 14 predictors (age, sex, ancestry, nevus density, freckling density, hair color, tanning ability, adult sunburns, family history, other cancer prior to baseline, previous skin cancer excisions, previous actinic keratoses, smoking status, and height) and 2 statistical terms (age squared, age-by-sex interaction), yielding an apparent discriminatory accuracy of 0.74 (95% CI, 0.73-0.76). The Youden index was optimized at a screening threshold selecting the top 40% of predicted risk, which captured 74% of cases (number needed to screen = 32).

Conclusions and relevance: This cohort study has identified an improved tool that offers enhanced accuracy for predicting the future risk of invasive melanoma compared with existing tools.