Editorial| Volume 134, ISSUE 6, P1494, June 2014

BJD Editor's Choice

        Socioeconomic status and cutaneous malignant melanoma

        In this review article, Idorn and Wulf from Denmark analyse the association of socioeconomic status (SES) with cutaneous malignant melanoma (CMM). They highlight that the largest increase in CMM incidence has been for individuals with high SES, in contrast to individuals with lower SES, who present with thicker tumours and have a higher risk of CMM-related death. This review highlights important aspects of the association of SES with CMM. The authors identify several studies suggesting that SES is associated with intermittent ultra-violet radiation (UVR) exposure during recreational activities. They describe how intermittent UVR exposure is a well-known risk factor for CMM, which may explain the large increase in CMM on intermittently exposed body parts among individuals with high SES. However, they point out that these individuals also have better access to screening services, and that this may explain the high incidence of thin CMM in this group. Despite this, the authors go on to point out that the association between SES and CMM is also seen in countries with equal access to healthcare for all SES groups. This is interpreted as suggesting that understanding the seriousness and nature of the disease may also be of importance. Lastly, they consider whether the major increase in CMM incidence observed during recent decades reects a real increase in the occurrence of CMM, is the result of earlier diagnosis of CMM, or is partly an artefact explained by the diagnosis of ‘biologically benign CMM lesions’ due to increased awareness of the disease among healthcare professionals and the general population. Br J Dermatol 2014; 170: 789–795.

        Intralesional steroid for orofacial granulomatosis

        Fedele et al., from the Eastman Dental Hospital in London, assessed the long-term benets of intralesional triamcinolone on the unsightly swelling of orofacial granulomatosis (OFG). They also studied prognostic factors for this treatment. The research consisted of an observational study of a cohort of 22 patients with OFG. The primary outcome was dened as a statistically signicant decrease in disease severity post-treatment. Statistically signicant association with prognostic factors was the secondary outcome. Statistical analysis included Wilcoxon signed-rank tests and logistic regression. Compared with pretreatment, the authors reported statistically signicant decreases in disease severity scores at all time points until 48 months post-treatment. No adverse effects were reported. The authors stated that this study conrmed the long-term effectiveness of intralesional triamcinolone in controlling the disguring swelling of OFG. However, they went on to caution that inherent limitations of observational studies make it important to carry out randomized case–control trials to conrm their data. Br J Dermatol 2014; 170: 796–803.

        Uganda: HIV and itchy papules in the antiretroviral therapy era

        Chua et al. start by stating that pruritic papular eruption (PPE) of HIV is common in HIV-infected populations living in the tropics, and it is reported to improve with antiretroviral therapy (ART). Indeed, its presence after at least 6 months of ART has been proposed as one of several markers of treatment failure. This study set out to determine the factors associated with PPE in HIV-infected persons receiving ART. A case–control study was carried out, nested within a 500-person cohort from a teaching hospital in Mbarara, Uganda. Forty-five cases and 90 controls were enrolled. Cases were required to have had ART for ≥ 15 months and an itchy papular rash for at least 1 month, with microscopic correlation by skin biopsy. Each case was individually matched with two controls for age, sex and ART duration. The results showed that 25 of 45 cases (56%) had microscopic ndings consistent with PPE, dened as PPE cases. At skin examination and biopsy (study enrolment), a similar proportion of PPE cases and matched controls had plasma HIV RNA < 400 copies mL1 (96% vs. 85%, P = 0.31). The odds of being a PPE case increased fourfold with every log increase in viral load at ART initiation (P = 0.02) but not at study enrolment. CD4 counts at ART initiation and study enrolment, and CD4 gains, CD8+ T-cell activation and kynurenine–tryptophan ratios measured 6 and 12 months after ART commencement were not associated with PPE cases. The authors concluded that PPE in HIV-infected persons receiving ART for ≥ 15 months was associated with greater HIV viraemia at ART commencement, independent of CD4 count. They also stated that skin biopsies were important to distinguish between PPE and other itchy papular eruptions. Br J Dermatol 2014; 170: 834–841.

        Western Australia Melanoma Health Study

        Cadby et al. start this paper by stating that Breslow thickness is the most important predictor of survival in localized malignant melanoma. They go on to describe how a number of melanoma risk factors have been associated with Breslow thickness. However, the role of genetic loci has been little investigated to date. The authors aimed to investigate the association of known melanoma susceptibility genetic loci with Breslow thickness. The participants were 800 cases from the Western Australian Melanoma Health Study, who completed a questionnaire and provided a DNA sample. Genetic association analyses were performed between Breslow thickness and single-nucleotide polymorphisms (SNPs) from 15 candidate melanoma susceptibility genes, controlling for relevant covariates. The authors found that older age at diagnosis and absence of naevi were associated with increased Breslow thickness. Following adjustment for multiple testing, no SNPs were significantly associated with Breslow thickness. They concluded that the associations observed between Breslow thickness, age and naevi reinforce current knowledge and that some evidence of shared genetic determinants between melanoma risk and Breslow thickness was found. They finish by stating that further studies are required to confirm these findings. Br J Dermatol 2014; 170: 853–859.