Sunil Kalia
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Dermatoepidemiology; Examining the epidemiology of skin cancer in the general population and identifying high risk population groups Skin cancer prevention; Using national surveys conducted by Statistics Canada, I have examined skin cancer prevention behaviours practiced by Canadians; Spectoscopy; Using imaging to differentiate skin cancer from benign lesions. Photobiology to study properties of the skin.
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Background: Targeted screening of high-risk individuals is recommended over population screening to identify and manage skin cancer patients. Previous published skin cancer risk prediction models have been developed from a general population with the purpose of identifying those at high risk from the general public. A model developed for use in clinics can potentially aid physicians in their care for patients. Before this model can be developed, risk factors for skin cancer in a clinical setting should be investigated.Objectives: The overall aim was to investigate the different risk factors for skin cancer and their associations with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma in a Canadian clinical population.Methods: For this case-control study, 1003 patients were surveyed from the Skin Care Centre in Vancouver between January 2020 and December 2021. Demographics, personal history, phenotypic characteristics, and ultraviolet exposure measures were collected through an interviewer-administered survey. Odds ratios were estimated from univariate regressions to assess the relationships between different variables and the different skin cancer types (melanoma, BCC, SCC).Results: Our study population of 1003 included 105 melanoma, 367 BCC, and 148 SCC cases. There were 13 significant variables for melanoma, 17 for BCC, and 15 for SCC. Apart from age, presence of many lentigines was the strongest risk factor for melanoma (odds ratio [OR] 9.44, 95% confidence interval [CI] 4.25-24.0) and BCC (OR 22.8, CI 10.7-56.7). Apart from age, light eyes (OR 24.5, CI 6.15-164 for green, OR 12.6, CI 3.72-78.4 for blue) showed strongest effects for SCC risk.Conclusion: We found significant associations between many proposed risk factors and the 3 types of skin cancer. Age, gender, phenotypic characteristics, and history of sunburns were important risk factors for all skin cancer types. At the same time, some of our findings did not support the relationships found in literature, possibly due to our study being based on a clinical population. Future research involving multivariate analyses should be conducted to provide further insight into the associations between risk factors and skin cancer in a Canadian clinical population.
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Background: Disease surveillance is essential for accurate cost estimates, monitoring and evaluation of risk factors and comorbidities of the diseases. Keratinocyte carcinoma (KC) and atopic dermatitis (AD) are frequently occurring skin diseases associated with reduced quality of life and significant burdens. However, KCs are excluded from cancer registries, and AD are reliant on survey sampling. Literature publications have limited claims-based methodologies for KC and AD ascertainment. Thus, there is a lack of any population-based method of ascertainment that is complete, efficient and generalizable for these conditions.Objectives: To propose and validate the use of health insurance claims and prescription records in ascertaining two independent skin conditions.Methods: This retrospective study involved reviewing medical charts and health insurance claims data of patients receiving care by family practitioners and specialists in metropolitan Vancouver from 2010 to 2018. Information on patient demographics, histopathology, atopy, physician diagnoses, claim codes and prescriptions associated with KC and AD were collected respectively in accordance with data abstraction forms. Algorithmic models were developed with predictor variables based on combinations of demographics, claim codes (diagnosis and therapy), and prescriptions.Results: Algorithms for KC ascertainment included the diagnostic code 173 (ICD-9: “other malignant neoplasm of skin” with service codes for procedural treatment and prescriptions for imiquimod, 5-fluorouracil, or vismodegib. High sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was achieved with values of 86.6% (confidence interval: 79.2-94.0%), 97.4% (CI: 96.2-98.6%), 78.9% (CI: 70.5-87.3%), 98.5% (CI: 97.6-99.4%) respectively. For AD ascertainment, the best-performing algorithms included predictors such asivage, diagnostic codes 691 or 692 (ICD-9: Other atopic dermatitis and related conditions; Contact dermatitis and other eczema), service codes for ultraviolet therapies, with either prescriptions for topical steroids, topical immunomodulators, or systemic immunosuppressive therapy. High sensitivity and PPV of 94.8% (CI: 93.2-96.3%) and 87.9% (CI: 85.8-90.1%), respectively, was achieved.Conclusion: Our health insurance claims and prescription records algorithms ascertained KC and AD with high predictive accuracy. These algorithmic definitions can be utilized in population databases for evaluating epidemiologic trends and subsequently plan for effective public health initiatives and resource allocations.
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Background: Ultraviolet (UV) phototherapy is an important treatment option in Canada for skin diseases. However, the long-term risk of skin cancer, has not been adequately studied and quantified in the published literature.Objectives: The objectives include i) to create an electronic database for patients receiving phototherapy at the Psoriasis and Phototherapy Clinic, Skin Care Center, Vancouver; ii) to explore incidence of skin cancers including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma in patients with UVB therapy; iii) to evaluate skin cancers by anatomical distribution and skin type; iv) to compare incidence rate of skin cancers in patients with phototherapy and British Columbia general population; v) to correlate total treatment session, cumulative dosage with skin cancer risk; vi) to estimate correlation between skin type and narrow-band UVB (NB-UVB) minimal erythemal dose.Methods: A retrospective chart review was conducted on patients receiving UV therapy from May 1977 to November 2018. These patients were identified via medical charts at the Psoriasis and Phototherapy Clinic. Pathological ascertainment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma for these patients was verified through linkage with an interhospital pathology database for the British Columbia Lower Mainland regional health authorities.Results: A total of 3,506 patients (1,999 male and 1,507 female) were analyzed for an average of 7.1 years. A total of 170 new skin cancers developed in 79 patients after receiving UVB phototherapy without systemic psoralen plus UVA. Male patients had significantly lower BCC incidence compared to BC general population (Z scores
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