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US Vet Study Identifies Risk Factors for Acral Melanoma
TOPLINE:
Exposure to Agent Orange, the defoliant used by the US Air Force during the Vietnam War, was one of the factors associated with increased odds of acral melanoma (AM), a rare melanoma subtype affecting palms, soles, and nail units.
METHODOLOGY:
- Researchers conducted a nested case-control study in the Veterans Affairs healthcare system, and identified 1292 veterans (median age, 70.13 years; 94.0% men; 73.4% White, 14.6% Black) with AM through the Veterans Affairs Cancer Registry and a validated natural language processing pipeline from 2000 to 2024.
- Researchers matched each case of AM to 4 individuals with nonacral cutaneous melanoma (CM) and 4 control individuals without melanoma diagnoses, based on diagnosis year and outpatient visit frequency.
- Exposures included age, sex, race, ethnicity, rurality, region, military branch, comorbidities, smoking status, alcohol use, BMI, Agent Orange exposure, prior photosensitizing medications, nevi, and keratinocyte carcinoma.
TAKEAWAY:
- Veterans exposed to Agent Orange had higher odds of AM than individuals with CM (adjusted odds ratio [AOR], 1.31; 95% CI, 1.06-1.62) and control individuals without melanoma (AOR, 1.27; 95% CI, 1.04-1.56).
- Individuals with current smoking habit had lower odds of AM than those with CM (AOR, 0.65; 95% CI, 0.52-0.81) and control individuals without melanoma (AOR, 0.50; 95% CI, 0.40-0.62).
- Patients with prior keratinocyte carcinoma and actinic keratosis had higher odds of AM than control individuals without melanoma but lower odds than those with CM.
- History of nevus was associated with higher odds of acral melanoma compared with individuals without melanoma (AOR, 2.11; 95% CI, 1.49-2.98).
IN PRACTICE:
“Our results support the need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between [Agent Orange exposure] in veteran populations, as well as those between other environmental exposures in different populations," the study authors wrote. Referring to the “continued search for a better understanding of a potential link” between Agent Orange and melanoma, as well as AM, and other possible etiologic factors for AM, this study “provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community,” Andrew F. Olshan, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, wrote in an accompanying editorial.
SOURCE:
The study was led by Jonathan C. Hwang, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and was published online on February 4 in JAMA Dermatology.
LIMITATIONS:
The case-control design limits causal inference and the findings might not be generalized outside US veterans. Exposure misclassification could be present.
DISCLOSURES:
The study was supported by the Department of Defense and the Department of Veterans Affairs. Several authors reported receiving grants from CU Anschutz Medical Center, Department of Defense, CDMRP Melanoma Research Program, and Merck, Bayer, and Department of Veteran Affairs. They also reported receiving royalty from UpToDate, and being shareholder in many companies, including Apple. NVIDIA, Amazon, Gilead, AstraZeneca, BioNTech, and Moderna. Olshan declared being a member of the National Academies of Sciences, Engineering, and Medicine Veterans and Agent Orange review committee.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Exposure to Agent Orange, the defoliant used by the US Air Force during the Vietnam War, was one of the factors associated with increased odds of acral melanoma (AM), a rare melanoma subtype affecting palms, soles, and nail units.
METHODOLOGY:
- Researchers conducted a nested case-control study in the Veterans Affairs healthcare system, and identified 1292 veterans (median age, 70.13 years; 94.0% men; 73.4% White, 14.6% Black) with AM through the Veterans Affairs Cancer Registry and a validated natural language processing pipeline from 2000 to 2024.
- Researchers matched each case of AM to 4 individuals with nonacral cutaneous melanoma (CM) and 4 control individuals without melanoma diagnoses, based on diagnosis year and outpatient visit frequency.
- Exposures included age, sex, race, ethnicity, rurality, region, military branch, comorbidities, smoking status, alcohol use, BMI, Agent Orange exposure, prior photosensitizing medications, nevi, and keratinocyte carcinoma.
TAKEAWAY:
- Veterans exposed to Agent Orange had higher odds of AM than individuals with CM (adjusted odds ratio [AOR], 1.31; 95% CI, 1.06-1.62) and control individuals without melanoma (AOR, 1.27; 95% CI, 1.04-1.56).
- Individuals with current smoking habit had lower odds of AM than those with CM (AOR, 0.65; 95% CI, 0.52-0.81) and control individuals without melanoma (AOR, 0.50; 95% CI, 0.40-0.62).
- Patients with prior keratinocyte carcinoma and actinic keratosis had higher odds of AM than control individuals without melanoma but lower odds than those with CM.
- History of nevus was associated with higher odds of acral melanoma compared with individuals without melanoma (AOR, 2.11; 95% CI, 1.49-2.98).
IN PRACTICE:
“Our results support the need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between [Agent Orange exposure] in veteran populations, as well as those between other environmental exposures in different populations," the study authors wrote. Referring to the “continued search for a better understanding of a potential link” between Agent Orange and melanoma, as well as AM, and other possible etiologic factors for AM, this study “provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community,” Andrew F. Olshan, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, wrote in an accompanying editorial.
SOURCE:
The study was led by Jonathan C. Hwang, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and was published online on February 4 in JAMA Dermatology.
LIMITATIONS:
The case-control design limits causal inference and the findings might not be generalized outside US veterans. Exposure misclassification could be present.
DISCLOSURES:
The study was supported by the Department of Defense and the Department of Veterans Affairs. Several authors reported receiving grants from CU Anschutz Medical Center, Department of Defense, CDMRP Melanoma Research Program, and Merck, Bayer, and Department of Veteran Affairs. They also reported receiving royalty from UpToDate, and being shareholder in many companies, including Apple. NVIDIA, Amazon, Gilead, AstraZeneca, BioNTech, and Moderna. Olshan declared being a member of the National Academies of Sciences, Engineering, and Medicine Veterans and Agent Orange review committee.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
Exposure to Agent Orange, the defoliant used by the US Air Force during the Vietnam War, was one of the factors associated with increased odds of acral melanoma (AM), a rare melanoma subtype affecting palms, soles, and nail units.
METHODOLOGY:
- Researchers conducted a nested case-control study in the Veterans Affairs healthcare system, and identified 1292 veterans (median age, 70.13 years; 94.0% men; 73.4% White, 14.6% Black) with AM through the Veterans Affairs Cancer Registry and a validated natural language processing pipeline from 2000 to 2024.
- Researchers matched each case of AM to 4 individuals with nonacral cutaneous melanoma (CM) and 4 control individuals without melanoma diagnoses, based on diagnosis year and outpatient visit frequency.
- Exposures included age, sex, race, ethnicity, rurality, region, military branch, comorbidities, smoking status, alcohol use, BMI, Agent Orange exposure, prior photosensitizing medications, nevi, and keratinocyte carcinoma.
TAKEAWAY:
- Veterans exposed to Agent Orange had higher odds of AM than individuals with CM (adjusted odds ratio [AOR], 1.31; 95% CI, 1.06-1.62) and control individuals without melanoma (AOR, 1.27; 95% CI, 1.04-1.56).
- Individuals with current smoking habit had lower odds of AM than those with CM (AOR, 0.65; 95% CI, 0.52-0.81) and control individuals without melanoma (AOR, 0.50; 95% CI, 0.40-0.62).
- Patients with prior keratinocyte carcinoma and actinic keratosis had higher odds of AM than control individuals without melanoma but lower odds than those with CM.
- History of nevus was associated with higher odds of acral melanoma compared with individuals without melanoma (AOR, 2.11; 95% CI, 1.49-2.98).
IN PRACTICE:
“Our results support the need for continued investigation of AM as a distinct entity from CM and may inform future evaluations of the associations between [Agent Orange exposure] in veteran populations, as well as those between other environmental exposures in different populations," the study authors wrote. Referring to the “continued search for a better understanding of a potential link” between Agent Orange and melanoma, as well as AM, and other possible etiologic factors for AM, this study “provides a strong impetus to further these research goals and contribute to the investigation of the legacy of the Vietnam War and honor a commitment to the veterans community,” Andrew F. Olshan, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, wrote in an accompanying editorial.
SOURCE:
The study was led by Jonathan C. Hwang, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and was published online on February 4 in JAMA Dermatology.
LIMITATIONS:
The case-control design limits causal inference and the findings might not be generalized outside US veterans. Exposure misclassification could be present.
DISCLOSURES:
The study was supported by the Department of Defense and the Department of Veterans Affairs. Several authors reported receiving grants from CU Anschutz Medical Center, Department of Defense, CDMRP Melanoma Research Program, and Merck, Bayer, and Department of Veteran Affairs. They also reported receiving royalty from UpToDate, and being shareholder in many companies, including Apple. NVIDIA, Amazon, Gilead, AstraZeneca, BioNTech, and Moderna. Olshan declared being a member of the National Academies of Sciences, Engineering, and Medicine Veterans and Agent Orange review committee.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
US Vet Study Identifies Risk Factors for Acral Melanoma
US Vet Study Identifies Risk Factors for Acral Melanoma