BETHESDA, MD — Skin malignancy has increased in prevalence over the last 15 years, but it is not clear how military personnel have been effective.
“Assessing correlation could lead to more effective, targeted screening programs that could lead to decreased mortality from skin malignancies,” according to Uniformed Services University of the Health Sciences-led researchers.
The authors published in Military Medicine a one-year analysis of the number needed to biopsy (NNB) to detect skin cancer and analysis of military-specific risk factors in a military dermatology training program.1
Researchers said their study sought to both compare skin biopsy rates to civilian institutions and patient populations and determine the significance of exposure variables including age, gender, military beneficiary status, branch of service and military rank.
To do that, the team performed a retrospective observational study over one year by identifying all skin biopsies performed in the Walter Reed National Military Medical Center dermatology clinic from August 2015 to July 2016.
With biopsies performed for the purpose of ruling out inflammatory/immunologic conditions or cosmeses manually excluded, the researchers focused only on efforts to rule out basal cell carcinoma, squamous cell carcinoma or melanoma.
The study team also decided to exclude malignant diagnoses that are very rare or could mimic inflammatory conditions, such as cutaneous T-cell lymphoma. In cases of uncertainty, the findings were only included if melanoma or nonmelanoma skin cancer (NMSC) diagnosis was the intended indication, it stated.
Included in the study were 3,098 biopsies diagnostic for 1,084 total skin malignancies and 54 melanoma diagnoses. The authors noted that melanoma made up 4.98% of all skin malignancy diagnosed.
Results indicated that the number needed for biopsy for all skin malignancy was 2.86 (95% CI 2.76-2.96). NNB for melanoma and NMSC was 20.93 (95% CI 19.70-22.15) and 1.91 (95% CI 1.83-2.00), respectively. The values were significantly affected by patient age, gender and military rank, according to the report.
“The proportion of melanoma skin cancers is notably increased in our population compared to published population statistics with comparable total biopsy yields,” the researchers wrote. “Skin biopsy for purpose of screening for malignancy should be performed in the military population, and consideration should be made for gender, age, and rank. Our findings can further expand on military risk factors for skin cancer and aid in further multivariant modeling.”
- Yong J, Raiciulescu S, Coffman M, Meyerle J. Skin Malignancy in the Military: A Number Needed to Biopsy Analysis. Mil Med. 2021 Feb 18:usab039. doi: 10.1093/milmed/usab039. Epub ahead of print. PMID: 33598688.
