Showing papers by "Jean-Jacques Grob published in 1995"

Cost-effectiveness of surveillance of stage I melanoma. A retrospective appraisal based on a 10-year experience in a dermatology department in France.

Abstract: Background: There is no agreement about surveillance after resection of a stage I melanoma. Objective: We assessed the cost-effectiveness of this surveillance. Methods: Out of 912 patients with stage I (and Clark’s level ≥ II) melanoma examined from 1981 to 1991, only 528 were regularly followed in our department. Results: 115 out of 528 relapsed; 33% were detected by the patient himself, 16% by the referring physician and 39% were detected in our department. Chest X-ray or abdomen ultrasonography revealed only 10% of relapses; CT scans were useless. There was a huge gap between the cost-effectiveness of clinical examinations and radiology. The time between relapse and the last check-up in our department was less than 4 months in one third of the metastases. Conclusions: In stage I melanoma, only clinical examination is really cost-effective in the detection of metastases. However, many metastases are likely to become prominent between two examinations if patients are examined less than 3 times a year. A progressive decrease in frequency is thus not advisable, until the risk is considered low enough to stop follow-up.

Influence of sun exposure after childhood on the development of nevi: a study in monozygotic twins

Abstract: Childhood has been shown to be a crucial period for the effect of sun exposure on the development of melanoma and melanocytic nevi. Whether or not sun exposure after childhood still promotes the genesis of nevi is still unclear. Theoretically, adult monozygotic twins represent a perfectly controlled model to answer this question. Twenty eight pairs of monozygotic twins over 30 years of age were examined and questioned about their sun exposure. As expected, there was good intrapair correlation for nevus density. However most twins exhibited at least a 20% difference in the number of nevi, which can be attributed to a different exposure to environmental factors after childhood. Within a pair, the twin who was more sun-exposed between 15 and 30 years of age had a twice hig er risk of having more nevi. This shows that the influence of sun exposure on the development of nevi is not limited to the first years of life. Intrapair differences in the number of nevi on never-exposed areas raises the possibility of either a systemic effect of sun exposure or other yet unidentified environmental risk factors for the development of nevi.