Publications by authors named "Feras M Ghazawi"

58 Publications

Incidence and Mortality of Prostate Cancer in Canada during 1992-2010.

Curr Oncol 2021 Feb 21;28(1):978-990. Epub 2021 Feb 21.

Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada.

In Canada, prostate cancer is the most common reportable malignancy in men. We assessed the temporal trends of prostate cancer to gain insight into the geographic incidence and mortality trends of this disease. Three independent population-based cancer registries were used to retrospectively analyze demographic data on Canadian men diagnosed with prostate cancer and men who died of prostate cancer between the years of 1992 and 2010. The incidence and mortality rates were calculated at the provincial, city, and forward sortation area (FSA) postal code levels by using population counts that were obtained from the Canadian Census of Population. The Canadian average incidence rate was 113.57 cases per 100,000 males. There has been an overall increasing trend in crude prostate cancer incidence between 1992 and 2010 with three peaks, in 1993, 2001, and 2007. However, age-adjusted incidence rates showed no significant increase over time. The national mortality rate was calculated to be 24.13 deaths per 100,000 males per year. A decrease was noted in crude and age-adjusted mortality rates between 1992 and 2010. Several provinces, cities, and FSAs had higher incidence/mortality rates than the national average. Several of the FSA postal codes with the highest incidence/mortality rates were adjacent to one another. Several Canadian regions of high incidence for prostate cancer have been identified through this study and temporal trends are consistent with those reported in the literature. These results will serve as a foundation for future studies that will seek to identify new regional risk factors and etiologic agents.
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http://dx.doi.org/10.3390/curroncol28010096DOI Listing
February 2021

Non-Melanoma Skin Cancer Distribution in the Russian Federation.

Dermatology 2020 Dec 23:1-9. Epub 2020 Dec 23.

Division of Dermatology, McGill University, Montreal, Québec, Canada,

Background: Non-melanoma skin cancer (NMSC) incidence has been increasing steadily around the world. The aim of the study is to describe geographic trends in incidence and mortality of NMSC in Russia between 2007 and 2017 and compare findings to other European countries.

Methods: We used geospatial analysis to map the incident cases and descriptive statistical analysis to analyze trends. Additionally, we assessed the relationship between ethnicity, geographic latitude/longitude, and NMSC incidence/mortality rates. We retrospectively analyzed the data from the Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, for 2007-2017. Routine methods of descriptive epidemiology were used to study incidence and mortality rates by age groups, years, and jurisdictions (i.e., Federal Districts and Federal Subjects).

Results: In total, 733,723 patients were diagnosed with NMSC in Russia over the period 2007-2017, of whom 63% were women. The overall age-standardized incidence and mortality rates were 29.64/100,000 and 0.70/100,000, respectively. There was a consistent increase in age-standardized incidence rates over the study period, with a decreasing mortality rate. Geographic mapping revealed north-to-south and east-to-west gradients for NMSC.

Conclusions: This study demonstrated longitudinal trends for NMSC incidence in Russia documenting that skin phototype, latitude/longitude, climate zones, and cultural practices remain dominant risk factors defining the epidemiology of NMSC. Moreover, this work identified several regions in the country (i.e., Republic of Adygea, Samara, Krasnodar Krai, etc.), where patient education/sun awareness campaigns will be useful to help reduce the risk of this malignancy.
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http://dx.doi.org/10.1159/000512454DOI Listing
December 2020

Rapidly enlarging scalp nodules in a 20-month-old child.

CMAJ 2020 Sep;192(37):E1066

Division of Dermatology (Ghazawi, Gavigan), University of Ottawa; Division of Plastic Surgery (Cheung), Children's Hospital of Eastern Ontario, Ottawa, Ont.

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http://dx.doi.org/10.1503/cmaj.200314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513940PMC
September 2020

Infection risk of dermatologic therapeutics during the COVID-19 pandemic: an evidence-based recalibration.

Int J Dermatol 2020 Sep 3;59(9):1043-1056. Epub 2020 Jul 3.

Division of Dermatology, University of Ottawa, Ottawa, ON, Canada.

Recommendations were made recently to limit or stop the use of oral and systemic immunotherapies for skin diseases due to potential risks to the patients during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic. Herein, we attempt to identify potentially safe immunotherapies that may be used in the treatment of cutaneous diseases during the current COVID-19 pandemic. We performed a literature review to approximate the risk of SARS-CoV-2 infection, including available data on the roles of relevant cytokines, cell subsets, and their mediators in eliciting an optimal immune response against respiratory viruses in murine gene deletion models and humans with congenital deficiencies were reviewed for viral infections risk and if possible coronaviruses specifically. Furthermore, reported risk of infections of biologic and non-biologic therapeutics for skin diseases from clinical trials and drug data registries were evaluated. Many of the immunotherapies used in dermatology have data to support their safe use during the COVID-19 pandemic including the biologics that target IgE, IL-4/13, TNF-α, IL-17, IL-12, and IL-23. Furthermore, we provide evidence to show that oral immunosuppressive medications such as methotrexate and cyclosporine do not significantly increase the risk to patients. Most biologic and conventional immunotherapies, based on doses and indications in dermatology, do not appear to increase risk of viral susceptibility and are most likely safe for use during the COVID-19 pandemic. The limitation of this study is availability of data on COVID-19.
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http://dx.doi.org/10.1111/ijd.15028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361427PMC
September 2020

Geographic Variations in Cutaneous Melanoma Distribution in the Russian Federation.

Dermatology 2020 5;236(6):500-507. Epub 2020 Jun 5.

Division of Dermatology, McGill University, Montreal, Québec, Canada,

Background: Cutaneous melanoma (CM) incidence has been increasing around the world. The goal of this study is to describe geographic trends in incidence and mortality of CM in Russia between 2001 and 2017.

Methods: To achieve this we used geo-informatic technique (mapping) and descriptive statistical analysis. Additionally, we studied the associations between ethnicity, geographic latitude/longitude, and CM incidence/mortality rates. We retrospectively analyzed the data from the Moscow Oncology Research Institute, Ministry of Health of the Russian Federation, for the period of the study. Routine methods of descriptive epidemiology were used to study incidence and mortality rates by age groups, years, and jurisdictions (i.e., Federal Districts and Federal Subjects of Russia).

Results: In total, 141,597 patients were diagnosed with melanoma in Russia over the period 2001-2017, of whom 62% were women. The overall age-standardized incidence and mortality rates were 4.27/100,000 and 1.62/100,000, respectively. Geographic mapping revealed north-to-south and east-to-west gradients. As the study was fully descriptive, retrospective, and based on official statistical reports, detailed characteristics of clinical forms, anatomic sites, Breslow depth, and treatments could not be analyzed.

Conclusions: This study outlined the burden of melanoma in the Russian Federation, and the trends were similar to those observed in countries with similar latitudes and skin phenotype. The importance of the skin color gradient and recreational/cultural practices were some of the most important risk factors highlighted in this study for the development of melanoma in Russia.
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http://dx.doi.org/10.1159/000507617DOI Listing
June 2020

Acute Generalized Exanthematous Pustulosis Induced by Topical Morphine and Confirmed by Patch Testing.

Dermatitis 2020 May/Jun;31(3):e22-e23

Division of Dermatology University of Ottawa Ontario, Canada Department of Pathology and Laboratory Medicine The Ottawa Hospital Ontario, Canada Division of Dermatology University of Ottawa Ontario, Canada

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http://dx.doi.org/10.1097/DER.0000000000000573DOI Listing
May 2020

The Novel Role of Antibiotic Treatment in the Management of Cutaneous T-Cell Lymphoma (CTCL) Patients.

J Cutan Med Surg 2020 Jul/Aug;24(4):410-411. Epub 2020 May 12.

507266 Division of Dermatology, McGill University, Montreal, QC, Canada.

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http://dx.doi.org/10.1177/1203475420926981DOI Listing
May 2020

Reply to: "Comment on 'Efficacies and merits of the cotton swab technique for diagnosing tinea capitis in the pediatric population'".

J Am Acad Dermatol 2020 09 13;83(3):e195-e196. Epub 2020 Apr 13.

Division of Allergy, Immunology and Dermatology, McGill University, Montreal, Quebec, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.04.029DOI Listing
September 2020

Epidemiology and Patient Distribution of Oral Cavity and Oropharyngeal SCC in Canada.

J Cutan Med Surg 2020 Jul/Aug;24(4):340-349. Epub 2020 Apr 2.

5620 Division of Dermatology, McGill University, Montreal, QC, Canada.

Background: Oral cavity cancers (OCCs) and oropharyngeal cancers (OPCs) continue to be a major source of morbidity and mortality worldwide requiring the shared effort of numerous specialists. Tobacco and alcohol consumption have long been identified as risk factors for both OCC and OPC. In addition, human papilloma virus (HPV) is gaining its position as the main causal agent for OPC.

Objective: The objective of this study is to analyze the epidemiology of OCC and OPC in Canada.

Methods: Data pertaining to the year of diagnosis, the patient's sex, age at the time of diagnosis, province/territory, city and postal code of oral cavity, and oropharyngeal malignancies diagnosed during 1992-2010 were extracted from the Canadian Cancer Registry and Le Registre Québécois du Cancer.

Results: In total, 21 685 OCC cases and 15 965 OPC cases were identified from 1992 to 2010. Of those, 84.97% were oral cavity squamous cell carcinomas (SCCs), 88.10% were oropharyngeal SCCs, and both had a significant male predominance. While oral cavity SCC incidence stabilized over the study period, oropharyngeal SCC continued to increase. Oral cavity SCC incidence increased with age, while oropharyngeal SCC incidence peaked in the 50- to 59-year age group. Detailed geographic distribution analysis of patients at the provincial/territorial, city, and postal code levels identified several patient clusters.

Conclusions: This work highlights important epidemiological differences in trends between oral and oropharyngeal cancers, identifies high-incidence postal codes for each malignancy, and correlates incidence/mortality with known risk factors including alcohol/tobacco use and HPV infections, therefore providing a comprehensive understanding of epidemiology for these cancers in Canada.
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http://dx.doi.org/10.1177/1203475420915448DOI Listing
April 2020

Epidemiology of invasive ocular surface squamous neoplasia in Canada during 1992-2010.

Br J Ophthalmol 2020 10 16;104(10):1368-1372. Epub 2020 Jan 16.

Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada

Background: Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented ocular surface malignancy. It is classified as invasive OSNN (IOSSN) when the underlying stroma are infiltrated by dysplastic squamous epithelial cells through the basement membrane. Here, we present the descriptive epidemiology and geographical distribution of IOSSN in Canada.

Methods: We determined the incidence and geographical distribution of IOSSN cases diagnosed between 1992 and 2010 using two independent population-based cancer registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer.

Results: The mean annual age-standardised incidence rate (WHO 2000-2025) of IOSSN for 1992-2010 was 0.45 cases per million individuals per year with an average annual percent increase in incidence of 4.5%. IOSSN localisation to the conjunctiva was documented in at least 57% of the reported cases. IOSSN exhibited a male predilection ratio of 3.3:1.0 with a mean age at diagnosis of 69 years. Incidence rates of IOSSN across Canadian provinces and cities showed no significant differences from the crude national average.

Conclusions: Our results, particularly concerning IOSSN patient age and male predilection, corroborate with data reported from the USA. Additional studies are needed to determine whether the observed increase in incidence rate over the study period (1992-2010) is significant.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314650DOI Listing
October 2020

Efficacies and merits of the cotton swab technique for diagnosing tinea capitis in the pediatric population.

J Am Acad Dermatol 2020 Sep 12;83(3):920-922. Epub 2020 Jan 12.

Division of Allergy, Immunology and Dermatology, McGill University, Montreal, Quebec, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.01.009DOI Listing
September 2020

The authors reply to: "Doubts about first report of krokodil use in Canada".

CMAJ 2020 01;192(1):E16

Dermatologist, Division of Dermatology, University of Ottawa, Ottawa, Ont.

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http://dx.doi.org/10.1503/cmaj.74079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944296PMC
January 2020

Incidence of acute myeloid leukemia: A regional analysis of Canada.

Cancer 2020 03 24;126(6):1356-1361. Epub 2019 Dec 24.

Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1002/cncr.32671DOI Listing
March 2020

Epidemiology of ophthalmic lymphoma in Canada during 1992-2010.

Br J Ophthalmol 2020 08 13;104(8):1176-1180. Epub 2019 Nov 13.

Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada

Background: Ophthalmic lymphoma (OL) is the most common orbital tumour, particularly in older individuals. Little is known about the epidemiology and geographic distribution of OL in Canada. Descriptive demographic statistics are an important first step in understanding OL burden and are necessary to inform comprehensive national cancer prevention programmes.

Methods: We determined patterns of incidence and geographical distribution of the three major subtypes of OL: extranodal marginal zone B cell lymphoma, follicular lymphoma (FL) and diffuse large B cell lymphoma. Here, we used cases that were diagnosed during 1992-2010 using two independent population-based cancer registries, the Canadian Cancer Registry and Le Registre Québécois du Cancer (LRQC).

Results: The OL mean annual age-standardised incidence rate for 1992-2010 was 0.65 cases per million people per year with an average annual increase in the incidence rate of 4.5% per year. The mean age of diagnosis was 65 years. OL incidence rate was the highest in the cities located along the heavily industrialised Strait of Georgia in British Columbia.

Conclusions: Our data on patient age, sex and temporal trends showed similarities with data reported in the USA and Denmark. Additional studies are needed to determine whether the observed increase in OL incidence is genuine or spurious.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314653DOI Listing
August 2020

Penile Invasive Squamous Cell Carcinoma: Analysis of Incidence, Mortality Trends, and Geographic Distribution in Canada.

J Cutan Med Surg 2020 Mar/Apr;24(2):124-128. Epub 2019 Nov 13.

Division of Dermatology, McGill University, Montreal, QC, Canada.

Background: Penile invasive squamous cell carcinoma (SCC) is a rare disease with several known risk factors. However, few studies have assessed its incidence, mortality, and temporal trends.

Objective: Our objectives are to analyze the epidemiology of penile SCC in Canada and to examine patient distribution with this cancer across Canada in order to elucidate population risk factors.

Methods: Three independent cancer registries were used to retrospectively analyze demographic data from Canadian men diagnosed with penile invasive SCC between 1992 and 2010. The Canadian Census of Population was used to calculate incidence and mortality rates at the province and Forward Sortation Area levels.

Results: The overall age-adjusted incidence rate was 6.08 cases per million males. Four provinces with statistically significantly higher incidence rates were identified. The national crude incidence rates increased linearly between 1992 and 2010, whereas the age-adjusted incidence rates showed no significant increase during this time period. The overall age-adjusted mortality rate was 1.88 deaths per million males per year. The province of Saskatchewan had significantly higher mortality rates. There was no increase in crude or age-adjusted mortality rates between 1992 and 2010. There was a significant positive correlation between incidence rates and obesity, Caucasian ethnicity, and lower socioeconomic status.

Conclusion: This study was able to establish geographic variation for this malignancy at the provincial level. Although there are many established risk factors for penile SCC, our results suggest that the increase in crude incidence rates observed is largely due to the aging population.
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http://dx.doi.org/10.1177/1203475419888869DOI Listing
January 2021

Epidemiologic trends and geographic distribution of esophageal cancer in Canada: A national population-based study.

Cancer Med 2020 01 12;9(1):401-417. Epub 2019 Nov 12.

Division of Dermatology, Department of Medicine, McGill University, Montreal, Quebec, Canada.

Background: Esophageal cancer can be subdivided into two main histological subtypes with significant variability in their etiology and epidemiology. The incidence of esophageal adenocarcinoma (AC) is increasing across the developed countries, whereas the incidence of esophageal squamous cell carcinoma (SCC) is declining. Several risk factors have been identified in the pathogenesis of each subtype, however, their epidemiologic characteristics and distribution throughout Canada remain poorly understood.

Methods: We performed a retrospective analysis of demographic data across Canada from 1992 to 2010 using two independent population-based cancer registries. The incidence of esophageal cancer, for each subtype, was examined at the levels of provinces/territories, cities, and postal codes.

Results: A total of 19 790 patients were diagnosed with esophageal cancer in Canada between 1992 and 2010; 74% were males. The average national incidence rate was 33.5 cases per million individuals per year. Incidence of esophageal AC increased over time, with notable high-incidence rates on the Vancouver Island, the coasts of the Great Lakes, and the coasts of the Northumberland Strait in the Maritimes. The overall incidence of esophageal SCC has decreased. However, high incidence of esophageal SCC was detected in the Vancouver city, rural eastern Québec, and in the Maritimes. We also report clustering for each subtype using postal codes, which sheds light onto new avenues of research for potential environmental etiologies.

Conclusions: This study, for the first time, provides a detailed analysis on the burden of esophageal cancer in Canada, revealing important geographic clustering trends.
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http://dx.doi.org/10.1002/cam4.2700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943153PMC
January 2020

Analysis of incidence, mortality trends, and geographic distribution of breast cancer patients in Canada.

Breast Cancer Res Treat 2019 Dec 4;178(3):683-691. Epub 2019 Sep 4.

Division of Dermatology, McGill University, Rm. E02.6236, 1001 Decarie Blvd, Montréal, QC, H4A 3J1, Canada.

Background/purpose: Breast cancer is the malignancy with the highest incidence rate excluding non-melanoma skin cancers, and the second leading cause of cancer-related deaths among Canadian women. Many modifiable risk factors have been linked to the pathogenesis of this disease. The purpose of this study is to analyze the epidemiology of breast cancer in Canada and to examine its geographic distribution to help identify new risk factors for this disease.

Methods: Three independent population-based cancer registries were used to retrospectively analyze demographic data from Canadian women diagnosed with invasive breast cancer across all provinces and territories between 1992 and 2010. The incidence and mortality rates were assessed at the provincial, city, and forward sortation area (FSA) postal code levels.

Results: The overall age-adjusted incidence rate was 114.4 cases per 100,000 females per year. Six provinces and several groups of FSAs had significantly higher incidence rates. There was a significant increase in incidence and decrease in mortality rates between 1992 and 2010. The overall mortality rate was 31.5 deaths per 100,000 females per year. However, three provinces had significantly higher mortality rates.

Conclusion: By identifying high-incidence areas for breast cancer, our study will help identify patient populations that are at higher risk for this malignancy. It will also act as a foundation for future studies to establish novel risk factors for this disease.
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http://dx.doi.org/10.1007/s10549-019-05418-2DOI Listing
December 2019

Identification of significant geographic clustering of polycythemia vera cases in Montreal, Canada.

Cancer 2019 11 5;125(22):3953-3959. Epub 2019 Aug 5.

Division of Dermatology, McGill University, Montréal, Québec, Canada.

Background: Polycythemia vera (PV) is a chronic myeloproliferative neoplasm associated at times with debilitating symptoms and a significant mortality rate. Understanding the demographics, epidemiology, and geography of this disease may provide further insight into important risk factors associated with its development. The objective of this study was to analyze patient demographics, incidence, and mortality rates, as well as the geographic distribution of PV patients in Canada between 1992 and 2010.

Methods: This study was achieved by analyzing the Canadian Cancer Registry, Le Registre Québécois du Cancer, and the Canadian Vital Statistics patient databases.

Results: A total of 4645 patients were diagnosed with PV between 1992 and 2010. While the annual incidence rate of this cancer fluctuated in Canada, mortality rate analysis indicated a decreasing trend. Geographically, PV incidence rates were notably elevated in the province of Quebec compared with the Canadian average. Further analysis of high-incidence forward sortation areas indicated a striking clustering of cases in the H4W region encompassing the Côte-Saint-Luc borough of Montreal, with an incidence of 102.97 (95% confidence interval, 75.11-137.79) cases per million per year, which is >13 times the national average.

Conclusion: The residential area of Côte-Saint-Luc is an important PV cluster in Canada, with high concentration of retirement homes and geriatric hospices. Also, Jewish residents comprise >60% of the population in this neighborhood. These findings suggest that an older age and, potentially, an inherent genetic predisposition may be implicated in the pathogenesis of this malignancy. This study provides a comprehensive overview of PV burden/geographic distribution of cases in Canada.
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http://dx.doi.org/10.1002/cncr.32417DOI Listing
November 2019

Necrotic leg ulcers associated with krokodil injection in a 41-year-old man.

CMAJ 2019 06;191(25):E712

Division of Dermatology (Ghazawi, Beecker), University of Ottawa; Department of Medicine (Beecker), The Ottawa Hospital; Ottawa Hospital Research Institute (Beecker), Ottawa, Ont.

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http://dx.doi.org/10.1503/cmaj.190027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592803PMC
June 2019

EBV-associated hydroa vacciniforme-like T-cell lymphoma.

Br J Haematol 2019 09 19;186(6):802. Epub 2019 Jun 19.

Department of Pathology, University of Montreal, Montreal, Canada.

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http://dx.doi.org/10.1111/bjh.16065DOI Listing
September 2019

A novel nonsense mutation in exon 9 in the extracellular matrix protein 1 gene associated with lipoid proteinosis: A case report.

SAGE Open Med Case Rep 2019 19;7:2050313X19850359. Epub 2019 May 19.

Division of Pediatric Dermatology, McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada.

Lipoid proteinosis is a rare autosomal recessive genodermatosis that is caused by loss-of-function mutations in the extracellular matrix protein 1 gene. This study identifies a novel nonsense mutation in exon 9 of the extracellular matrix protein 1 gene associated with lipoid proteinosis, contributing to recent advances in our understanding of the molecular genetics underlying this disease. It is important to identify the mutations in the extracellular matrix protein 1 gene that are associated with lipoid proteinosis and how these affect protein function. Understanding the molecular basis for such genetic disorders may lead to novel therapeutic approaches for treating hereditary genodermatoses.
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http://dx.doi.org/10.1177/2050313X19850359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537054PMC
May 2019

Cutaneous squamous cell carcinoma arising in hidradenitis suppurativa: A case report.

SAGE Open Med Case Rep 2019 17;7:2050313X19847359. Epub 2019 May 17.

Department of Surgery, University of Montreal, Montreal, QC, Canada.

We present a case of a 64-year-old man who presented with a rapidly growing tumor in the left buttock and intergluteal cleft area, which was affected by hidradenitis suppurativa. The patient was on tumor necrosis factor-alpha inhibitors for hidradenitis suppurativa for 2 years prior to the development of the mass. Initial biopsy of the mass showed a well-differentiated squamous cell carcinoma with spindle cells and positive epithelial immunomarkers. Subsequent excisional biopsy of the tumor showed an infiltrating poorly differentiated squamous cell carcinoma composed of islands of atypical sarcomatoid spindle cells. Squamous cell carcinoma arising in hidradenitis suppurativa is a rare complication which may occur secondary to chronic inflammation and epidermal hyperproliferation in hidradenitis suppurativa-affected areas.
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http://dx.doi.org/10.1177/2050313X19847359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537059PMC
May 2019

Successful management of pediatric oral pemphigus vulgaris with topical corticosteroid monotherapy.

Pediatr Dermatol 2019 Sep 9;36(5):730-731. Epub 2019 Jun 9.

Division of Dermatology, Montreal Children's Hospital, Montreal, Quebec, Canada.

Pemphigus vulgaris (PV) is an autoimmune intraepithelial bullous disease that affects the skin and mucous membranes. Typically, the management of PV is challenging, with systemic corticosteroids being the mainstay of treatment. We describe the case of a 14-year-old girl who was diagnosed with oral PV and successfully treated with topical corticosteroids alone. This case details a pediatric mucosal PV case successfully managed solely with topical corticosteroids.
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http://dx.doi.org/10.1111/pde.13876DOI Listing
September 2019

Incidence, Mortality, and Spatiotemporal Distribution of Cutaneous Malignant Melanoma Cases Across Canada.

J Cutan Med Surg 2019 Jul/Aug;23(4):394-412. Epub 2019 May 27.

2 Division of Dermatology, McGill University, Montréal, QC, Canada.

Background: We recently reported a steady increase in the incidence and mortality of cutaneous malignant melanoma (CMM) in Canada during 1992-2010.

Objectives: The objective of this article is to examine the distribution of Canadian CMM patients at the level of provinces, cities, and forward sortation area (FSA) postal codes.

Methods: Using 3 Canadian population-based registries, we conducted an in-depth examination of the incidence and mortality trends for 72 565 Canadian CMM patients over the period 1992-2010.

Results: We found that among 20- to 39-year-olds, the incidence of CMM in women (7.17 per 100 000 individuals) was significantly higher than in men (4.60 per 100 000 individuals per year). Women age 80 years and older had an incidence of CMM (58.46 cases per 100 000 women per year) more than 4 times greater than the national average (12.29 cases per 100 000 population per year) and a corresponding high mortality rate (20.18 deaths per 100 000 women per year), when compared with the Canadian melanoma mortality of 2.4 deaths per 100 000 per year. In other age groups men had higher incidence and corresponding melanoma mortality rates. We also studied CMM incidence by province, city, and FSA postal codes and identified several high-incidence communities that were located near the coast/waterfronts. In addition, plotting latitude measures for cities and FSAs vs CMM incidence rate confirmed the inverse relationship between geographical latitude and incidence of melanoma in Canada (slope = -0.22 ± 0.05).

Conclusions: This research may help develop sex-, age- and geographic region-specific recommendations to decrease the future burden of CMM in Canada.
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http://dx.doi.org/10.1177/1203475419852048DOI Listing
January 2020

Environmental and Other Extrinsic Risk Factors Contributing to the Pathogenesis of Cutaneous T Cell Lymphoma (CTCL).

Front Oncol 2019 18;9:300. Epub 2019 Apr 18.

Division of Dermatology, McGill University, Montréal, QC, Canada.

The applications of disease cluster investigations in medicine have developed rather rapidly in recent decades. Analyzing the epidemiology of non-random aggregation of patients with a particular disease fostered identification of environmental and external exposures as disease triggers and promoters. Observation of patient clusters and their association with nearby exposures, such as Dr. John Snow's astute mapping analysis in the mid-1800's, which revealed proximity of cholera patients in London to a contaminated water pump infected with , have paved the way for the field of epidemiology. This approach enabled the identification of triggers for many human diseases including infections and cancers. Cutaneous T-cell lymphomas (CTCL) represent a group of non-Hodgkin lymphomas that primarily affect the skin. The detailed pathogenesis by which CTCL develops remains largely unknown. Notably, non-random clustering of CTCL patients was reported in several areas worldwide and this rare malignancy was also described to affect multiple members of the same family. These observations indicate that external factors are possibly implicated in promoting CTCL lymphomagenesis. Here, we review the epidemiology of CTCL worldwide and the clinical characteristics of CTCL patients, as revealed by global epidemiological data. Further, we review the known risk factors including sex, age, race as well as environmental, infectious, iatrogenic and other exposures, that are implicated in CTCL lymphomagenesis and discuss conceivable mechanisms by which these factors may trigger this malignancy.
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http://dx.doi.org/10.3389/fonc.2019.00300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499168PMC
April 2019

Incidence trends of conjunctival malignant melanoma in Canada.

Br J Ophthalmol 2020 01 11;104(1):23-25. Epub 2019 May 11.

Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada

Background: Melanoma is the most common primary malignancy of the eye in adults. While the epidemiology of uveal melanoma has recently been described in Canada, little is known about the epidemiology and geographic distribution of patients with conjunctival melanoma (CM) in Canada.

Methods: We conducted a population-based study of CM incidence across all Canadian provinces and territories during 1992-2010 using two independent population-based registries.

Results: 190 patients were diagnosed with CM in Canada from 1992 to 2010. 55.3 % of these patients were men. The mean annual incidence rate of CM in Canada was 0.32 cases per million individuals (0.35 and 0.29 cases per million individuals for men and women, respectively). The incidence rates for Canadian provinces demonstrated that the eastern provinces of Nova Scotia and New Brunswick had higher age-adjusted incidence rates than the national average, with rates of 0.52 and 0.47 cases per million individuals per year, respectively.

Conclusions: This analysis demonstrates novel variations in CM incidence rates between different Canadian provinces. These results taken together with the data reported from the USA confirm the North-to-South geographic gradient of increasing CM incidence. This research highlights that the epidemiology of CM in North America is comparable to that of cutaneous malignant melanoma in contrast to the trends for uveal melanoma distribution.
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http://dx.doi.org/10.1136/bjophthalmol-2019-313977DOI Listing
January 2020

Cutaneous plasmacytosis and multinucleate cell angiohistiocytoma-like lesion in a patient with hepatitis B: A fortuitous triad?

J Cutan Pathol 2019 Sep 28;46(9):678-683. Epub 2019 May 28.

Division of Pathology, University of Montréal, Montréal, Québec, Canada.

A 28-year-old woman of Chinese descent, with congenital chronic hepatitis B presented with a 7-year history of erythematous-brown papules and plaques on her groins, axillae, and forehead. A first skin biopsy showed findings consistent with two concomitant, yet highly uncommon cutaneous diseases. The presence of lymphoid nodules with germinal centers and clustered polyclonal plasma cells was consistent with cutaneous plasmocytosis. Second, a diffuse proliferation of non-atypical small vessels (CD31+, CD34+, and HHV8-) in a hypercellular stroma peppered with angulated giant cells (CD163+, CD68-) was suggestive of multinucleate cell angiohistiocytoma (MCAH). Interestingly, the second biopsy of a different plaque on the forehead showed only plasmacytosis and the clinical appearance of both plaques and papules alluded to the distinct presence of both concurrent entities. We speculate the immune modulating effects of chronic hepatitis B may have led to a polyclonal plasmacytic proliferation within the dermis. Furthermore, MCAH has been reported in conjunction with other inflammatory skin diseases such as hidradenitis suppurativa and as such we propose that the MCAH lesion in our case may have arisen as a secondary, reactive process to the cutaneous plasmacytosis.
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http://dx.doi.org/10.1111/cup.13491DOI Listing
September 2019

The Crown Jewel, an Enigmatic Solitary Mass of Follicular Origin: Answer.

Am J Dermatopathol 2019 May;41(5):392-393

Department of Pathology and Dermatology, Dermatopathology Unit, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.

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http://dx.doi.org/10.1097/DAD.0000000000001022DOI Listing
May 2019

Multiple myeloma epidemiology and patient geographic distribution in Canada: A population study.

Cancer 2019 07 5;125(14):2435-2444. Epub 2019 Apr 5.

Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.

Background: Multiple myeloma (MM) is a malignancy of mature plasma cells. Environmental risk factors identified for this malignancy, among others, include farming and exposure to pesticides.

Methods: Using 3 independent population-based databases (the Canadian Cancer Registry, le Registre Québécois du Cancer, and Canadian Vital Statistics), this study analyzed patients' clinical characteristics and the incidence, mortality, and geographic distribution of MM cases in Canada during 1992-2015.

Results: In total, ~32,065 patients were identified, and 53.7% were male. The mean age at the time of diagnosis was 70 ± 12.1 years. The average incidence rate in Canada was 54.29 cases per million individuals per year, and linear regression modeling showed a steady rise in the annual rate of 0.96 cases per million individuals per year. At the provincial level, Quebec and Ontario had significantly higher incidence rates than the rest of Canada. An analysis of individual municipalities and postal codes showed lower incidence rates in large metropolitan areas and in high-latitude regions of the country, whereas high incidence rates were observed in smaller municipalities and rural areas. Land use analysis demonstrated increased density of crop farms and agricultural industries in high-incidence areas. A comparison with the available data from 2011-2015 showed several consistent trends at provincial, municipal, and regional levels.

Conclusions: These results provide a comprehensive analysis of the MM burden in Canada. Large metropolitan cities as well as high-latitude regions were associated with lower MM incidence. Higher incidence rates were noted in smaller cities and rural areas and were associated with increased density of agricultural facilities.
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http://dx.doi.org/10.1002/cncr.32128DOI Listing
July 2019

Retinoblastoma Incidence Trends in Canada: A National Comprehensive Population-Based Study.

J Pediatr Ophthalmol Strabismus 2019 Mar;56(2):124-130

Purpose: To determine the incidence rates and geographic distribution of retinoblastoma in Canada to aid cancer control programs.

Methods: Patients with retinoblastoma whose data were available from the Canadian Cancer Registry (CCR) and Le Registre Québécois du Cancer (LRQC) were studied. Using third edition International Classification of Diseases for Oncology (ICD-O) codes, the authors examined the incidence rates and geographic distribution of patients with retinoblastoma between 1992 and 2010. Patient data including sex, age, and laterality of the retinoblastoma were analyzed.

Results: Between 1992 and 2010 in Canada, the average annual incidence rate of retinoblastoma was 11.58 cases per 1 million children younger than 5 years (95% CI [confidence interval]: 10.48 to 12.76). The incidence rate was stable over time, with an average age at diagnosis of 2.30 ± 6.85 years and no gender predilection. The laterality of the reported cases was 81.48% for uni-lateral cases and 18.52% for bilateral cases. Provincially, Nova Scotia had twice the national average and the highest incidence rates of retinoblastoma across the Canadian provinces.

Conclusions: This is the first study to define the disease burden of retinoblastoma and to highlight important longitudinal, geographic, and spatial differences in the distribution of retinoblastoma in Canada between 1992 and 2010. The results of this study indicate continuity of clinical trends between Canada, the United States, and other developed countries. [J Pediatr Ophthalmol Strabismus. 2019;56(2):124-130.].
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http://dx.doi.org/10.3928/01913913-20190128-02DOI Listing
March 2019