Non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is the most common cancer occurring in people with fair skin. Australia has been reported to have the highest incidence of NMSC in the world. Using a systematic search of the literature in EMBASE and Medline, we identified 21 studies that investigated the incidence or prevalence of NMSC in Australia. Studies published between 1948 and 2011 were identified and included in the analysis. There were six studies that were conducted on national level, two at state level and 13 at the regional level. Overall, the incidence of NMSC had steadily increased over calendar-years in Australia. The incidence of NMSC per 100,000 person-years was estimated to be 555 in 1985; 977 in 1990; 1109 in 1995; 1170 in 2002 and 2448 in 2011. The incidence was higher for men than women and higher for BCC than SCC. Incidence varied across the states of Australia, with the highest in Queensland. The prevalence of NMSC was estimated to be 2% in Australia in 2002. The incidence and prevalence of NMSC still need to be accurately established at both national and state levels to determine the costs and burden of the disease on the public health system in Australia.

Melanomas are a major cause of premature death from cancer. The gradual decrease in rates of morbidity and mortality has occurred as a result of public health campaigns and improved rates of early diagnosis. Survival of melanoma has increased to over 90%. Management of melanoma involves a number of components: excision, tumor staging, re-excision with negative margins, adjuvant therapies (chemo, radiation or surgery), treatment of stage IV disease, follow-up examination for metastasis, lifestyle modification and counseling. Sentinel lymph node status is an important prognostic factor for survival in patients with a melanoma >1 mm. However, sentinel lymph node biopsies have received partial support due to the limited data regarding the survival advantage of complete lymph node dissection when a micrometastasis is detected in the lymph nodes. Functional mutations in the mitogen-activated pathways are commonly detected in melanomas and these influence the growth control. Therapies that target these pathways are rapidly emerging, and are being shown to increase survival rates in patients. Access to these newer agents can be gained by participation in clinical trials after referral to a multidisciplinary team for staging and re-excision of the scar.

Background: Chronic telogen effluvium (CTE) may be primary or secondary to various causes, including drug reaction, nutritional deficiency and female pattern hair loss (FPHL).  Oral minoxidil stimulates hair growth, and topical minoxidil is used in the treatment of FPHL and male androgenetic alopecia. minoxidil has not been used to treat CTE. This study aimed to assess the treatment of CTE with once daily oral minoxidil. Methods: Women with a diagnosis of CTE based on >6 month history of increased telogen hair shedding, no visible mid frontal scalp hair loss (Sinclair stage 1) and no hair follicle miniaturization on scalp biopsy were treated with once daily oral minoxidil.  Hair shedding scores (HSS) at baseline, 6 and 12 months were analysed using the Wilcoxon rank sum test for pair-wise comparisons. Results: Thirty-six women were treated with oral minoxidil (range, 0.25-2.5 mg) daily for 6 months.  Mean age was 46.9 years (range 20-83), HSS at baseline was 5.64, and duration of diagnosis was 6.55 years (range 1-27).  There was a reduction in mean HSS scores from baseline to 6 months of 1.7 (p<0.001) and baseline to 12 months of 2.58 (p<0.001). Five women who described trichodynia at baseline, noted improvement or resolution within 3 months.  Mean change in blood pressure was minus 0.5 mmHg systolic and plus 2.1 mmHg diastolic.  Two patients developed transient postural dizziness that resolved with continued treatment.  One patient developed ankle oedema.  Thirteen women developed facial hypertrichosis.  For 6 patients this was mild and did not require treatment; 4 had waxing of their upper lip or forehead; 3 had laser hair removal.  No patients developed any haematological abnormality.  All 36 women completed 12 months of treatment. Conclusions: Once daily oral minoxidil appears to reduce hair shedding in CTE.  Placebo controlled studies are recommended to further assess this response.

Alopecia areata (AA) is a common, non-scarring alopecia that usually presents as well-circumscribed patches of sudden hair loss and affects 0.1-0.2% of the population. The aetiology of AA is thought to be both genetic and autoimmune in nature. One hundred and thirty-nine single nucleotide polymorphisms linked to AA have been identified in 8 regions of the genome and have been found to be associated with T cells or the hair follicle. Furthermore, patients with AA have been found to have an increased frequency of hair follicle-specific auto-antibodies. The diagnosis of AA is usually made on clinical grounds, and further investigations are not usually needed. Intralesional corticosteroids remain the treatment of choice. Systemic steroids are also highly effective; however, side effects make them less desirable to both patients and physicians. Other available treatment options include anthralin, minoxidil, topical immunotherapy and systemic immunosuppressants. These treatments will be discussed in depth in this chapter. The morbidity of AA is largely psychological; therefore, the successful treatment of AA should include focusing on improving the psychological impact of this condition.

Background:  Epidemiological data surrounding non-melanomatous skin cancer (NMSC) is highly variable, in part due to the lack of government cancer registries. Several studies employ the use of Medical Australia (MA) rebate data in assessing such trends, the validity of which has not been studied in the past. Conversely, melanoma skin cancer is a notifiable disease, and thus, MA and cancer registry data is readily available. The aim of the current study is to assess the use of MA for epidemiological measures for skin cancers, by using melanoma as a disease sample. Methods:  Following ethics approval, data from MA and Victorian Cancer Registry (VCR) from 2004-2008 were extracted. Incidence of MA and VCR unique melanoma cases were compared and stratified by age and local government area (LGA). Regression and a paired-samples t-test were performed. Results: During the study period; 15,150 and 13,886 unique melanoma patients were identified through VCR and MA data sources respectively. An outlier in the >80­ year age group was noted between MA and VCR data. When stratified by age, significant correlation between MA and VCR was observed for all patients (gradient 0.91, R²= 0.936) and following exclusion of >80 patients (gradient 0.96, R²= 0.995). When stratified by LGA, a high degree of observation was observed for all patients (gradient 0.94, R²= 0.977) and following exclusion of >80 patients (gradient 0.996, R²= 0.975). Conclusion: Despite the inclusion of outlier data groups, acceptable correlation between MA and VCR melanoma data was observed, suggesting that MA may be suitable for assessing epidemiological trends. Such principals may be used to validate the use of MA data for similar calculations assessing NMSC trends.

Nonmelanoma skin cancer (NMSC) is the most commonly diagnosed cancer in Australia and has a significant impact on the cost of and use of healthcare resources. Current estimates of NMSC in the USA are 3.5 million cases in 2010 compared to 1.63 million cases of all other cancers combined.  However, we believe that this figure significantly underestimates the prevalence of NMSC in the USA.  We calculated that melanoma is diagnosed 5.7 times more in the USA than in Australia.  In Australia, in 2010, there were 767,000 NMSC diagnoses.  If the ratio of melanoma: NMSC is constant in both Australia and the USA, then there should be 5.7 times the number of NMSC in the USA or 4.3 million cases.  The assumptions that underlie this calculation are discussed.

Adolescents with cystic fibrosis and acne can be treated with oral isotretinoin. Oral isotretinoin should be considered for adolescents with cystic fibrosis who have acne associated with scarring, acne not clearing with topical and antibiotic treatment, acne associated with depression or severe cystic acne.

Objectives: To report the burden and cost of actinic keratosis (AK) treatment in Australia and to forecast the number of AK treatments and the associated costs to 2020. Design and setting: A retrospective study of data obtained from medicare Australia for AK treated by cryotherapy between 1 January 1994 and 31 December 2012, by year and by state or territory. Results: The total number of AK cryotherapy treatments increased from 247,515 in 1994 to 643,622 in 2012, and we estimate that the number of treatments will increase to 831,952 (95% CI 676,919 to 986,987) by 2020. The total Medicare Benefits Schedule (MBS) benefits paid out for AK in 2012 was $19.6 million and we forecast that this will increase to $24.7 million by 2020 (without inflation). Conclusion: The number of AK cryotherapy treatments increased by 160% between 1994 and 2012. we forecast that the number of treatments will increase by 30% between 2012 and 2020. The rates of non-melanoma skin cancer (NMSC) and AK appear to be increasing at the same rate. During the period 2010 to 2015 AK is anticipated to increase by 17.8% which follows a similar trend to published data that forecasts an increase in NMSC treatments of 22.3%.