The continued increases in melanoma death rates for older persons and for thin lesions suggest that the increases may partly reflect increased ultraviolet radiation exposure. The substantial contribution of thin lesions to melanoma mortality underscores the importance of standard wide excision techniques and the need for molecular characterization of the lesions for aggressive forms.

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Background Invasive melanoma of the skin is the third most common cancer diagnosed among adolescents and young adults (aged 15-39 years) in the United States. Understanding the burden of melanoma in this age group is important to identifying areas for etiologic research and in developing effective prevention approaches aimed at reducing melanoma risk. Methods Melanoma incidence data reported from 38 National Program of Cancer Registries and/or Surveillance Epidemiology and End Results statewide cancer registries covering nearly 67.2% of the US population were used to estimate age-adjusted incidence rates for persons 15-39 years of age. Incidence rate ratios were calculated to compare rates between demographic groups. Results Melanoma incidence was higher among females (age-adjusted incidence rates = 9.74; 95% confidence interval 9.62-9.86) compared with males (age-adjusted incidence rates = 5.77; 95% confidence interval 5.68-5.86), increased with age, and was higher in non-Hispanic white compared with Hispanic white and black, American Indians/Alaskan Natives, and Asian and Pacific Islanders populations. Melanoma incidence rates increased with year of diagnosis in females but not males. The majority of melanomas were diagnosed on the trunk in all racial and ethnic groups among males but only in non-Hispanic whites among females. Most melanomas were diagnosed at localized stage, and among those melanomas with known histology, the majority were superficial spreading. Limitations Accuracy of melanoma cases reporting was limited because of some incompleteness (delayed reporting) or nonspecific reporting including large proportion of unspecified histology. Conclusions Differences in incidence rates by anatomic site, histology, and stage among adolescents and young adults by race, ethnicity, and sex suggest that both host characteristics and behaviors influence risk. These data suggest areas for etiologic research around gene-environment interactions and the need for targeted cancer control activities specific to adolescents and young adult populations.

Background-Several 99m Tc-labeled agents that are not approved by the U.S. Food and Drug Administration are used for lymphatic mapping. A new low-molecular-weight mannose receptorbased, reticuloendothelial cell-directed, 99m Tc-labeled lymphatic imaging agent, 99m Tc-tilmanocept, was used for lymphatic mapping of sentinel lymph nodes (SLNs) from patients with primary breast cancer or melanoma malignancies. This novel molecular species provides the basis for potentially enhanced SLN mapping reliability.

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Synopsis Functional imaging using radiolabeled probes which specifically bind and accumulate in target tissues has improved the sensitivity and specificity of conventional imaging. Positron Emission Tomography using modified glucose probes (FDG-PET) has demonstrated improved diagnostic accuracy in differentiating benign from malignant lesions in the setting of solitary pulmonary nodules. In addition, FDG-PET has become a useful modality in pre-operative staging of patients with lung cancer and is being tested with many other malignancies for its ability to change patient management. This article provides an overview of the current status of FDG-PET and presents the challenges of moving towards routine use.

B reast carcinoma arises in the epithelial cells lining the milk ducts and lobules that comprise the ductal system of the breast. 1,2 Ductal lavage is a minimally invasive office procedure performed on women who are considered to be at high risk for breast carcinoma to collect breast ductal epithelial cells for cytologic analysis to provide further risk stratification. The procedure involves the insertion of a microcatheter approximately 1.5 cm into a nipple orifice after topical anesthesia; lavaging the cannulated ductal system with normal saline; and analyzing the collected lavage effluent for the presence of normal, atypical, or malignant breast ductal cells.The purpose of this commentary is to review the data supporting breast ductal cytology as a tool to provide high-risk women with individualized information regarding their risk of developing breast carcinoma, and to provide a discussion of clinical management options based on the results of ductal lavage cytology. Significance of Atypical Ductal Epithelial CellsPublished, peer-reviewed data with long-term follow-up have demonstrated that women with atypical ductal epithelial cells have an elevated, near-term risk of developing breast carcinoma. Wrensch et al. collected ductal epithelial cells from 2701 women volunteers by nipple aspiration, analyzed those cells cytologically, and performed prospective longitudinal follow-up on 2343 women with an average follow-up period of 12.7 years. 3 This study demonstrated that women with cellular atypia in nipple aspirate fluid (NAF) had a relative risk of developing breast carcinoma that was 4.9 times greater than women whose breasts did not yield NAF. Women with a family history of breast carcinoma and cellular atypia on NAF had an increase in their relative risk that was 18 times greater than that for women without cellular atypia on NAF. 3 292

OBJECTIVESLung cancer is one of the most lethal cancers. Currently, there are no biomarkers for early detection, monitoring treatment response, and detecting recurrent lung cancer. We undertook this study to determine if 1H magnetic resonance spectroscopy (MRS) of sputum and exhaled breath condensate (EBC), as a noninvasive tool, can identify metabolic biomarkers of lung cancer.MATERIALS AND METHODSSputum and EBC samples were collected from 20 patients, comprising patients with pathologically confirmed non-small cell lung cancer (n = 10) and patients with benign respiratory conditions (n = 10). Both sputum and EBC samples were collected from 18 patients; 2 patients provided EBC samples only. 1H MR spectra were obtained on a Bruker Avance 400 MHz nuclear magnetic resonance (NMR) spectrometer. Sputum samples were further confirmed cytologically to distinguish between true sputum and saliva.RESULTSIn the EBC samples, median concentrations of propionate, ethanol, acetate, and acetone were higher in lung cancer patients compared to the patients with benign conditions. Median concentration of methanol was lower in lung cancer patients (0.028 mM) than in patients with benign conditions (0.067 mM; P = 0.028). In the combined sputum and saliva and the cytologically confirmed sputum samples, median concentrations of N-acetyl sugars, glycoprotein, propionate, lysine, acetate, and formate were lower in the lung cancer patients than in patients with benign conditions. Glucose was found to be consistently absent in the combined sputum and saliva samples (88%) as well as in the cytologically confirmed sputum samples (86%) of lung cancer patients.CONCLUSIONAbsence of glucose in sputum and lower concentrations of methanol in EBC of lung cancer patients discerned by 1H MRS may serve as metabolic biomarkers of lung cancer for early detection, monitoring treatment response, and detecting recurrence.