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IMPORTANCE Melanoma is epidemiologically linked to UV exposure, particularly childhood sunburn. Public health campaigns are increasing sun-protective behavior in the United States, but the effect on melanoma incidence is unknown. OBJECTIVE To examine the incidence of melanoma in the United States and whether any age-specific differences are present. DESIGN, SETTING, AND PARTICIPANTS Observational, population-based registry data were extracted on July 3, 2018, from the combined National Program of Cancer Registries-Surveillance Epidemiology and End Results United States Cancer Statistics database for 2001-2015. Deidentified data for 988 103 cases of invasive melanoma, with International Classification of Diseases for Oncology histologic categorization codes 8720 to 8790, were used for analysis. Data analysis was performed from July 1, 2018, to March 1, 2019. MAIN OUTCOMES AND MEASURES The annual rates of melanoma in pediatric, adolescent, young adult, and adult age groups were determined. Analyses were stratified by sex, and incidence rates were age-adjusted to the 2000 US standard population. Annual percentage change (APC) in incidence rate was calculated over the most recent decade for which data were available (2006-2015) using the weighted least squares method. RESULTS In 2015, 83 362 cases of invasive melanoma were reported in the United States, including 67 in children younger than 10 years, 251 in adolescents (10-19 years), and 1973 in young adults (20-29 years). Between 2006 and 2015, the overall incidence rate increased from 200.1 to 229.1 cases per million person-years. In adults aged 40 years or older, melanoma rates increased by an APC of 1.8% in both men (95% CI, 1.4%-2.1%) and women (95% CI, 1.4%-2.2%). In contrast, clinically and statistically significant decreases were seen in melanoma incidence for adolescents and young adults. Specifically, incidence rates decreased by an APC of −4.4% for male adolescents (95% CI, −1.7% to −7.0%), −5.4% for female adolescents (95% CI, −3.3% to −7.4%), −3.7% for male young adults (95% CI, −2.5% to −4.8%), and −3.6% for female young adults (95% CI, −2.8% to −4.5%). Data on skin pigmentation and sun protection history were unavailable; similar trends were observed with data limited to non-Hispanic whites. Young adult women appeared to have twice the risk of melanoma as young adult men. CONCLUSIONS AND RELEVANCE The incidence of invasive melanoma in the United States appeared to decrease in adolescents and young adults from 2006 to 2015, and this finding contrasted with increases in older populations. These incidence trends suggest that public health efforts may be favorably influencing melanoma incidence in the United States.

IMPORTANCE Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome involving the skin, brain, and eyes. Consensus recommendations for management are lacking. OBJECTIVE To consolidate the current literature with expert opinion to make recommendations that will guide treatment and referral for patients with port-wine birthmarks (PWBs). EVIDENCE REVIEWIn this consensus statement, 12 nationally peer-recognized experts in dermatology with experience treating patients with SWS were assembled. Key topics and questions were formulated for each group and included risk stratification, optimum treatment strategies, and recommendations regarding light-based therapies. A systematic PubMed search was performed of English-language articles published between December 1, 2008, and December 1, 2018, as well as other pertinent studies identified by the expert panel. Clinical practice guidelines were recommended.FINDINGS Treatment of PWBs is indicated to minimize the psychosocial impact and diminish nodularity and potentially tissue hypertrophy. Better outcomes may be attained if treatments are started at an earlier age. In the US, pulsed dye laser is the standard for all PWBs regardless of the lesion size, location, or color. When performed by experienced physicians, laser treatment can be safe for patients of all ages. The choice of using general anesthesia in young patients is a complex decision that must be considered on a case-by-case basis. CONCLUSIONS AND RELEVANCEThese recommendations are intended to help guide clinical practice and decision-making for patients with SWS and those with isolated PWBs and may improve patient outcomes.The goals of this consensus statement are to review the literature and provide an approach to risk stratification and evaluation of PWBs, offer guidance on diagnostic workup for patients with suspected or newly diagnosed SWS, and assess current treatment options for PWBs in light of the patient's age and condition severity. The treatment recommendations are currently applicable to all patients with a PWB. MethodsTwelve national experts in dermatology were consulted to develop a consensus statement on the management and treatment of cutaneous manifestations of SWS as part of a larger consensus statement. The panel was created from a list of experts provided by the Sturge-Weber Foundation who had significant experience in treating patients with SWS and patients with PWBs who agreed to participate. Three key needs were identified: (1) risk stratification and evaluation of PWBs, (2) optimum treatment strategies for PWBs, and (3) specific recommendations regarding light-based therapies. The expert group was divided into 4 subgroups that formulated questions to address each topic. An extensive literature review was performed using PubMed for English-language articles published between December 1, 2008, and December 1, 2018, an arbitrarily selected date range, to explore articles within the past 10 years. Articles before 2008or after 2018were added by the expert panel based on importance. Search terms in...

In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.