Fair Skin Type Research Articles

Human papillomaviruses in hand squamous cell carcinomas from Chilean patients

IntroductionCutaneous squamous cell carcinoma (SCC) accounts for 20% of all skin cancers and its incidence continues to increase globally. It represents 75% of non-melanoma skin cancer (NMSC) mortality. Risk factors include ultraviolet radiation (UVR) exposure, advanced age, chemical exposure, fair skin types, and immunosuppression. While most human papillomavirus (HPV) infections are associated with the development of warts, a subgroup is potentially implicated in the development of cutaneous SCC. The prevalence of alpha, beta, and gamma-HPV in Chilean patients with hand SCCs has not been previously addressed. The objective of this study was to evaluate the presence of HPV and genotyping in hand SCC from Chilean patients.Materials and methodsAn observational, cross-sectional, descriptive study was conducted. Alpha (α), beta (β) and gamma (γ)-HPV detection was performed by conventional polymerase chain reaction (PCR) in paraffin-embedded tissue samples from 52 patients diagnosed with hand SCC from Santiago, Chile. HPV genotyping was carried out via direct amplicon sequencing by Sanger method.ResultsThe most frequent carcinoma site was the dorsum of the hands (52.5%). α-HPV was not detected in these specimens, whereas β-HPV and γ-HPV were detected in 25% of the analyzed samples. The most frequent genotypes found were β-HPV 100 (38%) and γ-HPV 178 (15%). Additionally, γ-HPV 101, 162, HPV-mSK_016, HPV-mSK_083, HPV-mSK_213 and HPV-mSK249nr genotypes were detected, none of which had been previously described in cutaneous SCC.Conclusionβ-HPV and γ-HPV are detectable in 25% of hand SCCs from Chilean patients. It is important to conduct prospective studies to better elucidate the role of these viruses in the development of this disease.

Epidemiology and Risk Factors of Actinic Keratosis. What is New for The Management for Sun-Damaged Skin.

Actinic keratosis (AK) is considered a chronic skin disease mostly caused by long-term exposure to UV radiation and other risk factors such as immunosuppression, leading to an individual susceptibility for skin cancer manifestation. The treatment of AK is laborious and costly, and the incidence of skin cancer is forecasted to double until the year 2030 in an aging society.Risk factors in AK for malignant transformation in cutaneous squamous cell carcinoma (cSCC) are not fully understood, but studies suggest that histological features, such as atypia in the basal epidermal third and basal proliferation (PRO score) in AK play a pivotal role for development of malignancy. As the clinical appearance of AK does not correlate with the risk for malignancy, guidelines suggest treating every single AK lesion upon diagnosis. Skin imaging techniques, such as line-field confocal optical coherence tomography (LC-OCT) can help to provide an individual holistic follow-up for AK lesions by non-invasive visualization of atypia and basal proliferation. A follow-up for patients with AK may be critical for treatment success in terms of strengthening therapy adherence. When AK presents therapy refractory, cSCC manifests in nearly 30% of the cases after several years. Patients with AK suffering from field cancerization and immunosuppression are susceptible for a severe course of disease including metastasis and high mortality rates. Those vulnerable subgroups benefit from close skin cancer screening, early adequate treatment and chemoprevention, such as niacinamide or acitretin. Skin cancer prevention is substantial. Primary prevention should include chemical and physical UV-light protection and avoidance of indoor tanning. Secondary prevention is essential in high-risk populations, such as fair skin type elderly men and STORs. Tertiary prevention should comprise adequate treatment strategies to prevent therapy resistance, reoccurrence and cSCC, especially when field cancerization and immunosuppression are present.

Iris melanoma in an Australian cohort.

To report the clinicopathological features and epidemiology of iris melanoma in Queensland, Australia. This was a retrospective study of 86 patients with iris melanoma treated between 2001 and 2022 at the Queensland Ocular Oncology Service, Brisbane, Australia. Main outcome measures included demographics, clinical and phenotypic features, age-adjusted incidence and relative survival. Eighty-six patients (63% female) were included. Mean age was 54 years (range 17-82 years). The majority of patients (97%) were Caucasian, with blue eyes, fair skin and Fitzpatrick Skin Type I or II. Demographic features and clinical history showed a tendency for high ultraviolet radiation (UVR) exposure in the cohort. Histopathology was available in 69 cases (82%), and of these, 77% tumours were of spindle cell origin, with low-risk genetic profiles. Patients were followed for a mean of 8 years (median 7, range 1-21 years) after diagnosis, and only one case of metastasis was documented. The association of iris freckles, history of UVR exposure and dermatologic findings supports the role of UVR in iris melanoma. Occupation and avocation history, as well as evaluation of iris freckles may offer an easily accessible way of stratifying the risk of an individual for development of UVR-related uveal melanoma.

Topical corticosteroids in the treatment of acute sunburn: a systematic review

Background: Acute sunburn is a prevalent dermatological issue, particularly affecting individuals with fair skin types I-III. It is characterized by erythema, edema, and discomfort due to ultraviolet (UV) radiation exposure. Topical corticosteroids are commonly used for their anti-inflammatory properties, but their efficacy in sunburn treatment is debated due to limited high-quality evidence from randomized controlled trials (RCTs). This study aims to assess the efficacy of topical corticosteroids in relieving symptoms and inflammation of sunburn. Methods: A systematic review was conducted by searching PubMed, Web of Science, ProQuest, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published up to April 30, 2024. Keywords included combinations of terms related to corticosteroids, topical application, and sunburn. Studies were selected based on PRISMA 2020 guidelines, focusing on adult patients treated with topical corticosteroids compared to placebo. Data extraction and quality assessment were independently performed by two researchers using the Cochrane Collaboration’s Risk of Bias tool. Results: The review included six RCTs with a total of 339 participants, aged 18-68 years, conducted in Europe and the USA. Various topical corticosteroids were studied, including methylprednisolone aceponate, hydrocortisone 17-butyrate, and hydrocortisone-21-acetate. Treatment durations ranged from single applications to twice daily for seven days. The results demonstrated that prolonged treatment with topical corticosteroids significantly reduced sunburn symptoms such as erythema and pain. When applied for seven days, treated areas showed lower sunburn reaction scores and reduced inflammation compared to untreated areas. Early application of corticosteroids, particularly within 6 hours post-exposure, was more effective than later applications. Histological analyses supported these findings, showing improvements in epidermal thickness and reduced dermal inflammation in treated areas. Conclusion: Topical corticosteroids can effectively alleviate acute sunburn symptoms and aid skin recovery by targeting inflammatory pathways. Their efficacy is enhanced with prolonged and early application. Further research is needed to optimize treatment protocols and assess long-term effects to fully realize the therapeutic potential of corticosteroid therapy in managing acute sunburn.

Diagnostic Value of Dermoscopic Structures in Predicting Superficial Basal Cell Carcinoma in the Skin of Color.

Basal cell carcinoma (BCC) manifests different dermoscopic patterns in individuals with dark skin complexion compared to those with fair skin types. This study aimed to investigate the diagnostic utility of dermoscopy in discerning superficial BCC from other types of BCC, specifically in patients with dark skin complexion. This cross-sectional study focuses on patients diagnosed with BCC who were referred for skin biopsy between July 2020 and September 2022. Initially, the demographic characteristics of patients, clinical attributes of lesions, and pathological sub-types of BCC were documented. Subsequently, videodermoscopy was employed to capture comprehensive views and dermoscopic images of the lesions. Univariate logistic regression analysis was then utilized to assess the reliability of dermoscopic structures in distinguishing superficial BCC from other BCC types. Last, the study evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of dermoscopy in the differentiation of superficial BCC from other BCC sub-types. The study enrolled 49 patients diagnosed with BCC, with a mean age of 66.22 ± 10.41 years. The most prevalent pathological sub-type observed was nodular (53.1%). Dermoscopy exhibited a higher specificity compared to the naked eye in the differentiation of superficial BCC from other types (55% vs. 35%, respectively). Univariate analysis revealed a significant association between spoke-wheel structures and superficial BCC (P = 0.02, odds ratio = 7.2, 95% confidence interval = 1.35-38.32). Dermoscopy exhibited superior specificity compared to the naked eye in differentiating superficial BCC from other BCC types. Notably, the spoke-wheel structure demonstrated the most robust correlation with superficial BCC.

Dermatoscopic profiling of inverted follicular keratosis indifferent skin phenotypes.

Inverted follicular keratosis (IFK) is a rare benign tumour of the follicular infundibulum. Owing to its similarity to other benign and malignant cutaneous lesions, it poses a diagnostic challenge. There is limited information on the dermatoscopic characteristics of IFK and the majority of cases have been reported in patients with lighter skin types. To describe the prevalent dermatoscopic features of IFK, especially in patients with skin of colour. We retrospectively analysed 35 histopathologically verified cases of IFK from a single university hospital in Turkey. With respect to the Fitzpatrick skin phototype, 2 (6%), 12 (34%), 16 (46%) and 5 (14%) patients had Fitzpatrick skin phototypes II, III, IV and V, respectively. Clinically, the majority of IFKs were hypopigmented or nonpigmented (83%). Pink-white structureless areas (54%), ulceration (54%), a central keratin mass (43%) and blood spots on keratin mass (43%) were the most frequent dermatoscopic findings. Pigmented structures were observed as blue-grey structureless areas in 12 lesions and as blue-grey clods in 5, primarily in Fitzpatrick phototype IV and V skin. The incidence of a pink, structureless area and blood spots on ulceration was found to be statistically significantly higher in individuals with fairer skin types, while a greater prevalence of blue-grey coloration was observed in those with skin of colour (P < 0.05). Although our study found some distinguishing dermatoscopic findings in IFK, diagnosis is generally confirmed by histopathology, as the clinical appearance and dermatoscopic findings may not be sufficient to differentiate it from other tumours, especially squamous cell carcinoma or keratoacanthoma. The dermatoscopic characteristics of dark skin are comparable to those of pale skin; however, hyperpigmentation can be more noticeable in skin of colour.

Frequency of skin cancer among psoriasis, vitiligo, and mycosis fungoides patients treated with narrowband ultraviolet B phototherapy.

Narrowband ultraviolet B (NB-UVB) phototherapy is a popular and relatively contemporary treatment option. However, only a few studies to date have explored the potential risk of skin cancer following NB-UVB treatment. This study aimed to investigate the potential long-term risk of skin cancer in patients treated with NB-UVB. This cohort study included patients with psoriasis, vitiligo, and mycosis fungoides treated with NB-UVB at two university hospitals in Israel in 2000-2005. Patients were followed up for skin cancer for at least 10 years. Data were extracted from the hospital and community medical records. A total of 767 patients were included in this study: 509 with psoriasis, 122 with vitiligo, and 136 with mycosis fungoides. The mean follow-up duration was 13 years. Among these patients, 4.43% developed skin cancer during the follow-up (3.93% had psoriasis, 2.46% had vitiligo, and 8.09% had mycosis fungoides). Old age and fair skin type were the only significant independent risk factors for skin cancer. There was no significant difference in the mean number of NB-UVB treatments among patients who developed skin cancer and those who did not (99.09 vs. 94.79, respectively). No association was observed between the number of NB-UVB treatments and carcinogenesis in any study group. Age is a significant risk factor, and older patients treated with NB-UVB should be followed up carefully.

Abstract C102: Correlates of thorough skin self-examination intentions among individuals at risk for skin cancer

Abstract Background: Melanoma is a growing public health concern in the United States and has the highest fatality rate of all skin cancers. Early identification of melanoma can improve survival rates. A thorough skin self-examination (TSSE) means examining the skin on all areas of the body systematically and deliberately and is an effective way to detect melanoma early, which could decrease melanoma mortality by 63%. Therefore, early surveillance or detection of melanoma has great potential to improve survival and lower disease morbidity. This study examined potential socioeconomic factors and health beliefs associated with TSSE among individuals at risk for skin cancer. Methods: Participants were recruited via Amazon MTurk and screened for their eligibility (at risk for skin cancer; e.g., having more than 2 moles that are larger than 1/4 inch, reporting very fair or fair skin type) via a Qualtrics survey. Eligible participants were then guided online to view educational materials related to skin cancer and skin self-examination and completed an online questionnaire that assessed their TSSE intentions, beliefs about skin cancer and skin self-examination, and demographic information (N=321). Results: Participants ranged from 18 to 76 years old (M = 36.61, SD = 10.57); 56.7% (n=182) of the sample was female, 76.0% (n=244) had a college or higher degree, and over 80% (n=194) identified as non-Hispanic White. Linear regression analyses, controlling for age, gender, education, and melanoma risk, showed that perceived benefits of SSE (B=.163, SE=.097, p =.001), perceived barriers of SSE (B=-.344, SE=.075, p&amp;lt;.001), perceived risk of getting skin cancer (B=.349, SE=.077, p &amp;lt;.001), perceived efficacy of doing SSE (B=.118, SE=.090, p &amp;lt;.05), being scared of getting skin cancer (B=.139, SE=.066, p &amp;lt;.01), and social norms of performing SSE (B=.207, SE=.089, p =.001) were significantly associated with TSSE intention among individuals at risk for skin cancer. Participants who had great perceived benefits (e.g., identifying spots or growths on the skin that are cancerous or may become cancerous), fewer perceived barriers (e.g., taking too much time to do regular skin self-examination), greater perceived risk of getting skin cancer (e.g., chances of having melanoma in the future), great efficacy of conducting SSE (e.g., confident that I can tell the difference between a melanoma and normal skin growths), greater fear of the possibility of getting skin cancer, and stronger norms that family and friends expected them to conduct SSE reported greater TSSE intentions in the next 3 months. Conclusion: The findings of this study contribute to the preventive direction of skin cancer by identifying correlates of TSSE intentions among individuals at risk. By uncovering the factors significantly associated with TSSE intention, this study offers valuable insights into areas that can be targeted in future skin cancer prevention and intervention efforts. Citation Format: Zhaomeng Niu, Carolyn Heckman. Correlates of thorough skin self-examination intentions among individuals at risk for skin cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C102.

Modern diagnostics and treatment of Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with epithelial and neuroendocrine differentiation, the incidence of which has increased substantially during the last decades. Risk factors include advanced age, fair skin type, UV exposure, and immunosuppression. Pathogenetically, a type caused by the Merkel cell polyomavirus is distinguished from a UV-induced type with a high tumor mutational burden. Clinically, MCC presents as a mostly painless, rapidly growing, reddish-violet tumor with a shiny surface, which is preferentially localized in the head-neck region and at the distal extremities. A reliable diagnosis can only be made based on histological and immunohistochemical features. At initial diagnosis, 20-26% of patients show locoregional metastases and 8-14% distant metastases, making staging examinations indispensable. If there is no clinical evidence of metastases, a sentinel lymph node biopsy is recommended. Essential columns of therapy are surgery, adjuvant or palliative radiotherapy and, in advanced inoperable stages, medicamentous tumor therapy. The introduction of immune checkpoint inhibitors has led to a paradigm shift, as they provide a considerably longer duration of response and better survival rates than chemotherapy. The PD-L1 inhibitor avelumab is approved for treatment of metastatic MCC in Germany, but the PD-1 antibodies pembrolizumab and nivolumab are also used with success. Adjuvant and neoadjuvant treatment concepts, immune combination therapies and targeted therapies as monotherapy or in combination with immune checkpoint inhibitors are in the clinical trial phase.

Far-UVC- and UVB-induced DNA damage depending on skin type.

Far-UVC radiation sources of wavelengths 222 nm and 233 nm represent an interesting potential alternative for the antiseptic treatment of the skin due to their high skin compatibility. Nevertheless, no studies on far-UVC-induced DNA damage in different skin types have been published to date, which this study aims for. After irradiating the skin with far-UVC of the wavelengths 222 and 233 nm as well as broadband UVB, the tissue was screened for cyclobutane pyrimidine dimer-positive (CPD+ ) cells using immunohistochemistry. The epidermal DNA damage was lower in dark skin types than in fair skin types after irradiation at 233 nm. Contrary to this, irradiation at 222 nm caused no skin type-dependent differences, which can be attributed to the decreased penetration depth of radiation. UVB showed the relatively strongest differences between light and dark skin types when using a suberythemal dose of 3 mJ/cm2 . As melanin is known for its photoprotective effect, we evaluated the ratio of melanin content in the stratum basale and stratum granulosum in samples of different skin types using two-photon excited fluorescence lifetime imaging (TPE-FLIM) finding a higher ratio up to skin type IV-V. As far-UVC is known to penetrate only into the upper layers of the viable skin, the aforementioned melanin ratio could explain the less pronounced differences between skin types after irradiation with far-UVC compared to UVB.

Multispectral Imaging for Vein Localization and Contrast Enhancement.

Intravenous (IV) catheterization is a common procedure. Still, there is a 26% chance of the first attempt catheterization failure due to the changing visibility of veins because of the patient's skin tone and body fat content. Ultrasound assistive devices help locate deeper veins but are not practical in emergencies, and transillumination assistive devices have a low field of view. Commercial near-infrared (NIR) imaging devices are effective in vein localization but are expensive and are not used in low-cost clinical settings. To overcome this, NIR Multispectral Imaging (MSI) was used to find the optimal wavelength that provides the enhanced visualization of veins for all skin types and Body Mass Index (BMI). The band with the highest vein-to-skin contrast ratio was selected and contrast enhancement was done using our proposed method. The primary blocks of the proposed method are Gamma correction, Contrast Limited Adaptive Histogram Equalization (CLAHE), Adaptive Thresholding, and image Fusion. The optimal spectral range was found to be 814-876 nm and our method increased the contrast by 0.41, 0.375, and 0.39 for fair, brown, and dark brown skin types, respectively, with different BMI.Clinical relevance- From the study, we can develop a potentially low-cost vein localization assistive device for training medical and nursing students and use it in emergencies for venous access to improve confidence in IV catheterization.

Dermoscopy of nonneoplastic diseases in dark skin

Dermoscopy is an important tool in general dermatology. To show differences of light and dark skin in nonneoplastic diseases with focus on dermoscopy. Using previously published studies, dermoscopic differences of various skin types as well as features of inflammatory diseases and pigmentary changes are illustrated. Certain structures are more difficult to assess in dermoscopy of dark skin (e.g., vessels), while other structures (e.g., follicular openings) are more prominent. The majority of studies on dermoscopy are from studies that predominantly included individuals with fair skin types. Further studies of individuals with skin typeIV or higher are needed to improve diagnosis in these patients.

"Well, to Be Honest, I Don't Have an Idea of What It Might Be"-A Qualitative Study on Knowledge and Awareness Regarding Nonmelanoma Skin Cancer.

Nonmelanoma skin cancer (NMSC) is the most common cancer type in Western industrialized countries. However, research into the knowledge and awareness in the general population regarding NMSC is still scarce. This qualitative study aims to fill this research gap. Face-to-face, semi-structured interviews with 20 individuals aged 55-85 years were conducted between February and October 2020. Transcribed interviews were analyzed using qualitative content analysis. The term "white skin cancer"-the German colloquial term of NMSC-was well-known, but the incidence was underestimated. None of the participants could give a precise definition of NMSC, and various alterations in the skin were, partially wrongly, stated as potential signs for NMSC. As risk factors for NMSC, solar radiation, and fair skin type were mentioned most often. The perceived individual risk of developing NMSC and risk compared to individuals of the same age and gender were low in our sample. Own knowledge about NMSC was mostly perceived to be insufficient, and the majority of the sample would like to receive more information on NMSC. Our results emphasize a need to inform about the signs and risks of NMSC not only in the studied older age group but also in younger people.

Factors Associated With Sun Protection Behaviors Among Childhood Cancer Survivors.

Childhood cancer survivors (CCS) are at increased risk of developing skin cancer. Engaging in sun-protective behaviors may ameliorate that risk, but prior work shows that survivors engage in suboptimal levels of sun-protective behaviors. Guided by the Health Belief Model (HBM), this study evaluated factors associated with sun-protective behavior among CCS. This is a secondary analysis of a survey study of 94 adult survivors of childhood cancer recruited from a long-term follow-up clinic. Participants reported their sun protection habits, skin type/sensitivity, barriers to sun protection, and perceived severity and susceptibility of getting skin cancer. Descriptive statistics were used to describe the prevalence of sun protection behaviors and hierarchical linear regression was used to evaluate predictors of sun protection behavior following the HBM. On average, CCS engaged in moderate levels of sun-protective behaviors ( M =2.53; SD=0.59). Hierarchical linear regression indicated that fair skin type ( P =0.02) and higher perceived susceptibility relative to noncancer survivors ( P =0.02) were associated with increased sun protection behaviors. Perceived barriers to sun protection were marginally significant ( P =0.09), whereas other constructs from the HBM did not contribute significantly to the model. Although CCS are at increased risk of developing skin cancer, they engage in suboptimal levels of sun protection behaviors. Findings suggest that interventions to educate survivors about their unique risk of skin cancer and effective prevention behaviors are needed.

32131 Updating the relative risk of ultraviolet exposure and melanoma in fair skin types: A systematic review

In 2005, a meta-analysis found that varying types of UV exposure contributed to an increased relative risk of melanoma. Recently, a 2021 review failed to establish a similar link in individuals with skin of color. Within the last 2 decades, no studies have comprehensively reviewed the risk of varying types of UV exposure on melanoma in fair skin. Thus, we performed a systematic review from 2002-2021 analyzing UV exposure and melanoma risk in Fitzpatrick type I-IV individuals. Out of 12,263 studies, 26 met inclusion criteria. A majority showed an association with UV index (6/9), left-sided laterality (1/1), sunburn history (11/13), and outdoor leisure activity (3/3). UV index studies were all ecological and presented primarily positive correlations. For sunburn history, studies encompassed 2309 melanomas, and significant odds ratios (OR) ranged from 1.69 (1.00-2.98) to 8.48 (4.35-16.54) with higher odds ratios for increasing numbers of sunburns. For outdoor leisure correlating with prior definitions of intermittent sun exposure, studies encompassed 514 melanomas, and ORs ranged from 2.70 (1.04-6.80) to 4.18 (1.83-9.93). A positive association was found in 2 (n = 2/6) studies for cumulative or annual sun exposure, 2 (n = 2/5) studies with occupational sun exposure, 2 (n = 2/4) studies with sun vacations, and 0 (n = 0/2) studies with latitude. This study highlights the significant relationships between specific types of UV exposure and melanoma at higher rates than previously summarized due to an emphasis on fair skin types. Critically, there remains high heterogeneity in how UV exposure is captured that may contribute to mixed results.

Rosacea pathogenesis, common triggers, and dietary role: The cause, the trigger, and the positive effects of different foods

Rosacea is a common chronic inflammatory cutaneous disorder, primarily manifesting on the cheeks, nose, chin, and forehead with a classic relapsing-remitting course that affects mostly fair skin types (Fitzpatrick I and II). The pathogenesis remains unclear, but the complex interplay between environmental and genetic factors may augment the innate immune response and neurovascular dysregulation. Different nutrients may play a role in the pathogenesis of rosacea. Many dietary triggers, including hot beverages, alcohol, spicy foods, caffeine, vanilla, cinnamon, niacin, marinated meats, and dairy products, have been postulated for this disease; however, there is a lack of well-designed and controlled studies evaluating the causal relationship between rosacea and dietary factors. We have explored the available evidence and hypotheses based on trigger-food categories of rosacea, the role of the skin-gut microbiome axis, and potentially benefiting dietary factors such as probiotics, prebiotics, and high-fiber diets.

Difference in Sun Exposure Habits Between Individuals with High and Low Risk of Skin Cancer.

Skin cancer incidence is rapidly increasing. The main risk factor, sun exposure, can be modified. Informational campaigns can be effective in raising skin cancer awareness and target the high-risk population. Still, sun exposure habits in people at high risk of skin cancer are not well-known. To investigate if and how sun exposure habits differ between low-risk and high-risk individuals. During the Swedish Euromelanoma campaign of 2018, questionnaires were collected containing information regarding sun exposure habits and risk factors for skin cancer. Data on 4,141 participants was used to investigate the association between risk factors and sun exposure habits. A fair skin type and a previous history of skin cancer were significantly associated with enhanced sun protective behavior. Family history of skin cancer, childhood sunburns and the presence of large/atypical nevi had no effect on sun exposure habits. Going on sunny holidays were particularly unaffected by being at high risk of skin cancer. Individuals at high risk of developing skin cancer showed suboptimal sun exposure habits and harmful traveling behaviors. We suggest that future skin cancer campaigns inform on accurate sun protection behavior during sunny holidays and associated risk factors. Risk factors such as childhood sunburns, numerous common and large/atypical nevi, as well as family history of skin cancer seem to be less recognized by the population.

Cutaneous Malignancies After Kidney and Simultaneous Pancreas-Kidney Transplantations

Organ transplant recipients are at increased risk of nonmelanotic skin cancers (NMSC). Scarce data exist regarding secondary malignancies developing post-simultaneous pancreas-kidney (SPK) transplantations. Our aim was to assess long-term risk of skin cancers among kidney alone (KA) and SPK transplantation recipients. In this study, 521 patients who underwent KA or SPK transplantation at our medical center were observed up by dedicated nephrologists and dermatologists. SPK transplantation recipients were matched with a control group of KA transplantation recipients based on demographic and clinical data. A multivariate analysis was performed to find independent cancer risk factors. Patients who developed skin cancer were generally older, had a fair skin type, and had a higher incidence of NMSC before transplantation. Older age and fair skin type were independent risk factors on multivariate analysis. SPK transplantation in itself was not an independent risk factor. Cancer recurrence was associated with older age and male sex. Darker skin type and lowered immunosuppressive burden were protective. In contrast to previous studies, the use of antithymocytic agents or SPK transplantation were not independently associated with increased skin cancer risk in this multivariate analysis. These findings emphasize the complex interplay between posttransplantation NMSC and various clinical and epidemiologic risk parameters.

Epidemiology of Vitiligo - A Dual Population-Based Approach.

BackgroundMost epidemiological data on vitiligo refer to selected environments or focus on the prevalence of comorbidity unrelated to the population.ObjectiveAim of the study was to gain robust representative prevalence data on vitiligo and on associated dermatologic comorbidity in the German adult population.MethodsA dual population-based approach was applied with 1) primary data obtained between 2004 and 2014 from dermatological exams in the general working population; 2) claims data from a large German statutory health insurance, reference year 2010.ResultsIn the working cohort (N = 121,783; 57% male; mean age 43 years), the prevalence of vitiligo was 0.77% (0.84% in men; 0.67% in women). In the claims data (N = 1,619,678; 38% male; mean age 46 years), prevalence was 0.17% (0.14% in men; 0.18% in women). In the working cohort, vitiligo was significantly more common in people with fair skin type, ephelides and port-wine stains and less common in people with acne and solar lentigines. In the claims data, vitiligo was associated with a variety of skin conditions, eg, atopic dermatitis, psoriasis and alopecia areata.ConclusionThe resulting discrepancy of claims vs primary data between 0.17% and 0.77% indicates the most probable spectrum of vitiligo prevalence in Germany. It is more frequently observed in clinical exams than recorded in claims data, indicating a marked proportion of people seeking no medical help. Such nonattendance may result from the fact that many treatment options do not provide satisfying benefits to the patients.

Skin cancer prevention counseling in populations with elevated risk: An analysis of the Health Information National Trends Survey 5 Cycle 2

To the Editor: US physicians are recommended to selectively counsel adults older than 24 years with fair skin types about limiting ultraviolet radiation (UVR) exposure to reduce skin cancer risk.1 Individuals who use indoor tanning, have photosensitive skin, or have a history of skin cancer are at increased skin cancer risk.1,2 Although counseling can improve primary skin cancer prevention,3 barriers may prevent health care providers (HCPs) from doing so.4 We investigated whether individuals with skin cancer risk factors, versus those without, differed in terms of receiving advice from HCPs to limit UVR exposure.