High Risk Of Skin Cancer Research Articles

The Application of Mohs Micrographic Surgery in the Treatment of Acral Basal Cell Carcinoma: A Report of Two Cases

Background/Objectives: Mohs micrographic surgery (MMS) is a precise skin surgery technique that is particularly useful in the treatment of high-risk skin cancers and tumors located in challenging anatomical areas. Methods: we report two cases of basal cell carcinoma located in the acral areas effectively treated using MMS. Results: the presented cases demonstrate that MMS is an excellent surgical modality providing outstanding medical, cosmetic, and functional outcomes. Moreover, this study provides another dermoscopic presentation of acral basal cell carcinoma in a patient without the diagnosis of hereditary genetic syndromes associated with an increased risk of skin cancer. Conclusions: basal cell carcinoma located on hands and feet, albeit rare, should be included in the differential diagnosis of amelanotic skin tumors in acral areas.

Factors associated with actinic keratoses in people with albinism in the Albivoire program

Abstract Background People with albinism (PWA) face health inequalities partly due to barriers in accessing health care, consequently delaying the diagnosis of skin precancerous and cancerous lesions. Actinic keratoses (AK), are common precancerous lesions, indicating a high risk of skin cancer. Given the scarcity of research on skin cancer prevention among PWA in Africa, this study aimed to determine the prevalence and factors associated with AK in PWA followed in the Albivoire program. Methods This cross-sectional analytical study was conducted within the ongoing Albivoire program in Ivory Cost. Initiated in Ivory Coast in 2021, Albivoire is the largest comprehensive preventive and care initiative with and for PWA, offering medical consultation campaigns in dermatology, ophthalmology, and psychology. Dermatological records of consenting patients were analyzed. The prevalence (95%CI) of AK was estimated, and the associated factors assessed using logistic model. Results To date, a total of 1978 PWA received care across four regions (Abidjan, Bouaké, Korhogo and Man). Available data from 475 PWA were analyzed, among whom 247 (52%) were women. The median age was 14 years (interquartile range [IQR]: 7-25). Of these, 181 individuals (38.1%, 95% CI [33.7 - 42.6]) presented with actinic keratoses (AK). The median age of PWA with AK was 22 years (vs 11 years for without AK (p < 0.001). Among PWA with AK, 87.8% were daily exposed to sun (vs 12.2% for those exposed occasionally, p = 0.026). In the multivariate analysis, factors significantly associated with AK included age 22 years or older (vs age < 22 years, aOR=4.83, p < 0.001), the presence of ephelides (vs absence; aOR=2.08, p = 0.003) and presence of xerosis (vs absence aOR=4.88, p < 0.001). Conclusions This study highlights the high prevalence of AK in PWA in Ivory Cost, and identifies specific modifiable associated factors which should be targeted in global health strategies to prevent skin cancer among this vulnerable population. Key messages • Prevalence of skin precancerous lesions (actinic keratoses) in people with albinism in Ivory Cost is high (38%) and associated with modifiable risk factors. • Tailored public health interventions needed to prevent skin cancers in vulnerable populations, targeting lesions like xerosis, ephelides, and actinic keratoses through skin protection.

Dermatologic surgery during pregnancy and lactation

It may be necessary for patients to undergo (dermato-)surgical procedures during pregnancy or lactation. Often, there are no drug approvals or guidelines in this context. The following article describes the most common dermatologic surgical conditions during pregnancy and lactation, as well as the special therapeutic considerations and risks to be aware of during treatment. Dermatosurgical procedures are subject to strict indications. Most of these procedures can be performed during pregnancy, but the risks to the mother and fetus must be carefully weighed against the disadvantages of nonsurgical therapy. Although surgery can be performed safely in any trimester, the second trimester and immediate postpartum period are optimal. Surgery should not be delayed for melanoma or high-risk skin cancer. Perioperative positioning and choice of analgesics, antiseptics, anesthetics and antibiotics must be considered carefully to avoid risks to the patient, fetus and infant.

In Vitro Anti-Photoaging Properties of Phylanthus urinaria L. Herb Extract

The overexposure to ultraviolet (UV) radiation from sunlight is related to photoaging of the skin and high risk of skin cancer. Sunscreen material and antioxidants are commonly used to protect skin from harmful UV. However, the application of synthetic compounds in sunscreen products is regulated to a limited amount because it can produce photosensitizers, inducing adverse reactions in the skin, and also harmful to the environment. Ethanol extract of Phyllanthus urinaria L. herb possesses a strong antioxidant activity similar to ascorbic acid, which makes it potential to substitute the synthetic compound in sunscreen products. Therefore, this research was conducted on the 70% ethanol extract of P. urinaria herb to analyze its in vitro anti-photoaging properties, i.e., antioxidant, protein antiglycation and antiinflammation, also to determine the Sun Protection Factor (SPF) and the quantitative composition of the metabolites. The extract exhibited a strong antioxidant activity IC50 of 3.01 mg/L, a higher moderate antiglycation activity IC50 of 216.67 mg/L, but low anti-inflammatory activity IC50 of 86.61mg/L. The presence of saponin, phenolic compounds, flavonoids, tannins, and methyl linoleates is suggested to contribute to the anti-photoaging properties. According to the anti-inflammatory assay, the extract may not inhibit signaling pathways that follow cytokine expression but possibly inhibit those that precede cytokine expression due to its antioxidant activity. An SPF value of 5.95 at 50 mg/L meets the recommended range for the skin phototypes of Southeast Asian, dark-skinned Asian, and African people. These results indicate that P. urinaria extract has potential as an anti-photoaging material for sunscreen products.Keywords: antiglycation, antiinflammation, antioxidation, Phyllanthus urinaria L., SPF.

Patients poorly recognize lesions of concern that are malignant melanomas: is self-screening the correct advice?

Australia is known for its outdoor culture, with a large percentage of its population engaging in outdoor recreational activities, aquatic, non-aquatic and outdoor occupational activities. However, these outdoor enthusiasts face increased exposure to ultraviolet radiation (UVR), leading to a higher risk of skin cancer, including malignant melanoma (MM). Over the past 40 years, there has been a significant rise in skin cancer rates in Australia, with two out of three Australians expected to develop some form of skin cancer by age 70. Currently, skin cancer examinations are not endorsed in asymptomatic or low-risk individuals in Australia, with only high-risk individuals recommended to undergo regular skin examinations. Notably, the Melanoma Institute Australia suggests that one-half of patients identify MMs themselves, although this claim appears to be based on limited Australian data which may not reflect contemporary practice. Therefore this study sought to determine the percentage of patients who were able to self-identify MMs as lesions of concern when presenting for a skin cancer examination. Multi-site, cross-sectional study design incorporating a descriptive survey and total body skin cancer screening, including artificial intelligence by a skin cancer doctor. A total of 260 participants with suspect MM lesions were biopsied, with 83 (31.9%) found to be melanomas. Of the true positive MMs only a small percentage of participants (21.7% specificity) correctly had concerns about the suspect lesion being a MM. These MMs were located primarily on the back (44.4%), shoulder (11.1%) and upper leg (11.1%). There was no significant difference in the size between those participants aware of a MM versus those who were not (P=0.824, 24.6 vs 23.4 mm2). Significantly more males identified lesions of concern that were MMs as compared to females (P=0.008, 61.1% vs 38.9%, respectively). With regard to true negatives males and females were similar (52.1% vs 47.9%, respectively). With regard to false negatives (n=65), a greater percentage of males than females did not recognize the MM as a lesion of concern (66.2% vs 33.8%, respectively). Participants were more likely to correctly identify an invasive MM as opposed to an in situ MM (27.3% versus 21.3%). Only a small percentage of participants in this study were able to self-identify either in situ or invasive MM as a lesion of concern with a tendency to identify the more advanced, thicker MMs. Given that MM is associated with a high mortality and cost of treatment, particularly when invasive, the inability of lay persons to identify these cancerous lesions will likely lead to delayed treatment and a possible adverse outcome. We believe the current melanoma screening practices in Australian general practice should be revisited to improve patient outcomes with regard to MM. Additionally, prevention campaigns should include images and primary risk factors for MM.

Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial.

Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations. This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer. This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn. The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant. The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed). ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492.

The Expression of PRAME as an Aid for Diagnosis and Evaluation of Histologic Margins of Intraepidermal Cutaneous Melanoma in Xeroderma Pigmentosum Patients.

Xeroderma Pigmentosum (XP) is a genetic disorder characterized by photosensitivity, dyschromia, and high risk of skin cancer. From a clinical and histologic view, it can be difficult to diagnose cutaneous melanoma (CM) in XP patients and to define its resection margins. We aimed to study the role of PRAME (PReferentially Expressed Antigen in MElanoma) in differentiating intraepidermal CM from superficial atypical melanocytic proliferation of uncertain significance (SAMPUS) and evaluating the histological margins of CMs. We included XP patients. melanocitic and nonmelanocytic lesions with adjacent skin, and, as control groups, sun-damaged skin from non-XP individuals. Melanocytic lesions with a consensus diagnosis were grouped into CM, SAMPUS, or benign. The selected samples were PRAME-immunoshistochemically stained, and the ratio between immuno-positive cells/mm was recorded, according to Olds and colleagues for intraepidermal lesions. Lezcano and colleagues' method was used for intradermal lesions. Clinical data from XP patients were reviewed. All 9 patients were alive and well at the study closure, even those who developed melanoma metastases. Positive/diffuse PRAME expression was found in 29% (7/24) of intraepidermal CMs and 20% (1/5) SAMPUS samples. All 103 XP control samples and 24 adjacent lesions skin of non-XP patients were PRAME negative. This was a single-center and retrospective study, using a relatively small sample, limiting our conclusions. In XP patients' lesions, PRAME expression could help in the setting of challenging melanocytic tumors and surgical margins evaluation. It is also possible that the method can avoid overdiagnosis and, consequently, more aggressive treatment recommendation in unequivocal CM cases.

Association between congenital heart disease and cancer: A meta-analysis of 30 million patients.

10568 Background: Birth defects have been associated with increased cancer risk; however, the association between congenital heart disease (CHD) and cancer risk has not been well established with limited and conflicting literature till date. Children afflicted with CHD possess multiple risk factors for oncogenesis, such as chromosomal and genetic abnormalities, ionising radiation exposure during cardiac imaging and interventions, chronic hypoxia and debility. We sought to evaluate the relationship between CHD and cancer risk and its various subtypes. Methods: We performed a systematic literature search on PubMed, EMBASE, and Scopus for relevant articles from inception until February 4th, 2023. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effects model, and a p-value of &lt;0.05 was considered statistically significant. Results: A total of 5 studies with 30,437,431 patients (CHD group=213,229, and non-CHD group = 30,224,202) were involved in the analysis. Mean age of patients with CHD and non CHD was 48.4 and 51.3 years. The pooled analysis revealed that patients with CHD had a higher risk of skin cancer (OR, 1.16(95%CI: 1.10-1.24), p&lt;0.00001), and thyroid cancer (OR, 1.47(95%CI: 1.20-1.80), p&lt;0.001) compared with non-CHD patients. However, leukemia (OR, 0.74(95%CI: 0.22-2.48), p=0.62), gastrointestinal cancer (OR, 1.50(95%CI: 0.79-2.87), p=0.22), central nervous systems tumor (OR, 1.18(95%CI: 0.74-1.88), p=0.48), respiratory system cancer (OR, 0.94(95%CI: 0.67-1.30), p=0.69), breast cancer (OR, 95%CI: 0.96-1.48), p=0.87, genitourinary system cancer (OR, 1.06(95%CI: 0.73-1.54), p=0.76), and musculoskeletal cancer (OR, 1.40(95%CI: 0.92-2.41), p=0.12) was comparable between CHD and non-CHD groups of patients. Conclusions: Our findings indicate that CHD patients are at higher risk of thyroid and skin cancer compared with non-CHD patients; however, no such association with other cancers was observed. The implications of these results extend to the delineation of subsequent research, and the results underscore the necessity for further exploration into the underlying pathophysiological mechanisms. Potential implications include the establishment of enhanced surveillance and screening protocols to protect this vulnerable patient group. [Table: see text]

The Knowledge, Attitudes, and Practices of Parents Regarding Sun Protection for Their Children.

To evaluate the knowledge, attitudes, and practices of parents toward protecting their children against skin cancer and the sun. This cross-sectional study was performed in Turkey from March through October 2022. The authors used a questionnaire investigating the parents' and children's characteristics, attitudes, and practices toward sun protection and the Skin Cancer and Sun Knowledge (SCSK) scale to collect data. Of 465 parents, 60.2% were women, 83.2% were light-skinned, 20.2% perceived their children as risk-free, 43.8% perceived their children as low risk in terms of skin cancer, 14.6% examined their children from head to foot, 62.3% applied sunscreen to their children, 9.7% made them wear long-sleeved clothing, 60.0% made them wear headgear, 61.1% made them remain in the shade or under a sunshade, and 32.3% made them wear sunglasses. The mean parental SCSK scale score was 14.3 ± 4.1. Scale scores were higher among those who perceived their children as being at high risk for skin cancer (P = .000), whose children had not experienced red or painful sunburn in the previous year (P = .000), and who informed their children about sun protection (P = .000). Although knowledge of skin cancer and solar protection was high, parental perception of the risk of skin cancer was very low, and attitudes toward skin examination were also very relaxed.

Predicting skin cancer risk from facial images with an explainable artificial intelligence (XAI) based approach: a proof-of-concept study

Efficient identification of individuals at high risk of skin cancer is crucial for implementing personalized screening strategies and subsequent care. While Artificial Intelligence holds promising potential for predictive analysis using image data, its application for skin cancer risk prediction utilizing facial images remains unexplored. We present a neural network-based explainable artificial intelligence (XAI) approach for skin cancer risk prediction based on 2D facial images and compare its efficacy to 18 established skin cancer risk factors using data from the Rotterdam Study. The study employed data from the Rotterdam population-based study in which both skin cancer risk factors and 2D facial images and the occurrence of skin cancer were collected from 2010 to 2018. We conducted a deep-learning survival analysis based on 2D facial images using our developed XAI approach. We subsequently compared these results with survival analysis based on skin cancer risk factors using cox proportional hazard regression. Among the 2810 participants (mean Age=68.5±9.3 years, average Follow-up=5.0 years), 228 participants were diagnosed with skin cancer after photo acquisition. Our XAI approach achieved superior predictive accuracy based on 2D facial images (c-index=0.72, 95% CI: 0.70-0.74), outperforming that of the known risk factors (c-index=0.59, 95% CI 0.57-0.61). This proof-of-concept study underscores the high potential of harnessing facial images and a tailored XAI approach as an easily accessible alternative over known risk factors for identifying individuals at high risk of skin cancer. The Rotterdam Study is funded through unrestricted research grants from Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. G.V. Roshchupkin is supported by the ZonMw Veni grant (Veni, 549 1936320).

Occupational skin carcinogens

Occupational skin cancer may manifest when employees are under exposure to one specific carcinogenic substance or more in the workplace. Workplaces often have higher concentrations of carcinogens compared to any other setting. The most common causes of skin cancer in the workplace are ultraviolet radiation, ionizing radiation, polycyclic aromatic hydrocarbons, and arsenic. However, there is only a limited number of studies on skin cancer from occupational exposure. Skin cancers that are considered mainly work-related are non-melanoma skin cancers. Their most common variants are basal cell carcinomas, squamous cell carcinomas, and actinic keratosis. Two factors that reduced the risk of occupational carcinogen exposure are as follows: a better understanding of skin cancer risk factors involved in industrial processes and better control of the use of ionizing radiation. However, the exposure risk to ultraviolet radiation at dangerous levels remains. Worse still, this risk is often not considered. Yet, the prevention and risk reduction for occupational skin cancer requires the elimination of the contact of all carcinogens present in the workplace with the employees’ skin. Additionally, to encourage and facilitate the early recognition and management of premalignant and malignant skin lesions, training should be given to those working under higher skin cancer risk, and periodic examinations should be performed.

The role of micrometastasis in high-risk skin cancers.

The propensity to metastasize is the most important prognostic indicator for solid cancers. New insights into the mechanisms of early carcinogenesis have revealed micrometastases are generated far earlier than previously thought. Evidence supports a synergistic relationship between vascular and lymphatic seeding which can occur before there is clinical evidence of a primary tumour. Early vascular seeding prepares distal sites for colonisation while regional lymphatics are co-opted to promote facilitative cancer cell mutations. In response, the host mounts a global inflammatory and immunomodulatory response towards these cells supporting the concept that cancer is a systemic disease. Cancer staging systems should be refined to better reflect cancer cell loads in various tissue compartments while clinical perspectives should be broadened to encompass this view when approaching high-risk cancers. Measured adjunctive therapies implemented earlier for low-volume, in-transit cancer offers the prospect of preventing advanced disease and the need for heroic therapeutic interventions. This review seeks to re-appraise how we view the metastatic process for solid cancers. It will explore in-transit metastasis in the context of high-risk skin cancer and how it dictates disease progression. It will also discuss how these implications will influence our current staging systems and its consequences on management.

Furocoumarins potentiate UVA-induced DNA damage in skin melanocytes

Epidemiological studies have found that high citrus fruit consumption was associated with higher risk of skin cancer. Citrus fruits and some vegetables contain furocoumarins, which may interact with ultraviolet radiation to induce skin cancer. We aimed to determine the effects of two furocoumarins, including 8-methoxypsoralen (8-MOP) and 6′,7′-dihydroxybergamottin (DHB), on UVA-induced DNA damage in human epidermal melanocytes, the origin of melanoma. Our hypothesis was that these dietary furocoumarins increase UVA-induced DNA damage in melanocytes, compared to cells exposed to UV alone. We incubated melanocytes with 8-MOP or DHB, followed by exposure to physiological doses of UVA radiation. We used Western blots to quantify the UVA-induced DNA damage measured by the fraction of phosphorylated histone variant H2AX (γH2AX), which is a marker of DNA damage, relative to total H2AX (γH2AX/H2AX) in the presence or absence of furocoumarins. To quantify the UVA-induced change in γH2AX/H2AX, we calculated the UVA:Control ratio as the ratio of γH2AX/H2AX in UVA-exposed cells to that in cells without UVA (control). The mean UVA:Control ratios were borderline significantly higher for cells treated with 8-MOP and significantly higher for cells treated with DHB, compared to that of untreated cells. This study suggests that furocoumarins (particularly 8-MOP and DHB) enhance UVA-induced DNA damage in melanocytes, which is a potential novel mechanism for citrus and furocoumarins to elevate the risk of skin cancer.

Quality by Design-Optimized Glycerosome-Enabled Nanosunscreen Gel of Rutin Hydrate.

Sunburn is caused by prolonged exposure to ultraviolet (UV) rays from the sun, resulting in redness of the skin as well as tenderness, swelling, and blistering issues. During the healing process, it can cause peeling, irritation, and some long-term effects, including premature aging, pigmentation, and a high risk of skin cancer. Rutin has antioxidant and anti-inflammatory effects, which could potentially reduce inflammation and soothe sunburned skin. The objective of the current proposal is to develop and create carbopol gel-encased glycerosomes for the treatment of sunburn. The Design of Expert (DoE) technique was used to optimize the proposed formulation and was subjected to various characterization parameters such as nanovesicles size, polydispersity index (PDI), surface charge, entrapment efficiency (EE), and surface morphology. The optimized rutin-loaded glycerosomes (opt-RUT-loaded-GMs) were further characterised for drug release, 2,2-Diphenyl-1-picrylhydrazyl (DPPH) assay, and confocal laser scanning microscopy (CLSM). The formulation showed sustained release, greater permeation into the skin, and good antioxidant activity. The dermatokinetic study of opt-RUT-loaded-GMs confirms that the Rutin hydrate had better retention in the epidermis as compared to the dermis, owing to its potential for long lasting protection after topical application. It was observed that the prepared formulation was stable, highly safe, and had good sun protection factor (SPF) values that could be used as a suitable option for topical drug administration to maximize the therapeutic efficacy of the drugs.

Association between statins exposure and risk of skin cancer: an updated meta-analysis.

This study aimed to investigate the relationship between statin (lipophilic statin and hydrophilic statin) exposure and the risk of skin cancer. The incidence of skin cancer under statin exposure was used as the primary outcome, and the relevant studies were screened from Web of Science, PubMed, Cochrane Library, and EBSCO electronic database until September 2022. Ten observational studies and two randomized controlled trials (RCTs) were included. The statistical results indicated that in lipophilic statins, the exposed group had a higher risk of skin cancer than the non-exposed group (OR: 1.09, P = 0.003). However, compared with the non-exposed group, there was no significant difference between hydrophilic statins exposure and the incidence of skin cancer (OR: 1.02, P = 0.341). Further subgroup analysis of the subtypes of statins revealed that compared with the non-exposed group, exposure to lovastatin (OR: 1.18, P = 0.048) or simvastatin (OR: 1.11, P < 0.001) was a risk factor for skin cancer. Besides, subgroup analysis based on the subtypes of skin cancer demonstrated that the risks of melanoma (OR: 1.13, P = 0.009), basal cell carcinoma (BCC) (OR: 1.05, P = 0.036), and squamous cell carcinoma (SCC) (OR: 1.13, P = 0.026) under lipophilic statin exposure were significantly higher than those in the non-exposed group. On the contrary, compared with the non-exposed group, the risk of BCC was significantly reduced under the exposure of hydrophilic statins (OR: 0.93, P = 0.031). This study showed that the relationship between statin exposure and skin cancer risk was affected by the subtypes of statins and skin cancer subtypes.

Acceptability and influence of a complex personalized intervention on changes in photoprotection behaviours among people with xeroderma pigmentosum.

Rigorous photoprotection is the only means to prevent skin cancer in people with the rare condition of xeroderma pigmentosum (XP). We conducted a qualitative process evaluation of patient experiences and responses to a highly personalized, multi-component intervention, 'XPAND', designed to influence the psychosocial determinants of inadequate photoprotection among adults with XP. Qualitative study of 15 patients following participation in a RCT. Semi-structured interviews explored acceptability, changes in photoprotection and attributions for behavioural changes. Analysis followed a framework approach. Participants were overwhelmingly positive in their views of the quality and range of components of XPAND and the relevance to their personal photoprotection barriers. All participants reported improved adherence to at least one photoprotection activity and nearly two-thirds of participants noted improvements across multiple activities. Participants believed improvements in their photoprotection behaviours were influenced by different change mechanisms. Sunscreen application, was mainly facilitated by habit formation, prompted by text messages, whereas the wearing of a photoprotective face buff was influenced by strategies, learnt during one-to-one sessions, to overcome worry about looking different. Enhancement of general self-confidence and perceived support from XPAND described by participants facilitated change more broadly. Exploration of responses to XPAND is required in the international XP population, followed by adaptation and evaluation to see if it could benefit other patient groups at higher risk of skin cancer. Implications for approaches to behaviour change include the acceptability of complex multidimensional interventions, the importance of dynamic personalization and the interactive nature of behaviour change mechanisms.

DS26 Review of 2-week suspected skin cancer activity shows a large increase in number of patients with basal cell carcinoma: implications for designing services and workforce planning

Abstract The 2-week wait (2WW) suspected skin cancer referral pathway is for people with high-risk skin cancers in particular squamous cell carcinoma (SCC) and malignant melanoma (MM) but not for most basal cell carcinomas (BCC). Conversion rates reflecting the number of SCC and MM diagnosed via a 2WW pathway are around 8–12%. Prior to the COVID-19, pandemic people with straightforward low-risk BCCs would be referred on a routine pathway with an expectation that their management would be completed within 18 weeks. The postpandemic pressure on routine waiting lists has meant that managing patients with BCC in a timely fashion is challenging, and the impression is that these patients are now being referred on the 2WW pathway to avoid delays in treatment. The aim of this study was to review the 2WW referral activity between 2019 and 2022, particularly in relation to the number of patients with BCC. Data were obtained from the cancer team (Table 1). There has been a 68% increase in 2WW referral activity. The proportion of people discharged at first attendance and the MM and SCC conversion rate has remained fairly stable. Looking specifically at BCCs, there was an increase from 13.7% to 16.2%. The total number of tumours managed increased overall by 85% over the study period (Table 1). For BCC, the activity has doubled from 552 to 1108 patients (to the end of November 2022). These data confirm the large increase in the number of patients referred on the 2WW suspected skin cancer pathway. Although there is little change in the proportion of patients with different types of skin cancer being seen and managed, the total numbers reported here demonstrate a significant knock-on impact of additional workload for specialist teams, including the need for more skin surgery activity, histopathology and specialist skin cancer nursing services. This needs to be considered when developing skin lesion diagnostic and management pathways and confirms the importance of developing locally agreed BCC pathways and defining workforce requirements.Table 1Two-week wait (2WW) referral activity between 2019 and 2022Number of tumours managed2019202020212022 (to the end of November 2022)2WW referrals (n)4038480260636837Discharged at first attendance (%)56505454Melanoma (%)2.32.221.8SCC (%)5.98.47.65.8Conversion rate (SCC and MM) (%)8.210.69.69.6BCC (%)13.713.816.516.2Number of tumoursSCC237403461395Melanoma93104121124BCC5526629981108Total882116915801627

Acral Melanocytic Nevi in a High-Risk Population: Prevalence, Clinical Characteristics and Dermatoscopic Patterns

Background: The prevalence of acral nevi and their dermatoscopic patterns have been mainly studied in Asian populations. Few data exist on the prevalence and clinico-dermatoscopic morphology of acral nevi in white populations. Objectives: The aim of this study was to assess the prevalence of acral nevi and evaluate their features in a cohort of Caucasian individuals at high risk for skin cancer. Methods: We prospectively examined the palms and soles of 680 high-risk patients who underwent total body clinical and dermatoscopic documentation, as a part of their routine follow-up, between January 2016 and March 2020 at a skin cancer referral center in Greece. Results: Overall, 334 acral lesions were detected in 217 (37.0%) of 585 patients in the study. The presence of acral nevi was associated with 2.6 higher odds of a total nevus count higher than 50 (OR: 2.6, p < 0.05, confidence intervals [CI]: 1.11–6.09). Of 334 acral nevi, 65.0% were clinically flat and 35.0% were clinically palpable. Palpable lesion had 19-fold higher probability of being located on the sole (OR: 19.44, p < 0.05, CI: 3.91–96.7). The parallel furrow pattern was present in 147 lesions (44.0%). In 76 lesions (22.8%), we observed a previously undefined pattern consisting of wavy lines, which was correlated with clinically palpable lesions (p < 0.001). The third most common pattern was homogeneous (10.5%), followed by the fibrillar (8.7%), the lattice-like (7.2%), the reticular (3.6%), and globular (3.3%). Conclusion: We observed a higher prevalence of benign acral melanocytic lesions than expected, probably related to our cohort selection of patients at high risk for developing skin cancer. Our study confirms the previously described dermatoscopic patterns and provides novel insights into the dermatoscopic morphology of acral palpable nevi, for which we described a new benign pattern consisting of wavy lines.

Safe and Timely Delivery of Essential Surgical Care for Skin Cancer in a Pandemic

Many surgical practices closed at the onset of the COVID-19 pandemic. We implemented operational changes to safely continue treating patients with cutaneous tumors during the pandemic. This study seeks to evaluate the impact of pandemic-based operational changes on safety, access, and treatment. Here, we report results from a retrospective study from a single academic office-based surgical practice that provided treatment to patients with skin cancer between November 2019 and September 2020. Time to treatment, tumor area, and upstaging after treatment were compared among patients seen “pre-pandemic” (November 2019 to March 2020), during the “pause” (March 2020 to June 2020), and in the “reopening” (June 2020 to September 2020). One-way ANOVA or Fisher Exact analyses were performed, and p &lt; 0.05 was considered significant. Our study included 691 patients (22–101 years old) with a total of 912 tumors. No cases of COVID-19 transmission occurred during the study period. The time from consultation to treatment was reduced during the pause and reopening periods relative to pre-pandemic (p ≤ 0.002), and the average Mohs post-operative defect size remained unchanged throughout the study period (p = 0.75). Consistent with the prioritization of higher-risk tumors in the pandemic peak, a significant reduction in the treatment of basal cell carcinoma tumors was noted during the pause (p = 0.01), and cutaneous squamous cell carcinoma tumors were upstaged more frequently after treatment (p &lt; 0.001). Our findings demonstrate that practice modifications can permit essential surgical care to be delivered safely to patients with high-risk skin cancers during a pandemic.

Regular glucosamine use may have different roles in the risk of site-specific cancers: findings from a large prospective cohort.

Previous studies indicated that glucosamine supplements may have a general anti-cancer effect. This study aimed to assess whether the potential effect differs across different types of cancers in a large prospective cohort study. All participants from the UK Biobank who were free of cancers and had complete information on glucosamine use at baseline were included and followed up from 2006 until 2021. Cox proportional hazards models were used to assess the associations between regular glucosamine use and different site-specific cancers. Subgroup analyses were performed to explore potential interactions. Several sensitivity analyses were conducted to assess the robustness of the main findings. A total of 450,207 eligible participants (mean age: 56.2 years; females: 53.3%) were included, of whom 84,895 (18.9%) reported regular glucosamine use at baseline. During a median of 12.5 years follow-up, glucosamine use was significantly associated with an increased risk of overall cancer (HR=1.04, 95% CI: 1.01-1.06), skin cancer (HR=1.11, 95% CI: 1.07-1.15) and prostate cancer (HR=1.07, 95% CI: 1.01-1.13), and with a reduced risk of lung cancer (HR=0.88, 95% CI: 0.79-0.97) after adjusting for potential confounders. Statistical interaction was observed for gender, age and education for the association of glucosamine use with overall cancer risk (all P-interaction <0.027). These results remained unchanged in the sensitivity analysis. Regular glucosamine use was associated with lower risk of lung cancer but higher risk of skin cancer, prostate cancer and overall cancer. The roles of glucosamine use potentially differ in the development of different site-specific cancers.