High Risk Of Skin Cancer Research Articles

Early detection of skin cancer by skin self‐examination

Skin cancer is increasing in many countries, including in the UK. For example, in the USA in 2017, over 87,000 people had been diagnosed with a dangerous type of skin cancer (melanoma); of these it was expected that nearly 10,000 would die from the condition. We are a U.K based research team that conducted a review of scientific papers from across the world. Our aim was to examine and pool the existing research on whether the different approaches to helping people to examine their own skin, to detect skin cancer early, are effective or not. This review identified all the relevant published articles for available research studies up to April 2018. The identified relevant studies totalled 18 in number, which we then summarised. These approaches included education, such as teaching and reminding people (sometimes using technology, for example, using computers and mobile phones) to examine their skin and quickly report any suspicious changes to their doctor. We found that the various approaches used had a positive effect on peoples’ likelihood and ability to examine their skin, especially in the short‐term. More studies targeted people at higher risk of skin cancer, such as those with a previous diagnosis of skin cancer, compared to people at no greater risk. Of the research we looked at, two thirds of the studies were poorly designed. Skin specialists should raise awareness and support people to routinely examine their skin for skin cancer, especially those at high risk.

Association of Skin Cancer Risk and Protective Behaviors with Health Literacy Among Young Adults in the USA.

The goal of this study was to investigate the association of health literacy with skin cancer risk and protective behaviors among young adults at moderate to high risk of skin cancer, the most common cancer. A US national sample of 958 adults, 18-25years old, at moderate to high risk of developing skin cancer, completed a survey online. Behavioral outcomes were ultraviolet (UV) radiation exposure (e.g., indoor and outdoor tanning, sunburn) and protective (e.g., sunscreen use, sunless tanning) behaviors. Multivariable regression analyses were conducted to determine whether health literacy (a four-item self-report measure assessing health-related reading, understanding, and writing) was associated with behavioral outcomes while controlling for demographic factors. Higher health literacy was independently associated with less sunbathing, odds ratio (OR) = 0.77, 95% confidence interval (CI) = 0.60-0.98; less indoor tanning, OR = 0.38, CI = 0.31-0.48; and less use of tanning oils, OR = 0.54, CI = 0.43-0.69. However, health literacy was also associated with a lower likelihood of wearing long pants, OR = 0.76, CI = 0.58-0.99, or a hat, OR = 0.68, CI = 0.53-0.87, when outdoors. On the other hand, higher health literacy was associated with higher incidental UV exposure, OR = 1.69, CI = 1.34-2.14, and a greater likelihood of ever having engaged in sunless tanning, OR = 1.50, CI = 1.17-1.92. Interestingly, higher health literacy was associated with lower levels of intentional tanning yet also higher incidental UV exposure and lower skin protection among US young adults. These findings suggest that interventions may be needed for young adults at varying levels of health literacy as well as populations (e.g., outdoor workers, outdoor athletes/exercisers) who may be receiving large amounts of unprotected incidental UV.

Total Body Skin Examination Practices: A Survey Study Amongst Dermatologists at High-Risk Skin Cancer Clinics.

Although total body skin examination (TBSE) is the primary screening mechanism for melanoma, there is no consensus on which anatomic sites a screening TBSE should include. We sought to establish which anatomic sites are examined during routine (>90%) TBSEs of patients at high risk for skin cancer. A Google survey was emailed to 173 international dermatologist skin cancer specialists. More than 75% of participants reported routinely examining the scalp, ears, face and neck, trunk, breasts, inframammary areas, axillae, extremities, palms and soles, nails, interdigital spaces, and buttocks. The least frequently inspected anatomic sites included genitalia, with male genitalia more frequently examined than female (penis n = 39; 52%; labia majora n = 21; 28%; P = 0.003), the perianal region (n = 26; 34.7%), and the ocular conjunctiva and oral mucosa (n = 35; 46.7%). Participants cited not screening these areas because of perceived patient discomfort, low prevalence of malignancy, and the expectation that other specialists examine the area. The role of routine surveillance of neglected anatomic sites is unclear and warrants further discussion weighing potential mortality benefit against the incidence of melanoma in obscure sites, morbidity of intervention in sensitive sites, cost-effectiveness, and potential for patient discomfort.

High-Risk Skin Cancers With Atezolizumab Plus NT-I7

High-Risk Skin Cancers With Atezolizumab Plus NT-I7

Introduction, High-Risk Skin Cancer.

Introduction, High-Risk Skin Cancer.

Sunbed use legislation in Europe: assessment of current status.

The use of UV-emitting tanning devices for cosmetic purposes is associated with an increased risk of melanoma and non-melanoma skin cancer. Young women are the most frequent users, therefore, there is an increasing concern about the regulation of sunbed use. The primary objective is to assess the current legislation on sunbed use among European countries. We developed a 30-item questionnaire to gather the most relevant information about sunbed use legislation. The questionnaire was sent to Euromelanoma coordinators and to designated coordinators out of the Euromelanoma network. We obtained a response rate of 64%. More than 25% of the countries did not report any specific legislation. Roughly one-third of the countries does not have a restriction for minors. Even in countries with a specific legislation, a lack or insufficient enforcement of age limit was observed in up to 100% of the inspections based on the PROSAFE report from 2012. Self-tanning devices were reported in 50%, and almost 40% of countries do not require supervision of use. Although a warning display is required in 77% of cases, a signed informed consent is not required in 80%. In the vast majority of cases, the number of licensed or closed tanning centres is unknown. Despite the evidence of its harmful effects, and its frequent use by young people, many of whom are at high risk of skin cancer because of fair skin, a significant number of European countries lack a specific legislation on tanning devices. In order to limit the access of young people to sunbeds, a more strictly enforced regulation is needed, as well as regulation regarding advertisement, and location of tanning centres, in addition to health promotion campaigns that target the vulnerable population of young women seeking its use for improved cosmesis.

The Importance of Dedicated Dermatology Clinics in the Care of Organ Transplant Recipients.

Organ transplant recipients have a high risk of skin cancer associated with immunosuppressive therapy and ultraviolet radiation. The incidence of non-melanoma skin cancer, in particular is up to 65-times higher than for the normal population. Field cancerization of sun- exposed skin is also a major health issue in these patients1.In Portugal there were 895 solid organ transplants in 2017, with the majority being kidney (529) and liver (259)2. There are already several publications concerning skin cancer in Portuguese organ transplant recipients, reporting a prevalence of non-melanoma skin cancer ranging from 15% to 25% in renal transplant recipients3,4,5and 8% in one series6that included more liver transplant recipients with relatively less immunosuppression.The sunny geographical location and sun exposure habits, namely the poor knowledge and adherence to photoprotective measures, such as hats, long-sleeved clothes or sunscreen while on outdoor work or leisure activities, pose serious difficulties for skin cancer prevention in this population. In one study concerning knowledge of sun protective measures in a population of Portuguese transplant recipients7, 29% did not know that their risk of skin cancer was increased, and 25% of those who went to the beach stayed there between 11.30 and 16:00 pm. Not surprisingly, only 8% consulted a dermatologist in the first year after transplant7.Different organizations like the Skin Care in Organ Transplant Recipients - Europe (SCOPE) or the International Transplant Skin Cancer Collaborative (ITSCC) together with institutions such as the British National Institute for Health and Clinical Excellence (NICE)8,9,10, recommend initial assessment of these patients by a dermatologist and providing them with education on photoprotection and self-examination of the skin. These patients also need regular follow-up with time intervals defined by their previous history of skin cancer and the presence of field cancerization of their sun-exposed skin. In such patients with previous skin cancer and detectable field cancerization, some authors11propose three months as time interval between appointments. Dedicated or specialist dermatology clinics for organ transplantation are recommended11,12,and have also been shown to improve compliance with photoprotection13. Their introduction in the main Portuguese referral hospitals for transplantation would allow earlier dermatological care, inclusion of dermatology among the specialties that collaborate in the transplant teams and reduction of the burden of skin cancer in these patients, saving lives and costs.

Optical coherence tomography for diagnosing skin cancer in adults.

Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Optical coherence tomography (OCT) is a microscopic imaging technique, which magnifies the surface of a skin lesion using near-infrared light. Used in conjunction with clinical or dermoscopic examination of suspected skin cancer, or both, OCT may offer additional diagnostic information compared to other technologies. To determine the diagnostic accuracy of OCT for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC), or cutaneous squamous cell carcinoma (cSCC) in adults. We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. We included studies of any design evaluating OCT in adults with lesions suspicious for invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC, compared with a reference standard of histological confirmation or clinical follow-up. Two review authors independently extracted data using a standardised data extraction and quality assessment form (based on QUADAS-2). Our unit of analysis was lesions. Where possible, we estimated summary sensitivities and specificities using the bivariate hierarchical model. We included five studies with 529 cutaneous lesions (282 malignant lesions) providing nine datasets for OCT, two for visual inspection alone, and two for visual inspection plus dermoscopy. Studies were of moderate to unclear quality, using data-driven thresholds for test positivity and giving poor accounts of reference standard interpretation and blinding. Studies may not have been representative of populations eligible for OCT in practice, for example due to high disease prevalence in study populations, and may not have reflected how OCT is used in practice, for example by using previously acquired OCT images.It was not possible to make summary statements regarding accuracy of detection of melanoma or of cSCC because of the paucity of studies, small sample sizes, and for melanoma differences in the OCT technologies used (high-definition versus conventional resolution OCT), and differences in the degree of testing performed prior to OCT (i.e. visual inspection alone or visual inspection plus dermoscopy).Pooled data from two studies using conventional swept-source OCT alongside visual inspection and dermoscopy for the detection of BCC estimated the sensitivity of OCT as 95% (95% confidence interval (CI) 91% to 97%) and specificity of 77% (95% CI 69% to 83%).When applied to a hypothetical population of 1000 lesions at the mean observed BCC prevalence of 60%, OCT would miss 31 BCCs (91 fewer than would be missed by visual inspection alone and 53 fewer than would be missed by visual inspection plus dermoscopy), and OCT would lead to 93 false-positive results for BCC (a reduction in unnecessary excisions of 159 compared to using visual inspection alone and of 87 compared to visual inspection plus dermoscopy). Insufficient data are available on the use of OCT for the detection of melanoma or cSCC. Initial data suggest conventional OCT may have a role for the diagnosis of BCC in clinically challenging lesions, with our meta-analysis showing a higher sensitivity and higher specificity when compared to visual inspection plus dermoscopy. However, the small number of studies and varying methodological quality means implications to guide practice cannot currently be drawn.Appropriately designed prospective comparative studies are required, given the paucity of data comparing OCT with dermoscopy and other similar diagnostic aids such as reflectance confocal microscopy.

Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults.

Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults.

High-frequency ultrasound for diagnosing skin cancer in adults.

Early, accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers with the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Ultrasound is a non-invasive imaging technique that relies on the measurement of sound wave reflections from the tissues of the body. At lower frequencies, the deeper structures of the body such as the internal organs can be visualised, while high-frequency ultrasound (HFUS) with transducer frequencies of 20 MHz or more has a much lower depth of tissue penetration but produces a higher resolution image of tissues and structures closer to the skin surface. Used in conjunction with clinical and/or dermoscopic examination of suspected skin cancer, HFUS may offer additional diagnostic information compared to other technologies. To assess the diagnostic accuracy of HFUS to assist in the diagnosis of a) cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, b) cutaneous squamous cell carcinoma (cSCC), and c) basal cell carcinoma (BCC) in adults. We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists as well as published systematic review articles. Studies evaluating HFUS (20 MHz or more) in adults with lesions suspicious for melanoma, cSCC or BCC versus a reference standard of histological confirmation or clinical follow-up. Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). Due to scarcity of data and the poor quality of studies, we did not undertake a meta-analysis for this review. For illustrative purposes, we plot estimates of sensitivity and specificity on coupled forest plots. We included six studies, providing 29 datasets: 20 for diagnosis of melanoma (1125 lesions and 242 melanomas) and 9 for diagnosis of BCC (993 lesions and 119 BCCs). We did not identify any data relating to the diagnosis of cSCC.Studies were generally poorly reported, limiting judgements of methodological quality. Half the studies did not set out to establish test accuracy, and all should be considered preliminary evaluations of the potential usefulness of HFUS. There were particularly high concerns for applicability of findings due to selective study populations and data-driven thresholds for test positivity. Studies reporting qualitative assessments of HFUS images excluded up to 22% of lesions (including some melanomas) due to lack of visualisation in the test.Derived sensitivities for qualitative HFUS characteristics were at least 83% (95% CI 75% to 90%) for the detection of melanoma; the combination of three features (lesions appearing hypoechoic, homogenous and well defined) demonstrating 100% sensitivity in two studies (lower limits of the 95% CIs were 94% and 82%), with variable corresponding specificities of 33% (95% CI 20% to 48%) and 73% (95% CI 57% to 85%), respectively. Quantitative measurement of HFUS outputs in two studies enabled decision thresholds to be set to achieve 100% sensitivity; specificities were 93% (95% CI 77% to 99%) and 65% (95% CI 51% to 76%). It was not possible to make summary statements regarding HFUS accuracy for the diagnosis of BCC due to highly variable sensitivities and specificities. Insufficient data are available on the potential value of HFUS in the diagnosis of melanoma or BCC. Given the between-study heterogeneity, unclear to low methodological quality and limited volume of evidence, we cannot draw any implications for practice. The main value of the preliminary studies included may be in providing guidance on the possible components of new diagnostic rules for diagnosis of melanoma or BCC using HFUS that will require future evaluation. A prospective evaluation of HFUS added to visual inspection and dermoscopy alone in a standard healthcare setting, with a clearly defined and representative population of participants, would be required for a full and proper evaluation of accuracy.

Teledermatology for diagnosing skin cancer in adults.

Teledermatology for diagnosing skin cancer in adults.

Risk of skin cancers in thiopurines-treated and thiopurines-untreated patients with inflammatory bowel disease: A systematic review and meta-analysis.

The thiopurines are effective in the management of patients with inflammatory bowel disease (IBD), but the association between thiopurines use and the risk of skin cancer (including nonmelanoma skin cancer [NMSC] and melanoma skin cancer) has already been sufficiently reported. However, the results of these studies are inconsistent, and thus, the objective of our analysis was to explore whether thiopurines can lead to an excess risk of skin cancer in IBD patients. MEDLINE, EMBASE, and the Cochrane Library were searched to identify relevant studies that evaluated the risk of skin cancer in IBD patients treated with thiopurines. A random effects meta-analysis was conducted to calculate the pooled incidence rate ratios as well as risk ratios (RRs). Subgroup analysis was performed to explore the potential source of heterogeneity. Thirteen studies comprising 149198 participants were included. The result suggested that thiopurines significantly increased the risk of overall skin cancer in IBD patients (random effects: RR=1.80, 95% confidence interval [CI] 1.14-2.87, P=0.013), among which NMSC showed an excess risk associated with thiopurines use (random effects: RR=1.88, 95% CI 1.48-2.38, P<0.001) while no increased risk was observed with respect to melanoma skin cancer (random effects: RR=1.22, 95% CI 0.90-1.65, P=0.206). Subgroup analysis regarding sample size and geographic distribution in skin cancer and follow-up duration in NMSC reached statistical significance, while other subgroups showed no significance. Exposition of thiopurines in patients with IBD is associated with a higher risk of skin cancer. Routine skin screening and daily skin protective practice are recommended for these patients.

Omega-3 fatty acid supplement skin cancer prophylaxis in lung transplant recipients: A randomized, controlled pilot trial.

Lung transplant recipients (LTRs) are at very high risk of skin cancer. Omega-3 fatty acids (FAs) are anti-inflammatory and immune-modulating and could potentially reduce this risk. We assessed the feasibility of omega-3 FA supplementation to reduce skin cancer among these patients. LTRs aged 18+ years, at least 1 year post-transplant, were recruited from the outpatient clinic of The Prince Charles Hospital, Brisbane. Participants were randomly allocated to 4-times-daily supplements containing either omega-3 FA (3.36 eicosapentaenoic acid [EPA] + docosahexaenoic acid) or placebo (4 g olive oil) for 12 months. Primary outcomes were rates of recruitment, retention, adherence (assessed by plasma omega-3 FA), and safety. Secondary outcomes were incident skin cancers. Among 106 eligible lung transplant recipients, 49 consented to take part (46%) with 25 allocated to omega-3 FA and 24 to placebo supplements. Of these, 22 (88%) and 20 (83%), respectively, completed the trial. After 12 months, median plasma EPA increased substantially in the intervention group (125.0 to 340.0 µmol/L), but not the placebo group (98.0 to 134.5 µmol/L). In the intervention group, 6 patients developed skin cancers compared with 11 in the placebo group, giving an odds ratio (95% confidence interval) of 0.34 (0.09 to 1.32). There were no serious, active intervention-related adverse events. This pilot trial among LTRs showed acceptable recruitment and high retention and adherence. We demonstrated a signal for reduction of new skin cancer cases in those taking omega-3 FA supplements, which supports the notion that a larger, more definitive trial is warranted.

Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory: Measure description and comparisons to UVR sensor and sun protection survey data

One in five US adults will be diagnosed with skin cancer. As most skin cancers are attributable to sun exposure, this risk factor is an important target for research and intervention. Most sun exposure measures assess frequency of specific sun-protection behaviors, which does not account for the use of multiple, potentially overlapping sun-protection methods. In contrast, the Daily Minutes of Unprotected Sun Exposure (MUSE) Inventory assesses sun-protection behavior during self-reported activities, providing several useful metrics, including duration of unprotected sun exposure on 17 body sites, combined to yield an overall MUSE score weighted by percent of body exposed. The present study was conducted July–September 2017, in Chicago, IL USA. For 10 days, participants (39 melanoma survivors; Mage = 58.59, 64.5% female) wore an ultraviolet radiation (UVR) sensor and completed the Daily MUSE Inventory each evening. The Sun Habits Survey was completed at the end of the study. Outdoor time reported in the MUSE Inventory significantly predicted outdoor time recorded by UVR sensors, B = 0.53, p < .001. For all sun-protection behaviors except shade, reports from the Daily MUSE Inventory (i.e., percentage of outdoor time a particular strategy was used) correlated with frequency ratings of the same strategy from the Sun Habits Survey (rs = 0.66–0.75, p < .05). In sum, the Daily MUSE Inventory corresponds with sensor and survey data, and provides a novel metric of unprotected sun exposure that will be useful for evaluating overall extent of sun exposure, including exposure on several smaller body sites that are at high risk for skin cancer.

Chronic Inflammation Promotes Skin Carcinogenesis in Cancer-Prone Discoid Lupus Erythematosus

High-risk skin cancer is a rare, but severe, complication associated with discoid lupus erythematosus (DLE). Chronic scar, inflammation, UVR, and immunosuppressive medications are proposed explanations for this heightened skin cancer risk; however, the exact mechanism driving skin carcinogenesis in DLE is unknown. The distinct co-localization of multiple independent skin cancers with areas of active inflammation in two DLE patients followed over 8 years strongly suggested that lupus inflammation promotes skin carcinogenesis in DLE. To investigate this clinical observation, we subjected lupus-prone MRL/lpr and control (MRL/n) mice to a skin carcinogenesis protocol. Skin tumors developed preferentially within the cutaneous lupus inflammation without scarring in MRL/lpr mice (P < 0.01). The inflammation in MRL/lpr skin was characterized by the accumulation of regulatory T cells, mast cells, M2 macrophages, and markedly elevated transforming growth factor-β1 and IL-6 levels, which have been linked to tumor promotion. Tacrolimus treatment reduced skin inflammation and blocked cancer development in MRL/lpr mice (P= 0.0195). A similar tumor-promoting immune environment was detected in SCCs and the perilesional skin of cancer-prone DLE patients. Therefore, discoid lupus inflammation promotes skin cancer in high-risk DLE patients, and blocking the inflammation may be critical for preventing this life-threatening complication of DLE.

Sun Protection Among Organ Transplant Recipients After Participation in a Skin Cancer Research Study

Because of long-term immunosuppressive therapy, organ transplant recipients experience significantly elevated skin cancer risk1 and mortality.2 Because of increasing rates of transplantation and improved survival among organ transplant recipients, primary skin cancer prevention is essential for organ transplant recipients to reduce their skin cancer burden. Elsewhere we reported the sun protection behaviors among a subset of organ transplant recipients who were at especially high risk of skin cancer because of a history of actinic skin lesions. We found that approximately 50% of the study participants regularly practiced multiple sun protection measures.3 It has been shown elsewhere that specific educational interventions can improve the use of sun protection measures among organ transplant recipients.4 Here we report a significant increase in the number of organ transplant recipients who practiced multiple sun protection behaviors after participation in a skin cancer research study for at least 1 year without any specific educational intervention.

Mohs Micrographic Surgery for Treatment of Non-melanoma Skin Cancer

The aims of this report are to review literature supporting the use of Mohs micrographic surgery for treatment of non-melanoma skin cancer and to address indications and potential limitations of this form of therapy for non-melanoma skin cancer. The first randomized controlled trial comparing standard excision to Mohs micrographic surgery for treatment of facial basal cell carcinoma has recently been published, demonstrating a lower recurrence rate after Mohs surgery compared to standard excision after a 5-year and 10-year follow-up period, supporting its use in the treatment of high-risk basal cell skin cancer. Mohs micrographic surgery is indicated for treatment of basal cell carcinomas and cutaneous squamous cell carcinomas at high risk of recurrence and for tumors located in areas where tissue conservation and/or functional preservation is desired.

981 The microbial flora of clinically infected cutaneous metastases

Cutaneous metastases (CM) represent skin involvement from internal malignancies or in-transit metastases from high-risk skin cancers. Knowledge of the microbial flora of skin lesions in patients with cutaneous metastases is critical towards mitigating associated symptoms of discharge, malodor, and pain, all of which may negatively impact quality of life and cutaneous health. We characterized the microbiota and antimicrobial management of cutaneous metastases. We conducted a retrospective chart review of patients with symptomatic CM seen by Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015. We identified 64 patients with cutaneous metastases and clinical evidence of skin infection. Culture swabs yielded 17 distinct bacterial and fungal species. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics. Our study showed that the normal skin microbial flora is disrupted in patients with infected skin metastases. Oral antibiotics may provide benefit when used as first-line therapy of infected skin lesions in patients with symptomatic cutaneous metastases. Further studies may include obtaining bacterial, viral, and fungal cultures of all patients with symptomatic cutaneous metastases and analysis of these samples using next-generation sequencing.

Use of Google Trends to Examine Interest in Mohs Micrographic Surgery: 2004 to 2016.

Mohs micrographic surgery (MMS) is the gold standard for treatment of high-risk skin cancers. There has been an upward trend in the use of this procedure as demonstrated by data from Medicare and the National Ambulatory Medical Care Survey. To assess interest in MMS among members of the general public as measured by number of online searches, and how that interest has changed over time. Google Trends was used to plot interest in search terms including "Mohs surgery," "basal cell carcinoma," "squamous cell carcinoma," "melanoma," and "skin cancer" from January 1, 2004, to November 30, 2016. Search interest for the term "Mohs surgery" has steadily increased since 2004 and correlates closely with increased interest for "basal cell carcinoma" (r = 0.82) and "squamous cell carcinoma" (r = 0.85). Search interest in MMS did not correlate well with searches for melanoma (r = -0.15) or skin cancer (r = -0.29). Public interest in MMS has continued to steadily increase in the United States, which may be a reflection of the increasing volume of MMS that is performed.

A Nurse-Led School-Based Sun Protection Programme in Turkey.

The aim of this study was to determine the effects of a nurse-led school-based sun protection programme in Turkey. A randomized controlled trial was performed at two public schools between February and October 2014. Children with written consent from their parents were screened by nurses for skin type, and 80 children at moderate to high risk for skin cancer were included in the study. The sample was randomized by age, gender and skin type. Stratified and block randomizations were used. The participants were separated into an intervention group (n=40) and control group (n=40). Data were collected using a personal information form and two scales for sun protection behaviour and self-efficacy. In the intervention group, the pretest mean score for sun protection behaviour was 19.25±5.44 and increased significantly in the posttest assessment (33.05±4.23, p<0.001). Self-efficacy scores also increased significantly after the intervention (pretest 20.50±6.68, post-test 35.85±4.70, p<0.001). However, there were no significant increases in mean sun protection behaviour or self-efficacy scores in the control group (p>0.05). A nurse-led school-based sun protection programme effectively promoted children's self-efficacy and sun protection behaviour.