Skin Cancer Incidence Rates Research Articles

Cancer incidence associations with drinking water arsenic levels and disinfection methods in Maine, USA

ABSTRACT Maine is a largely rural state where nearly half of the population uses drinking water from private wells. Arsenic (As) is present in some groundwater in the state and has been linked to cancer, and a lack of testing and treatment may expose people with private wells to elevated As levels. Disinfection byproducts (DBPs) include known and suspected carcinogens that form when chlorine or chloramines are added to water. People served by public water systems may be exposed to elevated levels of regulated DBPs such as trihalomethanes and haloacetic acids associated with chlorine and/or unregulated nitrogenous DBPs, or N-DBPs, such as nitrite and N-nitrosodimethylamine associated with chloramines. Contrary to initial expectations, there were no significant associations between median town As in well water and bladder, lung, kidney, or skin cancer incidence. Furthermore, bladder, melanoma, and other skin cancer incidence rates were negatively correlated with the percent of the town population using private wells. Analysis of cancer incidence associated with chlorine and chloramine disinfection showed elevated melanoma, and other skin cancer with chloramine use and elevated bladder and non-melanoma skin cancer with chlorine use compared to the no disinfectant case. We recommend more research on the links between disinfectant use and cancer.

Knowledge, Attitudes and Practices to Sunscreen Use among Dermatology Patients at University Hospital Amman, Jordan: A Cross-Sectional Study

Background and Aims: Skin cancer is a significant public health concern globally. Jordan’s location and high exposure to UV radiation have led to an increase in the incidence rate of skin cancer. This study aimed to investigate the knowledge, attitudes, and practices of patients to sunscreen use in one of the major hospitals in Jordan, and identify demographic factors associated with regular sunscreen use. Methodology: An observational cross-sectional study was conducted at the dermatology clinic of Jordan University Hospital, Amman, Jordan, from February 2, 2023 to March 6, 2023. The study included 397 participants recruited from the clinic’s waiting area. A validated survey questionnaire was used to collect data on demographics, previous skin cancer history, sunscreen allergies, knowledge, attitudes, and practices related to sunscreen use. The data were analyzed using SPSS v. 26. Statistical significance was established at a p-value of <0.05. Results: The majority of participants were female (67.0%) and aged 18–25 years (53.7%). Only 24.9% of participants reported using sunscreen regularly, while 34.0% reported never using it. Participants with higher education levels and income were more likely to use sunscreen regularly. The main sources of sunscreen recommendations were family and friends (48.1%), followed by dermatologists (32.7%). The most common reason for not using sunscreen was forgetfulness (40.1%). Conclusion: The study revealed that knowledge and practices related to sunscreen use among Jordanian dermatology patients are insufficient, and that there is a need for increased patient education regarding the importance of sunscreen use.

The Role of Artificial Intelligence in Early Diagnosis and Molecular Classification of Head and Neck Skin Cancers: A Multidisciplinary Approach.

Cancer remains a significant global health concern, with increasing genetic and metabolic irregularities linked to its onset. Among various forms of cancer, skin cancer, including squamous cell carcinoma, basal cell carcinoma, and melanoma, is on the rise worldwide, often triggered by ultraviolet (UV) radiation. The propensity of skin cancer to metastasize highlights the importance of early detection for successful treatment. This narrative review explores the evolving role of artificial intelligence (AI) in diagnosing head and neck skin cancers from both radiological and pathological perspectives. In the past two decades, AI has made remarkable progress in skin cancer research, driven by advances in computational capabilities, digitalization of medical images, and radiomics data. AI has shown significant promise in image-based diagnosis across various medical domains. In dermatology, AI has played a pivotal role in refining diagnostic and treatment strategies, including genomic risk assessment. This technology offers substantial potential to aid primary clinicians in improving patient outcomes. Studies have demonstrated AI's effectiveness in identifying skin lesions, categorizing them, and assessing their malignancy, contributing to earlier interventions and better prognosis. The rising incidence and mortality rates of skin cancer, coupled with the high cost of treatment, emphasize the need for early diagnosis. Further research and integration of AI into clinical practice are warranted to maximize its benefits in skin cancer diagnosis and treatment.

Photoaging and cosmeceutical solutions in sun-overexposed countries: The experience of Australia and Brazil.

Skin aging is the result of physiological changes determined by genetically driven processes and intrinsic factors, and exacerbated by a combination of multiple environmental factors, the main one being sun exposure. The effects of photoaging are particularly apparent on the face, where the appearance of aging signs can have a significant impact on the emotions conveyed and well-being. Photoprotection and facial skin care for managing photoaging signs are thus of particular importance for both physical and mental health. Countries, like Australia and Brazil, where the level of sun exposure is high and the populations have predominantly outdoor lifestyles, are particularly aware of the harms of photoaging and have implemented several measures to help reduce the risk of skin cancer in their populations. However, sun-seeking behaviours are difficult to change, and it takes time before interventions provide perceptible results. Australia still has some of the highest skin cancer incidence and mortality rates in the world. Solutions that target individuals can also be used for minimizing the clinical signs of facial aging and for improving skin quality, with the ultimate aim being not only to improve the appearance of the skin but also to mitigate the occurrence of pre-malignant and malignant lesions. This review summarizes the features of facial skin photoaging in photo-exposed populations, based on evidence gained from studies of Australian individuals, and discusses the various available solutions for skin photoaging, in particular those that are most popular in Brazil, which is a country with many years of experience in managing photoaged skin.

Continuing benefits of the Montreal Protocol and protection of the stratospheric ozone layer for human health and the environment

The protection of Earth’s stratospheric ozone (O3) is an ongoing process under the auspices of the universally ratified Montreal Protocol and its Amendments and adjustments. A critical part of this process is the assessment of the environmental issues related to changes in O3. The United Nations Environment Programme’s Environmental Effects Assessment Panel provides annual scientific evaluations of some of the key issues arising in the recent collective knowledge base. This current update includes a comprehensive assessment of the incidence rates of skin cancer, cataract and other skin and eye diseases observed worldwide; the effects of UV radiation on tropospheric oxidants, and air and water quality; trends in breakdown products of fluorinated chemicals and recent information of their toxicity; and recent technological innovations of building materials for greater resistance to UV radiation. These issues span a wide range of topics, including both harmful and beneficial effects of exposure to UV radiation, and complex interactions with climate change. While the Montreal Protocol has succeeded in preventing large reductions in stratospheric O3, future changes may occur due to a number of natural and anthropogenic factors. Thus, frequent assessments of potential environmental impacts are essential to ensure that policies remain based on the best available scientific knowledge.Graphical abstract

Sun exposure and protection habits: Self-reported attitudes, knowledge and behaviours.

As exposure to UV radiation is the primary modifiable environmental risk factor associated with skin cancer, it remains the principal focus of most prevention strategies. Numerous sun protection campaigns have been implemented worldwide; however, their impact on the actual incidence and mortality rates of skin cancer seems to be limited. To create successful skin cancer prevention campaigns, it is important to have a comprehensive understanding of individuals' attitudes and behaviours regarding sun protection. The aim of the current study was to determine and report on the prevalence of self-reported attitudes, knowledge and behaviours regarding two of the major sun protection recommendations-avoidance of sun exposure and use of sunscreens-in an international representative sample across five continents. This cross-sectional study was conducted in 20 countries using a web-based online survey. A total of 50,552 individuals, comprising 25,388 men (50.22%) and 25,164 women (49.78%), participated in the survey. Among them, 83.2% reported having been voluntarily exposed to the sun (for sun-basking reasons) at least once in the last 12 months, and 47.96% acknowledged being exposed to the sun between the hours of 10 AM and 4 PM. The primary reason for non-adherence was that these hours were the most convenient times (32.28%). Only 24.05% reported applying sunscreen every 2 h when outdoors. Forgetfulness was the primary reason as provided by 27.79% of participants. Males and older age groups were less likely to adopt sun-protective behaviours around the world. Forgetfulness and the challenges posed by time constraints seem to be the biggest barriers to proper adherence. These findings should prompt the collaboration with health authorities and the manufacturers to enhance adherence by setting reasonable sunscreen prices and creating formulations that make their application less burdensome.

Available medical imaging modalities for melanoma screening

The prevalence of melanoma of the skin has seen a significant rise in recent decades, constituting approximately one-third of all diagnosed cancer cases. Melanoma, the most fatal variant among cutaneous malignancies, exhibits a 4% probability of occurrence over an individual’s lifetime. The increasing incidence and mortality rates of skin cancer impose a substantial burden on healthcare resources and the economy. In recent years, several optical modalities, including dermoscopy, reflectance confocal microscopy (RCM), optical coherence tomography, multiphoton excited fluorescence imaging, and dermatofluorescence, have been extensively studied and utilized to improve the non-invasive diagnosis of skin cancer. This review article provides an analysis of the approach employed in the recently developed optical non-invasive diagnostic technologies. It explores the clinical uses of these techniques, while also examining their respective advantages and disadvantages. Furthermore, the paper explores the possibility for additional advancements in these technologies in the future.

Epidemiology of Keratinocyte Skin Cancer with a Focus on Cutaneous Squamous Cell Carcinoma

Keratinocyte skin cancer, consisting of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is by far the most common cancer in white-skinned populations, with rapid increases over the last 50 years. While the age-standardized incidence rates increase worldwide, the age-standardized mortality rates are variable. The incidence rates of keratinocyte skin cancer are much higher compared to those of melanoma, and are largely attributed to the raising exposure to ultraviolet (UV) radiation, the most important causal risk factor for skin cancer. Whereas the development of BCC is mainly due to intense UV exposure during childhood and adolescence, the development of SCC is related to chronic, cumulative UV exposure over decades. Although mortality rates are relatively low, SCC is an increasing problem for healthcare services, significantly causing morbidity, especially in older age groups. This review reports on the epidemiology of keratinocyte skin cancer, with a focus on SCC, in Australia, the United States, and the north of Europe, with an outlook on further challenges health systems will be confronted with in the next 20 years.

Incidence and profile of skin cancers in patients following ultraviolet phototherapy without psoralens: A retrospective cohort study

Psoralen+ultraviolet-A (PUVA) is associated with photocarcinogenesis. However, carcinogenic risk with other ultraviolet phototherapies remains unclear. Evaluate whether phototherapy without psoralens increases skin cancer risk. Retrospective cohort study of patients treated at a teaching-hospital phototherapy center (1977-2018). Skin cancer records were validated against pathology reports. Age-standardized incidence rates (ASIRs) of skin cancer were evaluated for gender, skin phototype, diagnosis, ultraviolet modality, anatomical site; and compared to provincial population incidence rates (2003). In total, 3506 patients treated with broadband-ultraviolet-B, narrowband-UVB and/or combined UVAB were assessed with a mean follow-up of 7.3years. Majority of patients had psoriasis (60.9%) or eczema (26.4%). Median number of treatments was 43 (1-3598). Overall, 170 skin cancers (17 melanoma, 33 squamous cell carcinoma and 120 basal cell carcinoma) occurred in 79 patients. Patient-based and tumor-based ASIR of skin cancer was 149 (95% CI: 112-187)/100,000 and 264 (219-309)/100,000 person-years, respectively. There was no significant difference between tumor-based ASIRs for melanoma, squamous cell carcinoma, and basal cell carcinoma compared to the general population; or in phototherapy patients with-psoriasis or eczema; or immunosuppressants. No cumulative dose-response correlation between UVB and skin cancer was seen. Treatment and follow-up duration. No increased risk of melanoma and keratinocyte cancer was found with phototherapy.

A CASE OF DEVELOPING SQUAMOUS CELL AND BASAL-CELL CARCINOMA IN PATIENTS WITH PSORIASIS

The described clinical example illustrates the rare association of psoriasis with basal cell and squamous cell carcinoma. This clinical case may be of interest to dermatologists and oncologists. It illustrates the neglect of the process in view of the late treatment of the patient. The rising incidence rates of skin cancer are caused by exposure to UVB procedures and increasing with age, which emphasizes the importance of thorough dermatological screening among patients with psoriasis and histological examination of old psoriatic plaques. Alertness for the early detection of skin tumors is relevant not only among medical workers, but also among the population.

Skin Cancer Prevention across the G7, Australia and New Zealand: A Review of Legislation and Guidelines.

Incidence rates of melanoma and keratinocyte skin cancers have been on the rise globally in recent decades. While there has been a select focus on personal sun protection awareness, to our knowledge, there is a paucity of legislation in place to help support citizens' efforts to protect themselves from the harmful effects of ultraviolet radiation (UVR). Given this, we conducted a comprehensive review of legislation and guidelines pertaining to a variety of sun protection-related topics in countries of the Group of Seven (G7), Australia and New Zealand. Australia was the only country to have banned tanning beds for individuals of all ages, while other select countries have instituted bans for minors. In workplace policy, there is very little recognition of the danger of occupational UVR exposure in outdoor workers, and thus very few protective measures are in place. With regard to sports and recreation, certain dermatological/professional associations have put forward recommendations, but no legislation was brought forward by government bodies outside of Australia and New Zealand. With regard to youth, while there are various guidelines and frameworks in place across several countries, adherence remains difficult in the absence of concrete legislation and standardization of procedures. Finally, only Australia and a few select jurisdictions in the United States have implemented sales tax exemptions for sunscreen products. In light of our findings, we have made several recommendations, which we anticipate will help reduce the rates of melanoma and keratinocyte cancers in years to come. However, minimizing UVR exposure is not without risk, and we, therefore, suggest the promotion of vitamin D supplementation in conjunction with sun protective practices to limit potential harm.

Skin cancer incidence and survival rates in England, 2013–2019

Skin cancer incidence and survival rates in England, 2013–2019

'Get Data Out' Skin: national cancer registry incidence and survival rates for all registered skin tumour groups for2013-2019 in England.

Providing detailed skin cancer statistics, including incidence and survival, by tumour type and patient characteristics is important for up-to-date epidemiological information. To create a new clinically relevant consensus-based classification for registered skin tumours using tumour type and patient characteristics and to describe its application to all registered tumours in England between 2013 and 2019. Tumours with skin topographical codes (ICD-10) and morphology and behaviour (ICD-O3) were grouped together in an iterative process creating a hierarchical tree structure. The primary-level grouping partitioned skin tumours into skin cancer, melanoma in situ, extramammary Paget disease (EMPD) and tumours of uncertain malignant potential. Second-level groups splitskin cancer into keratinocyte cancer (KC), melanoma and rare cancers. The third-level group splitKC into basal cell carcinoma (BCC) and squamous cell carcinoma (cSCC). Further groups were split intogenital or non-genital, first or subsequent tumour, age, gender, stage, orNational Health Service(NHS)region. Incidence counts, Kaplan-Meier and net survival estimates and referral routes [two-week wait (TWW), general practitioner (GP), outpatient] categorisations were calculated for each grouping across all years. A total of 1 445 377 skin cancers and 49 123 precancerous lesions and undefined entities were registered in England between 2013 and 2019. Skin tumours and skin cancer incidence rates are increasing for most tumour types. The most common type of skin cancer was BCC with an incidence rate of 282.36 per 100 000 person-years (PYs) [n = 158 934, 95% confidence interval (CI) 280.98-283.76] in 2019, followed by cSCC with an incidence rate of 85.24 per 100 000 PYs (n = 47 977, 95% CI 84.48-86.00) and melanoma with 27.24 (n = 15 332, 95% CI 26.81-27.67) per 100 000 PYs. Each year approximately 1800 rare skin cancers, 1500 genital cSCCs and 100 cases of EMPD are registered. Of 15 000 melanoma cases, 120 cases of melanoma occur in individuals aged < 25 years annually. One-year and five-year overall net survival varies by tumour type. cSCC 5-year net survival (89.8%, 95% CI 88.8-90.9) was comparable to the net survival of all melanomas (89.6%, 95% CI 88.7-90.6). BCC had excellent survival (overall net survival > 100%). Patients with late-stage melanoma, Merkel cell carcinoma and genital cSCC have a 5-year net survival < 60%. Older patients received fewer TWW referrals than their younger counterparts with the same tumour type at the same location. Patients with acral lentiginous melanoma had fewer TWW referrals and more standard GP referrals than patients with common melanomas. 'Get Data Out' Skin provides detailed and up-to-date statistics on all registrable skin tumours in England, including for the first time precancerous lesions and rare subtypes of common cancers. These data can be used by clinicians, researchers and commissioners to better understand skin cancer and improve resource allocation.

The Impact of Environmental Factors on Skin Cancer

Background: Skin cancer, as one of the most common cancers, is partly associated with environmental conditions. Objectives: The main purpose of this study was to investigate the effect of environmental factors on the incidence of skin cancer. Methods: The dataset contains the age-standardized incidence rate (ASR) of skin cancer in all provinces of Iran during a six-year period of time. Also, there were meteorological variables for a 29-year period for the provinces. We used the mean of meteorological variables for the 29-year period for each province as predictors. The ASR of skin cancer in each province in six years was considered as the response variable. Also, gender, latitude, altitude, wind speed, relative humidity, cloudy hours duration, and maximum air temperature in each province were considered independent variables. A mixed effects polynomial regression model was applied to data analysis. Results: Based on the applied model, the trend of ASR of skin cancer in different provinces was statistically significant (P &lt; 0.001). The ASR of skin cancer for males was more than the females (P &lt; 0.001). Furthermore, the positive linear effect of latitude was significant (P = 0.002). However, the quadratic term showed a deceleration in the growth rate of skin cancer incidence with increasing latitude. Furthermore, there was a positive significant impact of altitude on skin cancer incidence (P = 0.045). Conclusions: Health policymakers in their prevention planning should consider geographical conditions as influencing factors on skin cancer incidence. Moreover, men should be given more attention as the main group at risk for this cancer.

Understanding and Identifying Early Signs and Characteristic Changes Associated with Basal Cell Carcinoma vs. Melanoma Skin Cancers

The rise in the incidence rate of skin cancer(s) in the United States calls attention to the preventative measures and therapeutic treatments required to treat this condition. However, the needed treatment for cancers such as Basal Cell Carcinoma constitutes for a large portion of the financial burden on the healthcare system. Exploring different types of skin cancer allows us to explore the appropriate options for treatment. In the past decade or so, studies have given appropriate understanding of BCC biology and appropriate therapeutic responses. Mohs surgery, surgical excision, and cryosurgery are the preferred methods of treatment. Choosing between treatment options requires us to utilize evidence-based research to make the best decision. Yet, there are a limited amount of randomized, long-term studies that examine this. More research is needed in order to fully understand the effectiveness and long-term effects of these therapeutic treatments.

Prevalence and determinants of sunburns and sun protection behaviors among children: A nationwide cross-sectional survey in Switzerland

BACKGROUND: High exposure to solar ultraviolet radiation in early life increases the risk of developing skin cancer later, with increasing risk related to an increasing number of sunburns. Switzerland has high incidence rates of skin cancer compared to surrounding countries. We aimed to estimate the prevalence of sunburns and sun protection behaviors and their potential determinants among children in Switzerland. METHODS: In February 2019, we sent questionnaires to the parents of a random sample of 8,221 Swiss resident children. The questionnaires of 2,841 children were returned (response rate 35%). In spring and summer of the same year, follow-up questionnaires were sent to these children (response rate ~50%). Parents were asked about their child regarding protection measures, number of sunburns in the previous year, and skin phototype. We calculated the prevalence of sunburns and sun-protective behaviors (wearing a hat, seeking for shade, and use of sunscreen) by season, sociodemographic characteristics and skin phototype. RESULTS: Among participating children, 39.9% had at least one sunburn in the previous year, of whom 20.5% had a severe sunburn. When outside on a sunny day, 50.3% of the children wore a hat in summer (46.8% in spring), 21.1% (19.8%) sought shade more than half of the time, and 53.6% (43.5%) wore sunscreen. Prevalence of sunburns and of severe sunburns was higher among older children, boys, and children with sensitive skin. Protective measures were more frequent among younger children, girls, and children with sensitive skin. Prevalence of both outcomes varied substantially between regions. Sunburn prevalence was associated with lower use of sun protection. CONCLUSIONS: Compared to previous regional studies in Switzerland, we found a lower prevalence of sunburns and of protection behaviors, with important regional heterogeneity. Our results should help tailor sun exposure prevention measures to specific age groups and regions. KEYWORDS : sunburn, children, skin cancer

Horizon Shielding Factor: A Measure to Assess UV Exposure in Different Microenvironments

BACKGROUND AND AIM Skin cancer incidence rates have increased over recent decades worldwide. Ultraviolet radiation (UVR) is one of the main causes of skin cancer, as it induces mutations resulting from epidermal DNA damage. Exposure of people to UVR varies a lot depending on different factors such as the location of an individual. Additionally, UVR exposure can, for example, be lower due to shading effects. Being able to precisely measure UV exposure with a high repeatability on an individual level and to assess which microenvironments successfully reduce UV-exposure is, therefore, of high importance. METHODS In this analysis, we evaluated wearables at different body positions measuring ultraviolet radiation when worn during daily activities at different locations. First, we analyzed which of the body positions provide the most robust measurements. We then showed, that the measurements from the optimal body position can be used to infer the measurements taken at other positions. Using this optimal position, we devised a new measure, the horizon shielding factor, to evaluate the effect of horizon shielding. To explore if high/low horizon shielding factor values coincide with particular geospatial attributes, we inspected those values in their microenvironment on open street maps and found homogenous results per microenvironment. CONCLUSIONS The horizon shielding factor that has been developed in this project can be used to assess which microenvironments successfully reduce UV-exposure. It can be used in the future to find routes of transportation with less UV exposure due to horizon shielding. Systematic mapping of the horizon shielding factor in a given region may help policy makers and developers of new infrastructural projects to succeed in meeting the goals set by e.g. the National Climate Adaptation Strategy. KEYWORDS •Ultraviolet radiation exposure •Exposure assessment in microenvironments •Horizon Shielding

34714 Contextualization of skin cancer incidence rates in Costa Rica

Costa Rica is the only Central American country with a higher life expectancy than the United States. However, there are limited studies that characterize the country’s skin cancer burden. We contextualize regional trends on the incidence of skin cancer in Costa Rica through the lens of poverty rates and the estimated proportional density of dermatologists per province. The last report from the Ministerio de Salud de Costa Rica on the incidence of malignancies includes data from 2014. When combining incidence data on the female and male populations through an average weighing the country’s sex ratio, the highest rate was seen in San José (72.99 per 100,000 individuals) and the lowest rates in Limón and Guanacaste (31.78 and 38.56 per 100,000 individuals, respectively). A weak negative correlation was identified between skin cancer incidence and poverty rates across provinces (r = -0.195, r2 = 0.038). We identified a strong positive correlation between the incidence rate of skin cancer and the proportional density of dermatologists across provinces (r = 0.6464, r2 = 0.4178), and a strong negative correlation between the latter and poverty rates (r = -0.739, r2 = 0.546 ) These relationships suggest several possibilities, including: (1) more dermatologists translates to better access to skin examinations and biopsies, (2) a lower number of dermatologists in poorer provinces contributes to underdetection of skin cancer, and/or (3) overdiagnosis of skin cancer may be occurring and is more pronounced in provinces with more dermatologists. Further investigations are needed to elucidate the implications of these findings.

Characteristics of Malignant Eyelid Basal Cell Carcinoma in Dr. Mohammad Hoesin General Hospital: A Retrospective Study

Introduction: Incidence rates of skin cancer have risen significantly over the last two decades. Most tumors develop in sun-exposed areas of the head and neck. Basal cell carcinoma (BCC) rarely metastasizes but can cause significant morbidity and death due to direct spread to the orbit, head, and neck and frequent recurrence. In addition, approximately 40% of BCC patients have other lesions after 5 years. Although there has been a lot of epidemiological data regarding the characteristics of BCC in developed countries, reports of BCC in Asia, especially in Southern Sumatra, are still at a minimum rate.&#x0D; Methods: This study retrospectively reviewed the medical records specific to periocular BCC. Data were collected from the patient register book recorded from January 2021 to May 2022. The clinical characteristics of patients with BCC, such as gender and age, clinicopathological findings of BCC lesions, and BCC management, were reviewed retrospectively. This study aims to determine the epidemiological profile of the malignant eyelid BCC patient, the BCC lesion characteristics, and the management of BCC cases at Mohammad Hoesin General Hospital Palembang.&#x0D; Results: From 16 BCC patients recruited for this study, most of them were 51–60 years old and 71–80 years old, each with 5 patients (31.3%). The female preponderance of 56.3%. Occulus dextra (56.3%), lower eyelid (62.5%), T1 (87.5%), nodular BCC (75,0%), and primary lesion (75,0%) were the most side, periocular site, size, histopathological subtype and recurrence, respectively. Most therapy done is excision (93,8%), while the leading reconstructive technique was Tenzel’s flap (50,0%).&#x0D; Conclusion: There is a slight preponderance of females as BCC patients. BCC is commonly found in elderly people. The lower eyelid and right side are the most frequent anatomical locations. Nodular is the most common histological subtype. In addition, lesions often present in T1 size and primary lesions. Lastly, the treatment is mainly surgical (excision), with Tenzel's flap as the most used reconstruction technique option.

Risk of malignant melanoma and non-melanoma skin cancer in rheumatoid arthritis patients initiating methotrexate versus hydroxychloroquine: a cohort study.

To characterise the incidence rate of skin cancer associated with methotrexate and hydroxychloroquine in older adults with rheumatoid arthritis (RA). RA patients aged ≥65 years who initiated methotrexate or hydroxychloroquine as their first disease modifying antirheumatic drugs (DMARDs). The primary outcome was new occurrence of any skin cancer (i.e. malignant melanoma or non-melanoma skin cancer; NMSC) based on validated algorithms (positive predictive value >83%). Secondary outcomes were malignant melanoma, NMSC, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC). We estimated the incidence rates (IRs) and hazard ratios (HRs) for each outcome in the 1:1 propensity score (PS)-matched methotrexate and hydroxychloroquine groups. We included 24,577 PS-matched pairs of methotrexate and hydroxychloroquine initiators. Compared with hydroxychloroquine (IR 25.20/1,000 person-years), methotrexate initiators (IR 26.21/1,000 person-years) had a similar risk of any skin cancer [HR 1.03 -(95%CI 0.92, 1.14)] over a mean follow-up of 388 days. The HR (95%CI) associated with methotrexate was 1.39 (0.87, 2.21) for malignant melanoma, 1.01(0.90, 1.12) for NMSC, 1.37 (1.13, 1.66) for BCC, and 0.79 (0.63, 0.99) for SCC compared with hydroxychloroquine. In this large cohort of older RA patients initiating methotrexate or hydroxychloroquine as their first DMARD, we found no difference in the risk of skin cancer including malignant melanoma and NMSC. However, for specific components of NMSC, methotrexate initiators had higher risk of BCC but lower risk of SCC compared with hydroxychloroquine initiators.