Low Risk Of Skin Cancer Research Articles

Lower Skin Cancer Risk in Vitiligo: DNA Repair as Potential Mechanism?

Lower Skin Cancer Risk in Vitiligo: DNA Repair as Potential Mechanism?

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

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

Abstract 844: Immune-related diseases and risk of skin cancer

Abstract Introduction: The immune system plays an important role in skin cancer development, as evidenced by elevated rates in organ transplant recipients. However, there are limited studies on the association between immune-related diseases and skin cancer. This study prospectively evaluates the relationship between immune-related diseases and risks of melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) using two cohorts of women and men: the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). Methods: In the NHS and HPFS, participants completed biennial questionnaires that gathered information on lifestyle factors and medical history. In our study, the NHS data is comprised of 83,824 participants over a 26-year period (1986-2012), representing 1,738,926 person years. The HPFS data includes 48,277 participants over a 26-year period (1986-2012), representing 874,315 person years. Cox proportional hazard models were applied to estimate the associations between immune-related diseases (ulcerative colitis/Crohn's disease, multiple sclerosis, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, hypothyroidism, hyperthyroidism, and vitiligo) and skin cancer risk, both individually and as one composite variable. Multivariate models were adjusted for age and other skin cancer risk factors (body mass index, smoking status, alcohol consumption, hair color, number of blistering sunburns, nevi count, sunburn reaction, family history of melanoma and cumulative UV exposure level). Due to the small number and lower skin cancer risk in the nonwhite population, the analysis was limited to white participants. Exclusion criteria were participants who had melanoma, SCC, BCC, or other cancers at baseline. Results: During the follow-up period, 558 melanoma, 1,696 SCC, and 17,145 BCC incident cases were documented in the NHS and 589 melanoma, 1,388 SCC, and 9,962 BCC cases in the HPFS. When assessing individual diseases, there was a significantly increased risk for SCC and BCC among male participants with ulcerative colitis/Crohn's disease; relative risks (RR) were 1.69 (1.06, 2.67) and 1.38 (1.15, 1.66) respectively. Male participants with multiple sclerosis were also at a significantly increased risk of BCC; RR was 1.78 (1.17, 2.72) In female participants, participants with hypothyroidism and hyperthyroidism were at significantly decreased risk for BCC; RR were 0.88 (0.78, 0.99) and 0.81 (0.68, 0.96) respectively. There were no significant associations between diagnosis of skin cancer and immune-related diseases when evaluating them as one composite variable. Conclusions: Risk of skin malignancy in patients with immune-related diseases is disease dependent. There is an increased risk of SCC/BCC and BCC in male patients with ulcerative colitis/Crohn's disease and multiple sclerosis, respectively. Citation Format: Erica M. Lin, Rachel Lim, Tricia Li, Martin Weinstock, Abrar Qureshi, Eunyoung Cho. Immune-related diseases and risk of skin cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 844.

The influence of race/ethnicity and skin reaction to sun on sunscreen use

To the Editor: Despite a lower risk of skin cancer compared with non-Hispanic whites (NHWs), individuals of color have a greater propensity to present with skin cancer at an advanced stage.1 In 2011, Summers et al2 found that non-Hispanic blacks (NHBs) who reported severe sunburns were 7 times less likely to wear sunscreen compared with NHWs who reported severe sunburns.2 Through a comprehensive review on skin cancer in people of color, the American Academy of Dermatology recommended educational campaigns targeting communities of color in 2014.

Historical migration and contemporary health

Abstract We argue that migration during the last 500 years induced differences in contemporary health outcomes. The theory behind our analysis builds on three physiological facts. First, vitamin D deficiency is directly associated with higher risk of all-cause mortality. Second, the ability of humans to synthesize vitamin D from sunlight (UV-R) declines with skin pigmentation. Third, skin pigmentation is the result of an evolutionary compromise between higher risk of vitamin D deficiency and lower risk of skin cancer. When individuals from high UV-R regions migrate to low UV-R regions, the risk of vitamin D deficiency rises markedly. We develop a measure that allows us to empirically explore the aggregate health consequences of such migration in a long historical perspective. We find that the potential risk of vitamin D deficiency induced by migration during the last half millennium is a robust predictor of present-day aggregate health indicators.

Mediterranean dietary pattern and skin cancer risk: A prospective cohort study in French women

The Mediterranean diet (MD) has been reported to be associated with lower cancer risk. However, while previous studies explored major single components of the MD, only 1 previous study has investigated adherence to the MD in relation to melanoma risk. The aim of this study was to explore the relations between adherence to the MD and the risk of skin cancer, including melanomas, basal cell carcinomas (BCCs), and squamous cell carcinomas (SCCs). Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) is a prospective cohort of 98,995 French women aged 40-65 y in 1990. Dietary data were collected via a validated food questionnaire in 1993. Adherence to the MD was assessed using a 9-unit dietary score that incorporates intakes of fruit, vegetables, legumes, cereal products, olive oil, fish, dairy products, meat products, and alcohol. We used Cox proportional hazards regression models to compute HRs and 95% CIs adjusted for age and main known skin cancer risk factors. From 1993 to 2008, a total of 2003 skin cancer cases were ascertained among 67,332 women, including 404 melanomas, 1367 BCCs, and 232 SCCs. Score of adherence to the MD was associated with lower risk of skin cancer (HR: 0.83; 95% CI: 0.73, 0.93 for high compared with low score, Ptrend=0.001). MD score was also inversely and linearly associated with risks of melanoma (HR: 0.72; 95% CI: 0.54, 0.96; Ptrend=0.02) and BCC (HR: 0.77; 95% CI: 0.66, 0.90; Ptrend=0.0006) but not SCC (HR: 1.08; 95% CI: 0.75, 1.55; Ptrend=0.68), although with no heterogeneity across skin cancer types (Pheterogeneity=0.23). These findings suggest that adherence to the MD is associated with a lower skin cancer risk in women, particularly melanoma and BCC. If confirmed in future research, these findings may have important implications in skin cancer prevention.

Prevalence of Sun Protection Use and Sunburn and Association of Demographic and Behaviorial Characteristics With Sunburn Among US Adults

Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention efforts. To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population. In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey-Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017. The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling. A total of 31 162 respondents (mean [SD] age, 47.0 [0.36] years; 13 932 male [44.7%] and 17 230 female [55.3%]) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non-aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non-binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non-overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups. Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.

Historical Migration Flows and Global Health Differences

In this study we provide evidence that historical migration flows impact present-day global health differences. The underlying theory is based on three physiological facts. First, vitamin D deficiency is directly associated with increased risk of premature death. Second, the ability of humans to synthesize vitamin D from sunlight (i.e., ultraviolet radiation, UV-R) declines with the level of skin pigmentation. Third, the level of human skin pigmentation is the result of an evolutionary compromise between the costs of pigmentation (e.g., higher risk of vitamin D deficiency) and its benefits (e.g., lower risk of skin cancer); people living in high UV-R regions, as a result, became more intensely pigmented. Accordingly, when individuals indigenous to high UV-R regions migrate to low UV-R regions the risk of vitamin D deficiency rises markedly, which should in turn impact average health in the recipient region. We develop an empirical measure that allows us to explore the aggregate consequences of local populations’ differential risk of vitamin D deficiency, as caused by historical migration flows. Our proposed measure of risk of vitamin D deficiency holds strong explanatory power vis-a-vis health outcomes in a world sample as well as across US states.

Lower Skin Cancer Risk in Women with Higher Body Mass Index: The Women's Health Initiative Observational Study

The unclear relationship of obesity to incident melanoma and nonmelanoma skin cancer (NMSC) risks was evaluated in the large, geographically diverse longitudinal, prospective Women's Health Initiative (WHI) observational study. Risks of melanoma and NMSC in normal weight women were compared with risks in overweight [body mass index (BMI) = 25-29.0 kg/m(2)] and obese (BMI ≥ 30 kg/m(2)) women, using Cox proportional hazards models for melanoma and logistic regression for NMSC. Over a mean 9.4 years of follow-up, there were 386 melanoma and 9,870 NSMC cases. Risk of melanoma did not differ across weight categories (P = 0.86), whereas in fully adjusted models, NMSC risk was lower in overweight [OR, 0.93; 95% confidence interval (CI), 0.89-0.99] and obese (OR, 0.85; 95% CI, 0.80-0.91) women (P < 0.001). Excess body weight was not associated with melanoma risk in postmenopausal women but was inversely associated with NMSC risk, possibly due to lower sun exposure in overweight and obese women. This supports previous work demonstrating the relationship between excess body weight and skin cancer risk.

Sun Protection Attitudes and Behaviours Among First Generation Australians with Darker Skin Types: Results from Focus Groups

Despite residing in a country that has the highest rates of skin cancer in the world, little is known about the knowledge, attitudes and sun protection practices of first generation Australian-born individuals with olive and darker skin types. Six focus groups with first generation Australian-born individuals of Asian, Mediterranean, Middle Eastern and Indian background were conducted. Participants had good knowledge of the dangers of skin cancer. Most correctly perceived darker skin types as protective and believed they were at low risk of skin cancer. Most participants could recall high profile mass media sun protection campaigns. Several participants suggested that greater representation of ethnic minorities and/or individuals with darker skin types would increase the personal relevance of campaigns. Beliefs that sun protection is not necessary on the basis of skin type highlights the need for further studies to explore fundamental differences in attitudes and practices between those with olive and darker skin and the general Australian population.

Non-steroidal anti-inflammatory drugs, acetaminophen, and risk of skin cancer in the Nurses’ Health Study

Non-steroidal anti-inflammatory drugs (NSAIDs) have been associated with lower risk of certain cancers, but data on the effect on skin cancer risk have been limited and contradictory. We prospectively examined whether use of NSAIDS or acetaminophen was associated with a lower risk of skin cancer in women. The 92,125 Caucasian women in the Nurses' Health Study provided information on aspirin use in 1980. Other NSAIDs and acetaminophen were added in 1990. Medication use, frequency, and quantity were reassessed on biennial questionnaires. Through 2008, we confirmed 658 melanoma cases, 1,337 squamous cell carcinoma (SCC) cases, and had 15,079 self-reports of basal cell carcinoma (BCC). We used COX proportional hazards models to compute relative risks (RR) adjusted for known skin cancer risk factors. Neither aspirin nor non-aspirin NSAID use was associated with a lower risk of melanoma, SCC, or BCC, even for women with high quantity, frequency, or duration of use. Instead, we observed an increased risk of melanoma among current aspirin users (RR=1.32, 95% CI 1.03-1.70), though an increase of similar magnitude among past users and lack of a dose-response effect did not support a pharmacologic mechanism. We observed a mild reduction in SCC risk in current acetaminophen users (RR=0.88, 95% CI 0.75-1.02), with a linear decrease in risk with greater frequency of use (p=0.04). Aspirin and other NSAIDs were not associated with a lower risk of melanoma, SCC, or BCC in women. Our large, prospective study does not support a chemoprotective effect of NSAIDs against skin cancers.

Host Phenotype Characteristics and MC1R in Relation to Early-Onset Basal Cell Carcinoma

Basal cell carcinoma (BCC) incidence is increasing, particularly among adults under age 40. Pigment-related characteristics are associated with BCC in older populations, but epidemiologic studies among younger individuals and analyses of phenotype-genotype interactions are limited. We examined self-reported phenotypes and melanocortin 1 receptor gene (MC1R) variants in relation to early-onset BCC. BCC cases (n=377) and controls with benign skin conditions (n=390) under age 40 were identified through Yale’s Dermatopathology database. Factors most strongly associated with early-onset BCC were skin reaction to first summer sun for one hour [severe sunburn vs. tan odds ratio (OR)=12.27, 95% confidence interval (CI)=4.08–36.94] and skin color (very fair vs. olive OR=11.06, 95% CI=5.90–20.74). Individuals with two or more MC1R non-synonymous variants were 3.59 times (95% CI=2.37–5.43) more likely to have BCC than those without non-synonymous variants. All host characteristics and MC1R were more strongly associated with multiple BCC cases status (37% of cases) than single BCC case status. MC1R, number of moles, skin reaction to first summer sun for one hour, and hair and skin color were independently associated with BCC. BCC risk conferred by MC1R tended to be stronger among those with darker pigment phenotypes, traditionally considered to be at low-risk of skin cancer.

Abstract A83: Host phenotype characteristics and MC1R in relation to early-onset basal cell carcinoma

Abstract Background: Basal cell carcinoma (BCC), which accounts for 80% of non-melanoma skin cancers, is the most common cancer in the United States, with more than two million BCCs diagnosed annually. In recent decades, BCC incidence has been increasing, particularly among adults under age 40. While pigment-related characteristics have been associated with BCC in older populations, epidemiologic studies of these exposures in relation to BCC in younger individuals are lacking. In addition, investigations of potential interactions between pigment phenotype and pigment-related genotype for this malignancy are limited. Methods: We examined self-reported phenotypes and melanocortin 1 receptor gene (MC1R) variants in relation to early-onset BCC in the Yale Study of Skin Health in Young People. BCC cases (n=377) and controls with benign skin conditions (n=390) under age 40 were identified through Yale Dermatopathology between 2006 and 2010. Approximately two-thirds of dermatologists in Connecticut send their biopsied tissue to Yale dermatopathologists for diagnosis. Controls were frequency matched to cases on age, gender, and body site of biopsy. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate logistic regression. Cross-product terms in the multivariate models were used to evaluate potential effect modification of the association between MC1R and BCC by host phenotypes. Results: Skin reaction to first summer sun of the season (severe sunburn vs. tan OR=12.27, 95% CI=4.08–36.94) and skin color (very fair vs. olive OR=11.06, 95% CI=5.90–20.74) were most strongly associated with early-onset BCC. Individuals with two or more MC1R non-synonymous variants were 3.59 times (95% CI=2.37–5.43) more likely to have BCC than those without variants. All exposures were much more strongly associated with multiple BCC (two or more BCCs; 37% of cases). For example, the OR for two or more MC1R non-synonymous variants compared to no variants was 2.93 (95% CI=1.82–4.71) for single BCC, while the OR for multiple BCC was 5.15 (95% CI=2.84–9.32). With mutual adjustment, MC1R, moles, skin reaction to sun exposure, and hair and skin color remained independently associated with BCC. Even after accounting for other pigment related factors, very fair skin was associated with a 4.48 fold increased risk of BCC compared to olive skin (95% CI=2.21–9.09) and individuals with two or more MC1R non-synonymous variants had a 91% independent increased risk of BCC compared to those with no non-synonymous variants (95% CI=1.20–3.03). While there were no statistically significant phenotype-genotype interactions, BCC risk conferred by MC1R tended to be stronger among those with darker pigment phenotypes, such as darker eye color and skin color, fewer moles and freckles, as well as tanning rather than burning with sun exposure. Conclusions: Several pigment-related phenotypes and MC1R were strongly and independently associated with early-onset BCC. Even persons with darker phenotypes, traditionally considered to be at low risk of skin cancer, were at substantial risk of early-onset BCC if they had MC1R variants. Our observation of a pronounced effect of MC1R within low risk phenotype strata parallels existing research for melanoma and supports growing evidence that BCC may share etiologic similarities with melanoma. Despite an increasing prevalence of skin cancers in young people, this is the first epidemiologic investigation of BCC in this population. One-third of cases already had multiple BCCs, suggesting an urgent need for preventive interventions in at-risk persons. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A83.

From suntan to skin cancers: molecular pathways and prevention strategies

The incidence of skin cancer is rising, and significantly linked to carcinogenic effects of ultraviolet radiation. While clashes in lifestyle and cancer risk have undoubtedly contributed to this health crisis, it is equally clear that certain human populations have a notably lower risk of skin cancer. This apparent natural protection, typically afforded by darker skin pigmentation or an easy ability to tan, has begun to reveal mechanistic insights of great relevance to skin cancer risk. An understanding of the genes that participate in pigmentation and the sun-tanning response has permitted greater understanding of the intracellular and intercellular signaling events that culminate in human skin pigmentation. Moreover the same observations have also suggested novel targeted approaches to mimic the pigmentary response using agents that spare the cell from carcinogenic effects of ultraviolet radiation. The application of such strategies is not yet at hand, but potentially promises to provide a complementary approach to prevention of cutaneous cancer.

Balancing the Benefits and Risks of Drug Treatment

To examine the extent to which the attributes of a treatment affect patients' choice of treatment for psoriasis and the magnitude and nature of trade-offs between risks and benefits of treatment. A questionnaire, including a stated-preference, discrete choice experiment, was used to elicit patients' preferences for the treatment of psoriasis. Dermatology clinics in England. A total of 126 patients with psoriasis. Preferences of patients for, and trade-offs between, the 6 attributes of time to moderate (50%) improvement, relapse, and risks of experiencing skin irritation, high blood pressure, liver damage, and skin cancer. The mean age of respondents was 47.6 years, and the mean duration of psoriasis was 23 years. All 6 attributes were important factors affecting choice of treatment. The results indicated that patients with psoriasis prioritized low risk of skin cancer (beta = -0.054; P < .01) and liver damage (beta = -0.054; P < .01) and preferred treatment that resulted in a shorter time to achieve a moderate improvement (beta = -0.034; P < .01) over a longer time to relapse (beta = 0.028; P < .01). Patients were most willing to wait longer for a treatment to work if the likelihood of skin cancer or liver damage was reduced. This study shows that treatment attributes influence patients with psoriasis in their choice of treatment. The results of the discrete choice experiment presented herein indicate that most respondents would be willing to trade between different aspects of treatment to achieve improvements in their psoriasis and minimize the risks of adverse events.

Topical photodynamic therapy

Topical photodynamic therapy is a therapeutic modality in development, thus arises grate interest among dermatologists worldwide. It is an effective therapy for actinic keratosis, superficial BCC and Bowenos disease. Treatment efficacy, good cosmetics, low risk of skin cancer, low invasiveness, low rate of adverse events, facility for treating multiple or large lesions, especially in poor healing sites and, for penile, digital and facial involvement, low general toxicity and possibility of repeating the treatments with the same efficiency, enable topical photodynamic therapy to become increasingly practiced treatment modality. Researching aimed topical photodynamic therapy to prove as a treatment modality for clinical use in other dermatoses, is in experimental phase. To answer the question when dermatologist should consider using topical photodynamic therapy treatment modatility, we are present available date.

Initiating Narrow-band UVB for the Treatment of Psoriasis

Narrow-band UVB is effective for the treatment of psoriasis. 3,8,10 The numerous protocols available in the literature may make it challenging for a practitioner, wishing to initiate narrow-band therapy, to choose the appropriate protocol. This article is a review of the literature on narrow-band UVB protocols and a guide to initiate therapy. To commence therapy, a protocol that best suits the practi- tioner's expertise level and the type of staff the practitioner has is chosen. The two main types of narrow-band protocols presented in this review are the Skin Type and MED (minimal erythema dose) protocols. MED and skin type testing to determine the dose of narrow-band UVB to begin treatment are detailed in a step-by-step process. Subsequent treatment doses are based on the skin's response to the previous treatment. 11 Further adjustments in light dose can accommodate missed treatments. Narrow-band light treatments are continued until psoriasis clears or almost clears, followed by tapering maintenance treatments. The goals of therapy are to establish and maintain control over psoriatic flares, and to balance the risks and benefits of narrow-band treatment. Narrow-band ultraviolet B (NB-UVB) was introduced in 1976 and has been widely used for psoriasis, especially in Europe and Australia. It became available in the United States in 1996. NB- UVB emits a wavelength between 311-313 nm, which is most phototherapeutic for the clearance of psoriasis. NB-UVB has been shown to be more effective than broad-band ultraviolet B (BB-UVB) 1,2,3 and almost as effective as PUVA for the treatment of psoriasis, but with a shorter remission time, and possibly with a lower risk of skin cancer. 4,5,6 No standardized protocol has yet

Low risk of skin cancer with methoxsalen bath + PUVA

Low risk of skin cancer with methoxsalen bath + PUVA

Low risk of skin cancer with methoxsalen bath PUVA

Low risk of skin cancer with methoxsalen bath PUVA