Skin Cancer Research Articles

Transforming Skin Cancer Diagnosis: A Deep Learning Approach with the Ham10000 Dataset

Skin cancer (SC) is one of the three most common cancers worldwide. Melanoma has the deadliest potential to spread to other parts of the body among all SCs. For SC treatments to be effective, early detection is essential. The high degree of similarity between tumor and non-tumors makes SC diagnosis difficult even for experienced doctors. To address this issue, authors have developed a novel Deep Learning (DL) system capable of automatically classifying skin lesions into seven groups: actinic keratosis (AKIEC), melanoma (MEL), benign keratosis (BKL), melanocytic Nevi (NV), basal cell carcinoma (BCC), dermatofibroma (DF), and vascular (VASC) skin lesions. Authors introduced the Multi-Grained Enhanced Deep Cascaded Forest (Mg-EDCF) as a novel DL model. In this model, first, researchers utilized subsampled multigrained scanning (Mg-sc) to acquire micro features. Second, authors employed two types of Random Forest (RF) to create input features. Finally, the Enhanced Deep Cascaded Forest (EDCF) was utilized for classification. The HAM10000 dataset was used for implementing, training, and evaluating the proposed and Transfer Learning (TL) models such as ResNet, AlexNet, and VGG16. During the validation and training stages, the performance of the four networks was evaluated by comparing their accuracy and loss. The proposed method outperformed the competing models with an average accuracy score of 98.19%. Our proposed methodology was validated against existing state-of-the-art algorithms from recent publications, resulting in consistently greater accuracies than those of the classifiers.

Cancer-associated fibroblast subtypes modulate the tumor-immune microenvironment and are associated with skin cancer malignancy

Cancer-associated fibroblasts (CAFs) play a key role in cancer progression and treatment outcome. This study dissects the intra-tumoral diversity of CAFs in basal cell carcinoma, squamous cell carcinoma, and melanoma using molecular and spatial single-cell analysis. We identify three distinct CAF subtypes: myofibroblast-like RGS5+ CAFs, matrix CAFs (mCAFs), and immunomodulatory CAFs (iCAFs). Large-cohort tissue analysis reveals significant shifts in CAF subtype patterns with increasing malignancy. Two CAF subtypes exhibit immunomodulatory properties via different mechanisms. mCAFs sythesize extracellular matrix and may restrict T cell invasion in low-grade tumors via ensheathing tumor nests, while iCAFs are enriched in late-stage tumors, and express high levels of cytokines and chemokines to aid immune cell recruitment and activation. This is supported by the induction of an iCAF-like phenotype with immunomodulatory functions in primary healthy fibroblasts exposed to skin cancer cell secretomes. Thus, targeting CAF variants holds promise to enhance immunotherapy efficacy in skin cancers.

Pathological changes on the skin due to the combined effects of polycyclic aromatic hydrocarbons and ultraviolet radiation

Introduction. In the National Healthcare Project, one of the key areas is the federal project "Fight against oncological diseases for 2019-2024". The influence of the nature of work activities of workers in contact with industrial carcinogens — polycyclic aromatic hydrocarbons (PAHs) significantly increases the risk of skin neoplasms, as evidenced by differences in the frequency of their occurrence among representatives of different labor categories. The leading factor in the development of skin neoplasms is ultraviolet radiation (UV) of the A and B spectrum. There is literature evidence of a possible mutual enhancement of the combined effects of PAHs and UV in the occurrence of skin neoplasms and their malignancy. The study aims to evaluate the role of the combined effects of polycyclic aromatic hydrocarbons (PAHs) and ultraviolet radiation (UV) in the occurrence of pigmented skin tumors in workers engaged in the construction of highways and highways and in housing and communal services. Materials and methods. During periodic medical examinations (PMEs) in 2022–2024, specialists have examined 140 people who formed 4 study groups. The researchers have conducted a physical examination of skin tumors; examination in the rays of a Wood lamp; dermatoscopy of skin tumors using a Heine Delta 20 dermatoscope. Hyperpigmentation was assessed according to the hyperpigmentation area and severity index (NASI). Results. During the clinical examination, the authors assessed the presence of pigmentation and skin neoplasms (lentigo, ephelides, seborrheic keratomas). The most frequent localizations of pigmentation and skin neoplasms were open areas of the body: face, hands, upper third of the back. At the same time, in asphalt concrete workers — group I, working under the influence of PAHs and solar insolation (spectrum A and B, in the range of 320–400 nm and 280–320 nm), specialists revealed pigmented neoplasms in a larger number of individuals compared with the population control for all skin localizations. The HASI index (in the surveyed groups) showed that the highest rates (24–48) of HASI were observed in a larger number of individuals — 57.1% — from group I (UV+PAHs), compared with groups of individuals (II, III, IV) who do not work under conditions of exposure to solar insolation (spectra A and B, in the range of 320–400 nm and 280–320 nm). The authors noted that the intensity of pigmentation is higher and the lesion area is larger when assessing the foci of hyperpigmentation in the rays of the Wood lamp compared with the clinical examination in all the examined groups. Limitations. The study is limited by the number of subjects examined, corresponding to the design of the study and the time interval of the study. Conclusion. To obtain objective results of the study of the role of the combined effects of polycyclic aromatic hydrocarbons (PAHs) and ultraviolet irradiation (UV) in the occurrence of pigmented skin tumors, scientists used a method for determining the hyperpigmentation area index and severity index (HASI) in the rays of a Wood's lamp. When comparing the results obtained, experts revealed an increase in the area of hyperpigmentation and its intensity with localization in open areas of the body in workers engaged in the construction of highways and housing and communal services, in contact with the combined effects of carcinogens (PAHs) and ultraviolet irradiation (UV A and B). Further in-depth studies are needed to study the etiopathogenesis of photogenotoxicity depending on the dose-effect ratio. Ethics. The work was performed in accordance with the ethical standard set out in the Helsinki Declaration of the World Medical Association of 1964 (as amended and supplemented in 2013). The authors conducted all the studies after receiving informed consent and a decision of the Local Ethics Committee (extract from Protocol No. 7 dated 10/21/2020).

Exploring mechanisms of skin aging: insights for clinical treatment

The skin is the largest organ in the human body and is made up of various cells and structures. Over time, the skin will age, which is not only influenced by internal factors, but also by external environmental factors, especially ultraviolet radiation. Aging causes immune system weakening in the elderly, which makes them more susceptible to dermatosis, such as type 2 inflammatory mediated pruritus. The immune response in this condition is marked by senescent cells consistently releasing low amounts of pro-inflammatory cytokines through a senescence-associated secretory phenotype (SASP). This continuous inflammation may accelerate immune system aging and establish a connection between immune aging and type 2 inflammatory skin diseases. In addition, two chronic pigmentation disorders, vitiligo and chloasma, are also associated with skin aging. Aged cells escape the immune system and accumulate in tissues, forming a microenvironment that promotes cancer. At the same time, “photoaging” caused by excessive exposure to ultraviolet radiation is also an important cause of skin cancer. This manuscript describes the possible links between skin aging and type 2 inflammation, chronic pigmentation disorders, and skin cancer and suggests some treatment options.

Enhancing Skin Lesion Classification Performance with the ABC Ensemble Model

Skin cancer is one of the most easily developed cancers and is continuously seeing an increased incidence rate. In this study, we propose a novel ABC ensemble model for skin lesion classification by leveraging the ABCD rule, which is commonly used in dermatology to evaluate lesion features such as asymmetry, border, color, and diameter. Our model consists of five distinct blocks, two of which focus on learning general image characteristics, while the remaining three focus on specialized features related to the ABCD rule. The final classification results are achieved through a weighted soft voting approach, where the generalization blocks are assigned higher weights to optimize performance. Through 15 experiments using various model configurations, we show that the weighted ABC ensemble model outperforms the baseline models, achieving the best performance with an accuracy of 0.9326 and an F1-score of 0.9302. Additionally, Grad-CAM analysis is employed to assess how each block in the ensemble focuses on distinct lesion features, further enhancing the interpretability and reliability of the model. Our findings demonstrate that integrating general image features with specific lesion characteristics improves classification performance, and that adjusting the soft voting weights yields optimal results. This novel model offers a reliable tool for early skin lesion diagnosis.

Activated Charcoal-Alginate Platform for Simultaneous Local Delivery of Bioactive Agents: At the Nexus of Antimicrobial and Cytotoxic Activity of Zn2+ Ions

Antimicrobial resistance (AMR) is a global public health threat that affects cancer patients more than the general population. In this work, a composite system based on Zn-alginate hydrogel and activated charcoal (AC) particles that, upon contact with physiological fluids, simultaneously releases bioactive agents (Zn2+ and AC particles impregnated with povidone–iodine) was designed to locally address specific problems characteristic for malignant wounds (MWs). This composite was comprehensively investigated in vitro regarding its morphology (field-emission scanning electron microscopy), Zn2+ release (flame atomic absorption spectrometry), iodine adsorption and desorption from AC particles (energy dispersive X-ray analysis and UV–visible spectroscopy) as well as its antimicrobial and antitumor activity. With respect to the ongoing AMR crises, antimicrobial activity was tested against a wide range of wild multi-drug resistant bacterial and yeast strains, all isolated from patient wounds. Since Zn2+ ions proved to be selectors of resistant strains of bacteria, the synergistic activity of AC particles and adsorbed iodine was shown to be crucial for excellent antibacterial activity. On the other hand, the synergy of AC particles and Zn2+ ions showed an equally strong antifungal effect. In addition, antimicrobial concentrations of Zn2+ ions showed cytotoxic activity against two cancer cell lines derived from cancers affecting skin either as metastatic cancer (breast cancer MDA-MB-453 cell line) or primary cancer of the skin (malignant melanoma Fem-X cell line), which enables Zn2+ ions to be further investigated as potent local agents targeting malignant cells.

A two-step, two-sample Mendelian randomization analysis investigating the interplay between gut microbiota, immune cells, and melanoma skin cancer.

This study aims to rigorously explore the potential causal relationships among gut microbiota (GM), immune cells, and melanoma skin cancer among participants from Europe, where this disease exhibits significant prevalence and profound societal impact. Using the genome-wide association analysis database, a double-sample Mendelian randomization (MR) analysis was drawn upon to investigate GM, immune cells, and melanoma skin cancer. The inverse variance weighted approach was applied to estimate the causal connections among these variables. A two-step MR analysis was employed to quantitatively gauge the impact of immune cells mediated GM on melanoma skin cancer. To address potential sources of bias, such as pleiotropy and heterogeneity, multiple analytical techniques were integrated. The MR analysis pinpointed 6 GM taxa related to either an augmented or declined risk of late-stage melanoma skin cancer. In the same vein, 32 immune cell phenotypes were noticed as correlates with modified risk of melanoma skin cancer. Our study also implies that the probable association between GM and melanoma could be facilitated by 5 immune cell phenotypes. The findings of our study underline certain GM taxa and immune cells as potential influencers on the onset and development of melanoma skin cancer. Importantly, our results spotlight 5 immune cell phenotypes as potential agents mediating this association.

The evolution of BRAF-targeted therapies in melanoma: overcoming hurdles and unleashing novel strategies

Melanoma, a highly aggressive form of skin cancer, poses a significant global health burden, with 331,647 new cases and 58,645 deaths reported in 2022. The development of melanoma is influenced by various factors, including sunlight exposure and BRAFV600 mutations that activate the MAPK/ERK pathway. The introduction of BRAF and MEK inhibitors has revolutionized the treatment landscape for melanoma patients. However, innate and acquired therapeutic resistance remains a significant challenge. This review provides a comprehensive overview of the current state of BRAF-targeted therapies in melanoma, highlighting the efficacy and limitations of FDA-approved combinations of BRAF and MEK inhibitors such as vemurafenib, dabrafenib, trametinib, and cobimetinib. The review also explores the off-target effects of BRAF inhibitors on endothelial cells, emphasizing the need for more selective therapies to minimize vascular complications and metastatic potential. The article also discusses potential druggable targets, including ERK5, CD73, ALDH1A1, PLA1A, and DMKN, which are promising in addressing diagnostic hurdles and guiding personalized therapeutic decisions. Recent studies on regorafenib, ERK5 signaling, and CD73 inhibition are highlighted as novel strategies to overcome resistance and improve treatment outcomes. The review also delves into the role of advanced therapeutic tools, such as mRNA vaccines and CRISPR-Cas9, in revolutionizing personalized oncology by targeting specific genetic mutations and enhancing immune responses against melanoma. The ongoing synergy between advancing research, targeted interventions, strategic treatment combinations, and cost-effectiveness evaluations offers a promising pathway to elevate patient outcomes in the persistent battle against melanoma significantly.

Impact of Physician Specialty on Treatment Costs of Invasive Melanoma

Introduction: Melanoma is a deadly type of skin cancer that develops from melanocytes and can manifest on the skin or other regions of the body. Its incidence is increasing rapidly, with approximately 100,000 diagnoses and 7000 deaths per year in the US alone. We conducted a cross-sectional study with the aim of determining an association between the cost of care for invasive melanoma and the specialty involved in the treatment to adequately guide future treatment. Methods: We analyzed data from 3817 patients (2013–2018) using the Florida inpatient/outpatient dataset, CMS cost reports, and the National Plan and Provider Enumeration System. Covariates included age, sex, race/ethnicity, insurance type, region, county rurality, the number of procedures, the comorbidity index, obesity, metastatic cancer presence, hospital size, and physician volume. Multivariable mixed linear regression was used to analyze the data, and the cost was adjusted to the 2019 USD. Results: Dermatology had the largest decrease in the overall and outpatient costs compared to general surgery, followed by plastic surgery. The inpatient costs for dermatology and plastic surgery were lower than those for general surgery, but not significantly so. Conclusions: The costs associated with surgical procedures may vary depending on the specialty of the physician treating the patient. Dermatology was associated with lower treatment costs for invasive melanoma compared to other specialties, indicating that physician specialty influences the cost of care.

Photoprotection and its implications for drug safety

Appropriate photoprotection plays a key role in the safety of using medicinal preparations whose active substances may induce photosensitivity reactions. This aspect applies not only to drugs applied topically to the skin, but also systemically. Drug-induced photosensitivity reactions to light depend on the active substance contained in the medicinal product and its dose, which translates into the concentration in the skin, the type of ultraviolet radiation, its intensity and exposure time. The chemical structure of phototoxic drugs contains unsaturated chemical bonds and aromatic groups, which are responsible for the absorption of radiation, the formation of degradation products and/or free radicals and hypersensitivity reactions. Therefore, in order to prevent hypersensitivity reactions, it is necessary to use appropriate sun protection and/or avoid exposure to solar radiation during pharmacotherapy with selected groups of drugs. The paper presents the latest research results on the impact of drug-induced photohypersensitivity on the increased likelihood of skin cancer. Drugs with the potential to induce photohypersensitivity reactions are discussed, including information on the relationship between their long-term use and the incidence of skin cancer. Based on the data contained in the Product Characteristics, exemplary indications regarding the appropriate photoprotection method to ensure the safe use of the medicinal product are presented. Med Pr Work Health Saf. 2024;75(5).

Nuclear versus cytoplasmic IKKα signaling in keratinocytes leads to opposite skin phenotypes and inflammatory responses, and a different predisposition to cancer.

IKKα is known as an essential protein for skin homeostasis. However, the lack of suitable models to investigate its functions in the skin has led to IKKα being mistakenly considered as a suppressor of non-melanoma skin cancer (NMSC) development. In this study, using our previously generated transgenic mouse models expressing exogenous IKKα in the cytoplasm (C-IKKα mice) or in the nucleus (N-IKKα mice) of basal keratinocytes, we demonstrate that at each subcellular localization, IKKα differently regulates signaling pathways important for maintaining the balance between keratinocyte proliferation and differentiation, and for the cutaneous inflammatory response. In addition, each type of IKKα-transgenic mice shows different predisposition to the development of spontaneous NMSC. Specifically, N-IKKα mice display an atrophic epidermis with exacerbated terminal differentiation, signs of premature skin aging, premalignant lesions, and develop squamous cell carcinomas (SCCs). Conversely, C-IKKα mice, whose keratinocytes are nearly devoid of endogenous nuclear IKKα, do not develop skin SCCs, although they exhibit hyperplastic skin with deficiencies in terminal epidermal differentiation, chronic cutaneous inflammation, and constitutive activation of STAT-3 and NF-κB signaling pathways. Altogether, our data demonstrate that alterations in the localization of IKKα in the nucleus or cytoplasm of keratinocytes cause opposite skin changes and differentially predispose to the growth of skin SCCs.

Cancer disparities by age: a focus on sexual and gender minorities.

The purpose of this study is to examine the age at which sexual and gender minorities are diagnosed with cancer relative to heterosexual cisgender individuals. We use population-based representative Behavioral Risk Factor Surveillance Survey data with self-reported sexual orientation, gender identity, cancer diagnoses, and the age at diagnosis. We determined the mean age at diagnosis and used logistic regression modeling to obtain odds ratios, reporting significant differences defined as p < 0.05. Separately, we adjusted for race/ethnicity and corrected for underlying differences in the age of survey respondents. Compared to heterosexual cisgender populations, sexual and gender minorities are diagnosed about 4-11years earlier, with bisexual women and transgender individuals reporting the youngest age, 43.9 and 52.1years, respectively. When focusing on select cancer types, lesbian and bisexual women are diagnosed earlier with breast, melanoma, other skin cancers, and leukemia & lymphoma. Gay and bisexual men are diagnosed earlier with colorectal cancers, and transgender individuals earlier with breast, prostate, melanoma, and other skin cancers compared to heterosexual men and women. These findings suggest that sexual and gender minorities experience earlier onset of cancer and many of these age differences remained even after adjustments were made. These findings need to be confirmed in oncology settings that have cancer incidence and sexual orientation and gender identity data and call for greater attention to sexual and gender minorities in cancer research.

AI in Aesthetic/Cosmetic Dermatology: Current and Future.

Recent advancements in artificial intelligence (AI) have significantly impacted dermatology, particularly in diagnosing skin diseases. However, aesthetic dermatology faces unique challenges due to subjective evaluations and the lack of standardized assessment methods. This review aims to explore the current state of AI in dermatology, evaluate its application in diagnosing skin conditions, and discuss the limitations of traditional evaluation methods in aesthetic dermatology. Additionally, the review proposes strategies for future integration of AI to address existing challenges. A comprehensive review of AI applications in dermatology was conducted, in both diagnostic and aesthetic fields. Traditional methods such as subjective surveys and hardware devices were analyzed and compared with emerging AI technologies. The limitations of current AI models were evaluated, and the need for standardized evaluation methods and diverse datasets was identified. AI has shown great potential in diagnosing skin diseases, particularly skin cancer. However, in aesthetic dermatology, traditional methods remain subjective and lack standardization, therefore limiting their effectiveness. Emerging AI applications in this field show promise, but they have significant limitations due to biased datasets and inconsistent evaluation methods. To develop the potential of AI in aesthetic dermatology, it is crucial to create standardized evaluation methods, collect diverse datasets reflecting various ethnicities and ages, and educate practitioners on AI's utility and limitations. Addressing these challenges will improve diagnostic accuracy, better patient outcomes, and help integrate AI effectively into clinical practice.

Safety and efficacy of filgotinib in Japanese patients with rheumatoid arthritis: Week 156 interim results in FINCH 4.

To describe safety and efficacy of filgotinib 200 or 100 mg (FIL200/FIL100) in Japanese patients with rheumatoid arthritis in a long-term extension (LTE; NCT03025308). Patients who completed any of three parent studies (NCT02889796: inadequate response [IR] to methotrexate [MTX]; NCT02873936: IR to biologic disease-modifying antirheumatic drugs; NCT02886728: MTX-naïve) without rescue therapy could enter the LTE; patients taking FIL continued their dosage, and those who received comparators were rerandomised to FIL200 or FIL100. This analysis includes week 156 interim results. Among Japanese patients, 110 received FIL200, and 97 received FIL100. Mean (SD) FIL200 and FIL100 exposure was 157.0 (51.49) and 156.0 (52.45) weeks. The exposure-adjusted incidence rates (95% CI) for FIL200/FIL100 were 2.7 (1.4, 5.2)/2.4 (1.2, 5.1) for herpes zoster, 0.9 (0.3, 2.8)/1.0 (0.3, 3.2) for malignancy (excluding nonmelanoma skin cancer), and 0.6 (0.2, 2.4)/0.3 (0.0, 2.4) for major adverse cardiovascular events. More patients receiving FIL200 with prior FIL200 exposure achieved clinical remission vs other groups (including Clinical Disease Activity Index remission in 40% vs 27% or less at week 156). FIL200 and FIL100 were generally well tolerated by Japanese patients, without new, unexpected adverse events.

Enhanced skin cancer diagnosis through grid search algorithm-optimized deep learning models for skin lesion analysis

Enhanced skin cancer diagnosis through grid search algorithm-optimized deep learning models for skin lesion analysis

Optical and structural characterization of Au@ZnO core–shell nanoparticles prepared by pulsed laser ablation as anticancer agents for skin cancer

Optical and structural characterization of Au@ZnO core–shell nanoparticles prepared by pulsed laser ablation as anticancer agents for skin cancer

PEG600 induced krill oil-based nanoemulsion system: ternary phase behaviour and cytotoxicity assessment

BackgroundEndogenous substances of krill oil (KO) are lipophilic in nature and have clinical significance viz. DHA/EPA, phospholipids and astaxanthin. To improve the nanodispersibility of endogenous substances of KO, a self-nanoemulsifying system (SNE) was developed.ResultsTernary phase behaviour of KO was explored in ethanol (ET); propylene glycol, (PG); and PEG600 using Tween80 and Tween20 as surfactants. PEG600 induced the self-nanoemulsification of KO and yielded one phase region (OPR); dilution lines (KO/Smix fraction containing PEG600) traversed across OPR, produced a fully dilutable nanoemulsion system. PEG600-based nanoformulations (NFs) of KO underwent phase transformation via percolation behaviour in nanostructure domains (86–207 nm). PEG600 induced ternary phase behaviour of KO as revealed from rheological data (higher eta values), refractive index (nonlinear) and conductivity (bimodal) patterns. Induced phase transformation could be an interaction between aqueous phase and KO/Tween20 in PEG600 environment; generating highly viscous domains of low electrical conductivity. NFs offered antioxidant activity over corresponding coarse systems (p < 0.01) as measured using DPPH method. Optimized NFs (F4 and F6) inhibited the growth of skin cancer cell line (A431) in the range of 100–500 × dilutions.ConclusionPhase behaviour of KO was induced by PEG600, transforming the dilution pattern via generation of one phase region; however, ethanol and propylene glycol as co-solvents did not. PEG600-based NFs of KO possessed antioxidant as well as cytotoxic to skin cancer cell lines (A431).

A comprehensive and systematic review on Curcumin as a promising candidate for the inhibition of melanoma growth: From pre-clinical evidence to molecular mechanisms of action

BackgroundMelanoma, a highly malignant skin tumor, can develop systemic metastases during the early stage. Several studies of melanoma animal models indicate that curcumin, a natural plant extract, inhibits melanoma growth through various mechanisms. To evaluate the relationships among different experimental conditions, curcumin itself, its derivatives, and special formulations, it is necessary to conduct a systematic review and meta-analysis. PurposeThis meta-analysis aims to evaluate the potential of Curcumin as a drug for inhibiting the growth of melanoma and to determine the optimal dosage range and treatment duration for Curcumin administration. MethodsA systematic search of studies published from inception to December 2023 was conducted across six databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data, and VIP). Methodological quality was assessed using SYRCLE's RoB tool. Study heterogeneity was assessed using Cochran's Q test and I2 statistics. Publication bias risk was evaluated using a funnel plot. All analyses were performed using R (version 4.3.3). Additionally, three-dimensional effect analysis and machine learning techniques were utilized to determine the optimal dosage range and treatment duration for Curcumin administration. ResultsForty studies involving 989 animals were included. The results demonstrated that, relative to the control group, administration of Curcumin resulted in a significant reduction in tumor volume. [SMD=−3.44; 95 % CI (−4.25, −2.63); P<0.01; I2 = 79 %] and tumor weight [SMD=−1.93; 95 % CI (−2.41, −1.45); P<0.01; I2 = 75 %]. Additionally, Curcumin demonstrated a significant capacity to decrease the number of lung tumor nodules and microangiogenesis, as well as to extend survival time, in animal models. The results from three-dimensional effect analysis and machine learning emphasize that the optimal dosage range for Curcumin is 25–50 mg/kg, with an intervention duration of 10–20 days. ConclusionCurcumin can inhibit the growth of melanoma, and the dose-response relationship is not linear. However, further large-scale animal and clinical studies are required to confirm these conclusions.

Ethical implications of artificial intelligence in skin cancer diagnostics: use-case analyses.

Skin cancer is the most common cancer worldwide. Early diagnosis is crucial for improving patient survival and morbidity. Artificial intelligence (AI)-assisted smartphone applications (apps) for skin cancer potentially offer accessible, early risk assessment of suspicious skin lesions. However, the integration of novel technologies into dermatology pathways raises ethical concerns. Although ethical principles for AI governance are well known, how these principles should be applied to real-life AI apps readily available for public use is less well understood. We conducted an ethical use-case analysis of commercially available skin cancer apps to better understand the ethical issues arising from their development and use in a real-world context. Established methods for ethical analysis of clinical AI applications were applied to two popular skin cancer apps in the UK: SkinVision and Scanoma. Systematic searches of published literature, regulatory documents, and websites were conducted to review the evidence regarding app development, effectiveness, and use. Screening for inclusion was undertaken by two researchers independently. Ethical concerns were identified with reference to previously described ethical concerns and principles for AI-assisted healthcare. By conceptualising ethical principles within the use-context of skin cancer apps, we identified specific ethical issues arising throughout the AI lifecycle of both apps. One company provided extensive detail regarding algorithm development and decision-making, this information was insufficiently reported for the other app. Other concerns identified related to number, quality, and consistency of studies assessing algorithm efficacy. Limited efforts to address potential skin tone biases and exclusion of individuals with darker skin tones as target users by one app risks perpetuating existing inequalities. Inadequate regulatory oversight was identified. Findings from our ethical use-case analysis of two patient-facing AI-assisted skin cancer apps suggest inadequate incorporation of bioethical norms such as justice, responsibility and transparency into the development and deployment of both apps. Improved regulation should increase accountability. Ensuring ethics by design through integration between technology developers, dermatologists, ethicists, and the public is urgently needed to prevent the potential benefits of AI-assisted skin cancer apps being overshadowed by potential ethical harms.

Skin cancer prevention: a systematic review of the efficacy of clinical trial-based interventions

Skin cancer is one of the most common malignancies and its incidence continues to increase worldwide, especially in areas of high ultraviolet (UV) radiation. This systematic review highlights that an effective preventive approach combines sun protection, education, and workplace policies. Advanced sunscreens with DNA repair complexes are useful in reducing precursor lesions such as actinic keratosis. The implementation of workplace policies that provide protective equipment and create shaded areas is especially effective for outdoor workers. Educational programs in schools and on-the-job training encourage sun protection practices from childhood and in work settings, although their effectiveness depends on demographic and cultural factors. It is recommended to tailor interventions to each population and explore their long-term sustainability, as well as to evaluate the economic impact of these policies to achieve effective skin cancer prevention.