Previous History Of Skin Cancer Research Articles

Predictor Variables Associated With Dermatology Referral Completion and the Impact on Surgical Treatment: A Retrospective Cohort Study.

Delays or failure to complete a dermatologic referral may affect health care outcomes. Factors associated with these delays remain understudied. This study investigated socioeconomic and demographic factors associated with delays or failure to complete dermatology referrals and potential impact on surgical outcomes. A retrospective chart review was performed for 400 patients internally referred to an academic dermatology center from 19 primary-care clinics from July 2018 to June 2019. Only patients referred after an in-person primary-care visit in which the provider documented a specific concerning lesion were included. Multivariate analyses were performed to explore variables associated with delays or failure to complete dermatology referrals. Patients were more likely to complete their referral if they had a personal history (adjusted odds ratio [aOR] = 7.843, 95% CI 1.383-14.304) or family history (aOR = 11.307, 95% CI 2.344-20.27) of skin cancer. Patients were more likely to delay referral completion past 30 days if they were ages 18 to 34 (aOR = 6.665, 95% CI 1.285-12.044) and less likely to delay referral past 30 days if they had a previous history of skin cancer (aOR = 0.531, 95% CI 0.181-0.882). Single institution, retrospective study, limited surgical patients. Understanding factors associated with delays in dermatology referral completion can help identify at-risk patient populations.

Skin cancer in essential thrombocythaemia and polycythaemia vera patients treated with hydroxycarbamide.

Hydroxycarbamide (HC) is used as a cytoreductive treatment in myeloproliferative neoplasms (MPN). Observational studies have raised the possibility that HC contributes to the development of secondary malignancies, including skin tumours in MPN patients. In this retrospective observational study, we report a single-centre experience of 324 HC-treated MPN patients with long-term follow-up, compared to 47 MPN patients not on HC. Thirty-three patients (10.2%) (HC) versus one patient (2.1%) (no HC) developed skin tumours during follow-up (Hazard ratios [HR] 5.70, 95% confidence intervals 0.66-48.09, p=0.112). However, male gender, age at MPN diagnosis, type of MPN (polycythaemia rubra vera) and previous history of skin cancer were prognostic variables associated with development of skin cancer.

795 Adequacy of Surgical Excision Margins in Lentigo Maligna: An Audit

Abstract Aim The optimal excision margin for Lentigo Maligna (LM) lesions has been a frequent topic of debate. An audit was carried out to compare the excision margins used for LM excisions with current NICE guidelines, and to assess the adequacy of these excision margins. Method A retrospective study was carried out to analyse all excisions of LM lesions in 2018. 33 patients were identified from the plastic surgery departmental database. Patient demographics, the site and distribution of LM lesions, and any history of previous skin cancer were analysed. Patient electronic records, operative notes, and histopathological reports were examined to determine the number of excisions done for each LM lesion along with the peripheral and deep surgical excision margins, and the histological clearance achieved. Complete histological clearance was determined by the Multidisciplinary team for each lesion. Results 60 cases were identified. 60% of cases were located on the head and neck. The average peripheral surgical excision margin at first excision was 2.3mm. 55% of patients had a 2nd excision. The average peripheral surgical excision margin at 2nd excision was 5.4mm. 70.6% of cases achieved complete histological clearance at 2nd excision. 72.7% of lesions excised at 2nd excision with a 5mm or less surgical excision margin achieved complete histological clearance. Conclusions Taking >5mm surgical excision margins did not increase the rate of complete histological clearance for Lentigo Maligna lesions.

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.

Outlier lesion on the back

A 61-year-old man presented to Dermatology as a follow-up for transient acantholytic dermatosis (Grover disease). An examination of his back revealed multiple benign-appearing seborrheic keratoses (SKs). Also, a 2-lobed brown and red plaque was visible on his back in the midthoracic area. He had no previous history of skin cancer and was otherwise in good health.What’s your diagnosis?

Impact of Sun Exposure and Tanning Patterns on Next-Generation Sequencing Mutations in Melanoma

BackgroundFor the past 30 y, the incidence rate of malignant melanoma has risen steadily. Ultraviolet radiation exposure has been identified as the most prevalent modifiable risk factor for melanoma. Here, next-generation sequencing was used to analyze the relationship between multiple sun exposure factors and select cancer-related genes to determine the relationship of sun exposure on the molecular profiles of melanomas. MethodsThe collection and analysis of study samples were approved by the institutional review board. The patient cohort consisted of 173 patients whose melanoma tissue samples underwent next-generation sequencing analysis for somatic mutations of 50 cancer-related genes. Univariate and multivariate analyses were conducted. ResultsPatients with a history of blistering sunburn had an absolute mutation incidence of 1.67 mutations per patient, compared with patients without a history of blistering sunburn, who had an absolute mutation incidence of 1.16 mutations per patient (P = 0.028). A BRAF mutation was found in more tumors of patients who reported visiting a tanning salon (57.14%), compared with those who had not (18.75%; P = 0.0463). Patients with a previous history of skin cancer were more likely to have a CDKN2A mutation (20.83%), compared with those without a previous history of skin cancer (7.76%; P = 0.0292). ConclusionsThe trends seen in the molecular profiles of melanomas with respect to various sun exposure factors suggest that sun exposure impacts genetic makeup. Considering the increase in absolute mutation incidence in patients with a history of blistering sunburn suggests that additional genes may contribute to the pathology of malignancy. Future studies will use the unique molecular profiles of melanomas to personalize patient treatments.

Abstract P2-08-27: Clinicopathologic characteristics of native vs. foreign-born breast cancer patients in a contemporary cohort

Abstract Introduction: Previous studies have found clinicopathologic differences in foreign-born women diagnosed with breast cancer compared to those who are native to the United States. A few studies have documented that the foreign-born women with breast cancer have limited information regarding their family history due to decreased contact with their relatives. The purpose of our study was to look at a contemporary cohort of women who are newly diagnosed with breast cancer and compare the clinical and tumor characteristics among the women who are foreign-born compared to those who are born in US in our institution. Methods: The Institutional Breast Cancer Database includes patients diagnosed with breast cancer between 2010-2018. Variables of interest included nativity and clinical and tumor characteristics. Statistical analyses included age and race adjusted logistic regression at the α=0.05 level. Results: Out of 3,199 BC patients, 984 (30.8%) were foreign-born and 2215 (69.2%) were native-born. We found that the foreign-born patients immigrated to the US mainly from Europe (35.7%), Asia (32.8%), and Central/South America (26.1%). Compared to the native-born patients, there was a significantly higher proportion of foreign-born patients with minority race (p<0.001), lower education (p<0.001), and lower income (<0.001). Foreign-born patients were less likely to have a personal history of BC (OR=0.70, 95% 0.52-0.95, p=0.020), personal history of other cancer (OR=0.68, 95% CI 0.52-0.88, p=0.003), family history of BC (FHBC) with a first-degree relative (OR=0.66, 95% CI 0.55-0.80, p<0.001) or have undergone genetic testing (OR=0.52, 95% 0.43-0.64, p<0.001). Upon further investigation of the personal history of other cancers, we found that the native-born patients were significantly more likely to have a previous history of skin cancer (OR=2.93, 95% CI 1.76-4.87, p<0.001). Foreign-born patients were more likely to have HER2 enriched molecular subtype (OR=1.69, 95% CI 1.09-2.61, p=0.049). Among those with hormone sensitive cancers, the foreign-born patients were more likely to have a lower Oncotype Dx Recurrence Score <18 (OR=1.67, 95% CI 1.15-2.42, p=0.021). Age at diagnosis, BRCA1/2 status, palpability, tumor stage, histology, tumor size, Ki-67, and recurrence were not significantly different between the foreign and native-born cohorts. Conclusions: In a contemporary cohort of women with newly diagnosed breast cancer, we found that our foreign-born patients appeared to have adequate information regarding their family history of breast cancer. This may be a result of enhanced digital and global communication in the 21st century. There was a significantly higher proportion of native-born patients with a strong FHBC (17.4% vs. 9.7%). We also found a significant proportion of foreign-born patients to have ER/PR-negative and HER2 enriched tumor molecular subtypes (10.6% vs. 6.3%). This observation did not reflect a higher proportion of BRCA mutation carriers, suggesting other possible mechanisms for this finding. Further investigation is warranted in a larger global cohort of foreign-born breast cancer patients from diverse populations, including Africa and the Middle-East. Citation Format: Jennifer Chun, Elianna Kaplowitz, Grace Gibbon, Jenny Goodgal, Amber Guth, Deborah Axelrod, Daniel Roses, Richard Shapiro, Freya Schnabel. Clinicopathologic characteristics of native vs. foreign-born breast cancer patients in a contemporary cohort [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-27.

Aspirin and NSAID use and keratinocyte cancers

It is thought that aspirin and other nonsteroidal anti‐inflammatory drugs (NSAIDS) may protect against keratinocyte skin cancers, i.e. squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). However, the evidence for this is scant. The authors, based in Queensland, Australia, studied a group of middle‐aged or elderly Queensland residents obtained from the register of voters (the QSkin study). They compared the incidence of keratinocyte cancers in a three‐year period in individuals who self‐reported taking aspirin or another NSAID regularly, with those who did not. In patients at high risk (such as having a history of previous skin cancer or multiple patches on the skin called actinic lesions) they found that taking aspirin infrequently (less than once a week) was associated with a slightly reduced risk of SCC. Regular use of other NSAIDS (at least once a week) led to a slightly reduced risk of BCCs. In low‐risk patients (no history of skin cancer and fewer than 5 actinic lesions) the authors found no reduced risk from taking aspirin or other NSAIDs. The authors comment that many patients are on low dose aspirin to reduce the risk of heart attacks or strokes, but this may be inadequate to prevent skin cancer. As most patients purchase non‐steroidal drugs over the counter, it was not possible to determine dosage and duration of treatment. They conclude that the protective effect of NSAIDS is slight and only of value in patients at high risk.

Evaluation of Post Wide Excision Non-Melanoma Skin Cancer at DR Cipto Mangunkusumo Hospital in 2012-2015: Recurrence and Prognostic Factors

Background Skin cancer is one of many kinds of cancer which incidence increases globally. Basal cell carcinoma (BSC) and squamous cell carcinoma (SCC) are the most common prevalence of non-melanoma skin cancer, and also are the most common cancer among skin cancer. The main therapy for such skin cancer is wide excision within its safety margin added by adjuvant therapy. Despite of adequate therapy, people with skin cancer still have risk of recurrence. This study assesses the prognostic factors of recurrence among people with non-melanoma skin cancer who underwent wide excision surgery. Method This study was a retrospective cohort with survival analysis. The patients data who underwent wide excision surgery were from Perhimpunan Ahli Bedah Onkologi Indonesia (PERABOI) registry and medical record from Oncology Surgery Division in RSCM from January 2012-December 2015. Data selection was done based on inclusion and exclusion criterias. Result There were 187 patients with non-melanoma skin cancer who underwent wide excision surgery; the recurrence was detected on 15% of the case. Most of the patients were ≥45 years old with the most common histopathological feature of the skin cancer was basal cell carcinoma. We did survival analysis with cox regression and the result was previous history of skin cancer (RR 6,903; 95% CI 2,925-16,292), perineural invasion (HR 3,818; 95%CI 1,561-9,340), location of the lesion (HR 0,071; 95% CI 0,022-0,228), andsize of the tumour (HR 1,842; 95%CI 1,244-2,729) was the factors that increased recurrence. Conclusion Previous history of skin cancer, perineural invasion, location of the lesion, and size of the tumour were the prognostic factors for recurrence among patients with non-melanoma skin cancer who underwent wide excision surgery.

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

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

Kératoacanthomes sur tatouages récents : deux cas

Increasing numbers of reports of rapidly arising, isolated or eruptive keratoacanthomas (KA) and squamous cell carcinomas (CSC) on the red part of tattoos tend to suggest a non-fortuitous link with the procedure. We report herein two different presentations of KAs on tattoos: one patient with multiple eruptive KAs on sun-exposed areas of a recent red tattoo and another with a solitary lesion on a recent tattoo. We discuss the issues related to the distinction between KAs and CSCs in this particular context. Case No. 1: A 55-year-old heavily tattooed man presented multiple round keratotic verrucous-like lesions restricted to a red tattoo. The tattoo had been performed by a professional tattooist in summer 2016, a week before the onset of the symptoms. The patient did not protect a part of his tattoo from sun-exposure during the healing phase and lesions developed only on the sun-exposed tattooed parts. In January 2017, he consulted with about ten lesions. The histologic study by shaving of a lesion militated in favor of a CSC, KA type. The physical examination was unremarkable. He had no previous history of skin cancer. Two weeks later, most of the lesions regressed spontaneously. Based on the clinical history and progression of the lesions, a diagnosis was made of eruptive KA on a red tattoo. Residual lesions were treated by cryotherapy or excision. Case No. 2: A 72-year-old woman developed a 1-cm painful dome-shaped nodule with a central crust three weeks after tattooing. Full excision confirmed the diagnosis of KA. To date, we have found 31 case reports and series (17 men, median age: 50.5 years) of KA and CSC on tattoos. Lesions usually develop rapidly after completion of the tattoo, after between one week and several months. Exceptional cases have been described in old tattoos. Red tattoo ink is most commonly the culprit. The main difficulty lies in distinguishing between KA and CSC. Nowadays pathologists agree that a KA should be considered as a variant of CSC. Eruptive forms of KA present a peculiar situation. They may sometimes be inherited, and KA on recent traumatized areas or drug-induced have been described. Like other authors, we believe that cases of CSC on red tattoos belong rather to the KA type. The physiopathogenesis of tattoo-associated eruptive KA and CSC is not clearly understood, but could be multifactorial, involving: the trauma induced by tattooing, local inflammatory reaction, a component of the red ink, external factors such UV exposure, and a possible genetic predisposition. Rapidly arising KA and eruptive KA on top of recent (red) tattoos are not fortuitous. The lesions should be excised and the patient monitored. Additional studies on tumor specimens are warranted to identify the possible causative agents in tattoo ink that may be responsible for such reactions.

Skin disorders in renal transplant recipients: a retrospective study.

BackgroundImmunosuppressive therapy, which is necessary to avoid graft rejection in renal transplant recipients, presents an increased risk of several pathologies, namely infectious and neoplastic.ObjectivesTo identify the most frequent skin diseases and their clinical and demographical risk factors within a population of renal transplant recipients.MethodsA retrospective study of renal transplant recipients referred to dermatology visit and observed for the first time from January 2008 to December 2014.ResultsThe study included 197 patients, 120 men (60,9%). Mean age was 50,7 years (±13,4). 12 patients (6,1%) had previous skin cancer. Infections were the most frequent reason of referral (93/197; 44%). From the total referred, 18,3% (36/197) presented pre-cancerous lesions. Malignancy was diagnosed in 36 patients (18,3%), with 29 non-melanoma skin cancers (14,7%) and 7 Kaposi sarcomas (3,6%). Ratio of basal cell carcinoma to squamous cell carcinoma was 1,1:1. Non-melanoma skin cancer was significantly associated with older age (p = 0,002), male gender (p = 0,028), history of previous skin cancer (p = 0,002) and higher duration of immunosuppressive therapy (p<0,001).Study limitationsRetrospective study, with data from the first visit in dermatology. We didn't made classification on skin-types.ConclusionsThe great incidence of cutaneous infections and skin cancer is responsible for a significant morbidity. It is important to assure the regular dermatological follow-up of renal transplant recipients, which will promote the prevention, an early diagnosis and an efficient treatment.

Focal Cutaneous Squamous Cell Carcinoma Following Radium-223 Extravasation

Long-term sequelae due to extravasation of intravenous radioisotopes resulting in radiation injuries are rarely reported. As the use of radioactive isotopes for the treatment of osteoblastic metastases increases, information regarding the prevention, treatment, and long-term monitoring of suspected extravasation injury will become increasingly important. We present a patient with no previous history of skin cancer who developed an aggressive cutaneous squamous cell carcinoma at the site of prior radium-223 extravasation. We recommend that patients who experience extravasation of therapeutic radioisotopes be monitored by dermatologists for long-term sequelae. Cutaneous squamous cell carcinoma should be recognized as a rare but potential adverse event following cutaneous extravasation of radium-223 and is likely a side effect that is severely underreported.

Advancing Survivors’ Knowledge (ASK) about skin cancer study: A randomized intervention within the Childhood Cancer Survivor Study (CCSS).

255 Background: Adult survivors of childhood cancer who received radiation therapy have high rates of basal cell carcinoma and melanoma compared with the general population. Both the National Cancer Institute and Children’s Oncology Group Guidelines recommend regular skin self-checks and annual clinical skin exams for survivors. The ongoing ASK randomized intervention trial aims to identify strategies, including use of mobile health technology, which may improve early detection practices. Methods: Participants previously treated with radiation and had no previous history of skin cancer were identified, and eligible participants are currently being enrolled. 800 participants are being randomized into: (1) patient activation and education (PAE) including targeted print and web-based materials and monthly text messages prompting skin checks and driving participants to the ASK website; (2) PAE + physician activation (PAE + MD) adding targeted physician activation/educational materials about survivors’ increased skin cancer risk and recommendations for conducting full-body skin examinations; (3) PAE + MD + teledermoscopy (PAE + MD +TD). The TD group receives a dermatoscope that attaches to their smartphone to photograph suspect moles for review by the study dermatologist. Results: To date, 1,302 survivors are eligible. In the first five months of recruitment, 80% of the initial 400 eligible participants have responded to the study invitation and 248 participants (62%) have enrolled. Twenty-six percent of participants have visited the website and 12 images of suspicious moles have been submitted for review. Completion of recruitment is anticipated by spring 2016. Conclusions: The ASK study addresses screening barriers by providing educational and motivational information for both survivors and physicians on the value of regular and thorough skin examinations. It also determines whether use of innovative mobile health technology activates survivors to conduct skin self-examinations, request physician examinations, and obtain treatment when worrisome lesions are found. Clinical trial information: NCT 02046811.

Black Tea Consumption and Risk of Skin Cancer: An 11-Year Prospective Study

Tea consumption has been shown to protect against skin carcinogenesis in laboratory-based studies; however, epidemiological evidence is limited and inconsistent. This prospective study examined the association between black tea consumption and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Usual black tea consumption was estimated from food frequency questionnaires completed in 1992, 1994, and 1996 by 1,325 Australian adults. All histologically confirmed skin cancers diagnosed in participants from 1997 to 2007 were recorded. Relative risks (RRs) and 95% confidence intervals (CIs) were assessed using generalized linear models with Poisson and negative binomial distributions and adjusted for confounding factors including skin phenotype and sun exposure. Compared with never drinking black tea, drinking ≥4 cups/day was not associated with BCC (RR = 1.03, 95% CI: 0.70–1.53; P-trend = 0.74) or SCC (RR = 1.25, 95% CI: 0.71–2.19; P-trend = 0.29) in person-based analyses. Stratification by previous history of skin cancer as well as tumor-based analyses also showed no significant associations between black tea intake and incidence of BCC or SCC tumors. Our results do not support the hypothesis that high black tea consumption reduces risk of skin cancer, including in people with a previous history of skin cancer.

Risk of second primary malignancies following a diagnosis of cutaneous malignant melanoma or nonmelanoma skin cancer in Alberta, Canada from 1979 to 2009

Recent studies have revealed geographical variations with respect to the risk of second primary malignancies (SPMs) following cutaneous malignant melanoma (CMM) and nonmelanoma skin cancer (NMSC). To provide the largest analysis of the risk of SPM following skin cancers in Canada and to detect associations that may shed light on common pathogeneses between linked malignancies. Relative risks for development of SPMs following a diagnosis of CMM or NMSC were calculated via a retrospective analysis of data retrieved from the Alberta Cancer Registry (ACR) from 1979 to 2009. From 1979 to 2009, 85,967 NMSC and 6884 CMM incident cases were recorded in the ACR. In total 19,869 SPMs were identified following a primary NMSC (7709 cutaneous and 12,160 noncutaneous), while 1437 SPMs (908 cutaneous and 529 noncutaneous) followed CMM. Patients with a previous history of skin cancer had a 60% increased risk of developing an SPM compared with those without [observed/expected ratio (O/E) 1.6, 95% confidence interval (CI) 1.6-1.7; P < 0.001]. Thirty and 10 different SPMs were significantly identified to follow a diagnosis of NMSC and CMM, respectively. Patients under the age of 40 years with a prior history of CMM had a marked increased expectancy for SPM [O/E 5.6, 95% CI 4.5-7.0; P < 0.001). Further studies are warranted to identify environmental and molecular connections among linked cutaneous and noncutaneous malignancies, which may lead to earlier detection of related neoplasms via expanded screening protocols and development of shared treatment regimens. Heightened surveillance for the development of SPMs in patients with CMM under the age of 40 years should be considered.

CONHECIMENTO SOBRE CANCRO DE PELE E HÁBITOS DE FOTOPROTEÇÃO EM TRANSPLANTADOS: ESTUDO DESCRITIVO DE 127 DOENTES COM TRANSPLANTE RENAL

Introdução: Os doentes transplantados têm maior risco de neoplasias cutâneas e a exposição à radiação ultravioleta é o maior fator de risco. Os objetivos deste estudo foram averiguar as medidas de fotoproteção utiliza- das e o conhecimento sobre o maior risco de cancro cutâneo. Material e métodos: estudo descritivo dos doentes referenciados à nossa consulta de Dermatologia para transplantados, observados pela primeira vez no período de Julho de 2010 a Dezembro de 2011. Os dados foram obtidos através de inquérito e os dados analisados com nível de significância de 5%. Resultados: 127 doentes foram incluídos no estudo, 67% dos quais do sexo masculino e a média de idades foi 53 anos (s= 12,98). O número médio de anos de escolaridade foi 8 (s=4,7). O conhecimento do maior risco de cancro cutâneo em transplantados estava presente em 70% dos doentes e o uso regular de protetor solar foi referido por 22%. A observação por dermatologista no primeiro ano após o transplante foi reportada por 8%. Na análise estatística, o conhecimento sobre o risco aumentado de neoplasias cutâneas esteve significativamente associado a maior número de anos de escolaridade e ter sido observado por dermatologista após o transplante. O uso de protetor solar esteve significativamente associado ao sexo feminino e a história prévia de cancro de pele. Conclusões: os doentes transplantados são raramente observados por dermatologista após o transplante e as medi- das de fotoproteção são referidas por apenas uma minoria. Estes doentes beneficiam de uma observação dermato- lógica regular após o transplante em consultas especializadas.PALAVRAS-CHAVE – Fotoproteção; Transplantação renal; Neoplasias da pele.

Skin care in solid organ transplant recipients: risk-adjusted follow-up

Solid organ transplant recipients (SOTRs) have an increased risk of skin cancer due to their long-term immunosuppressed state. These patients should benefit from pre- and post-transplant screening and management of skin cancer by a dermatologist. The frequency of the dermatological consultations mainly depends on the previous history of skin cancer and this will be discussed in detail. In addition to cancer screening and management, dermatological consultations serve to educate and enforce patients’ sun-protective behavior. Indeed, SOTRs are very sensitive to sun damage due to their immunosuppressed state, leading to cumulative sun damage and numerous in situ epithelial lesions termed ‘field cancerization’, which are large areas with increased carcinogenesis. Lesions should be recognized and treated as early as possible using therapeutic options ranging from topical therapy and surgical management to the adjustment of the patient’s immunosuppressive therapy and chemoprevention. Therefore, dermatological f...

Association of Tea Consumption and Cutaneous Squamous Cell Carcinoma

Laboratory and epidemiologic studies suggest a protective effect of tea consumption on risk of cutaneous squamous cell carcinoma (SCC). We designed a case-control study to examine the association between putative protective exposures, including tea consumption, and SCC risk using a large health maintenance organization population. Cases (n = 415) were defined as Kaiser Permanente Northern California (KPNC) members with a pathology-verified SCC in 2004 and controls (n = 415) were age-, gender-, and race-matched members with no previous history of skin cancer. Tea consumption and SCC risk factors were ascertained by questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression to estimate the association of SCC with regular use, as well as dose and duration of tea consumption. Risk factor adjusted models included education, smoking, hair and eye color, skin type, family history of skin cancer, and history of freckling, sunburns, sun exposure, and tanning bed use. Adjusted analyses showed no reduction in SCC risk with regular consumption of tea (OR = 1.11, 95% CI: 0.81–1.54). Examining duration, dose, and combined duration and dose exposure variables did not alter findings. We found no evidence that tea consumption was associated with cutaneous SCC risk.

A Randomized, Double-Blind, Placebo-Controlled Phase 3 Skin Cancer Prevention Study of α-Difluoromethylornithine in Subjects with Previous History of Skin Cancer

AbstractPreclinical studies have shown that the inhibition of ornithine decarboxylase (ODC) by α-difluoromethylornithine (DFMO) and resultant decreases in tissue concentrations of polyamines (putrescine and spermidine) prevents neoplastic developments in many tissue types. Clinical studies of oral DFMO at 500 mg/m2/day revealed it to be safe and tolerable and resulted in significant inhibition of phorbol ester–induced skin ODC activity. Two hundred and ninety-one participants (mean age, 61 years; 60% male) with a history of prior nonmelanoma skin cancer (NMSC; mean, 4.5 skin cancers) were randomized to oral DFMO (500 mg/m2/day) or placebo for 4 to 5 years. There was a trend toward a history of more prior skin cancers in subjects randomized to placebo, but all other characteristics including sunscreen and nonsteroidal anti-inflammatory drug use were evenly distributed. Evaluation of 1,200 person-years of follow-up revealed a new NMSC rate of 0.5 events/person/year. The primary end point, new NMSCs, was not significantly different between subjects taking DFMO and placebo (260 versus 363 cancers, P = 0.069, two-sample t test). Evaluation of basal cell (BCC) and squamous cell cancers separately revealed very little difference in squamous cell cancer between treatment groups but a significant difference in new BCC (DFMO, 163 cancers; placebo, 243 cancers; expressed as event rate of 0.28 BCC/person/year versus 0.40 BCC/person/year, P = 0.03). Compliance with DFMO was &amp;gt;90% and it seemed to be well tolerated with evidence of mild ototoxicity as measured by serial audiometric examination when compared with placebo subjects. The analysis of normal skin biopsies revealed a significant (P &amp;lt; 0.05) decrease in 12-0-tetradecanoylphorbol-13-acetate–induced ODC activity (month 24, 36, and 48) and putrescine concentration (month 24 and 36 only) in DFMO subjects. Subjects with a history of skin cancer taking daily DFMO had an insignificant reduction (P = 0.069) in new NMSC that was predominantly due to a marked reduction in new BCC. Based on these data, the potential of DFMO, alone or in combination, to prevent skin cancers should be explored further. Cancer Prev Res; 3(1); 35–47