Risk Of Skin Cancer Research Articles

Risks of Multiple Skin Cancers in Organ Transplant Recipients

There are limited reports on the risks of multiple primary skin cancers in organ transplant recipients (OTRs). To determine the risks over time and risk factors for OTRs developing (1) any skin cancer posttransplant, (2) a subsequent skin cancer after the first posttransplant skin cancer in the data sets used in the study, and (3) 10 or more skin cancers. This retrospective cohort study used data from Optum deidentified electronic health record data set (7.7 million patients) and Truven Health MarketScan insurance claims data set (161 million patients) from 2007 to 2017. Skin cancers were identified using diagnosis plus treatment codes for basal cell carcinoma, squamous cell carcinoma, and melanoma; OTRs were identified using 4 or more diagnosis codes for organ transplant. Data analysis took place from January 1, 2007, to December 31, 2017. Cumulative risks of (1) any skin cancer treatment posttransplant, (2) a subsequent skin cancer treatment after the first posttransplant skin cancer treatment in our data, and (3) 10 or more skin cancer treatments in OTRs. A Wei-Lin-Weissfeld marginal model was used to evaluate risk factors for any skin cancer. A total of 7390 OTRs in Optum and 133 651 in MarketScan were identified, 4.5% and 13.3% of which had had at least 1 skin cancer treatment, respectively. At 2 years after the initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments. Statistically significant risk factors for any skin cancer included age, history of skin cancer, and history of actinic keratosis in both data sets, and male sex and thoracic transplant in MarketScan. In this retrospective cohort study, approximately half of the OTRs who developed at least 1 posttransplant skin cancer developed a subsequent skin cancer within 2 years, and approximately 1 in 20 developed 10 or more skin cancers. Identifying OTRs at highest risk for multiple primary skin cancers may help target strategies for prevention and early detection.

Research progress on the mechanism of wound skin dys- pigmentation after burns

Burn wound healing often shows a certain degree of pigmentation disorder. It may not only cause cosmetic and psychological issues affecting patient's normal social activities, but also increase risk of skin cancer or photoaging. Although normal skin pigmentation is fairly well studied, the mechanism that leads to dyspigmentation after burn injury needs to be further explored. Based on summarizing the mechanism of normal skin pigmentation, this paper reviews the latest research progress in postburn dyspigmentation in recent years.

Two shades of malignancy in a psoriatic patient

Psoriasis is a chronic inflammation of the skin, affecting approx. 120 million people worldwide. The risk of developing skin cancer in psoriatic patients has been stressed, although with a significant amount of conflicting data in the literature. The most consistent findings suggest that psoriatic patients are at an increased risk of non-melanoma skin cancer. An increased risk of melanoma has not been well established. Herein, we report the case of a patient with a history of pustular psoriasis present since the age of ten, who developed an SCC and a melanoma, and discuss the etiopathology of this association.

Sunlight Exposure and Phototherapy: Perspectives for Healthy Aging in an Era of COVID-19.

Most humans depend on sunlight exposure to satisfy their requirements for vitamin D3. However, the destruction of the ozone layer in the past few decades has increased the risk of skin aging and wrinkling caused by excessive exposure to ultraviolet (UV) radiation, which may also promote the risk of skin cancer development. The promotion of public health recommendations to avoid sunlight exposure would reduce the risk of skin cancer, but it would also enhance the risk of vitamin D3 insufficiency/deficiency, which may cause disease development and progression. In addition, the ongoing global COVID-19 pandemic may further reduce sunlight exposure due to stay-at-home policies, resulting in difficulty in active and healthy aging. In this review article, we performed a literature search in PubMed and provided an overview of basic and clinical data regarding the impact of sunlight exposure and vitamin D3 on public health. We also discuss the potential mechanisms and clinical value of phototherapy with a full-spectrum light (notably blue, red, and near-infrared light) as an alternative to sunlight exposure, which may contribute to combating COVID-19 and promoting active and healthy aging in current aged/superaged societies.

Common filaggrin gene loss-of-function variants are associated with skin cancer risk

To the Editor: FLG encodes a protein that maintains the epidermal barrier while also functioning as an endogenous sunscreen and moisturizer.1 FLG loss-of-function (LOF) variants are a major cause of ichthyosis vulgaris and atopic diseases. People with FLG LOF variants have decreased epidermal FLG expression, resulting in functional compromise of the skin barrier.2 The compromised endogenous sunscreen effect, resulting from FLG LOF mutations, promotes greater penetration of ultraviolet (UV) radiation.

Vitiligo: 30years to put together the puzzle pieces and to give rise to a new era of therapeutic options.

Vitiligo: 30years to put together the puzzle pieces and to give rise to a new era of therapeutic options.

Ageing research: rethinking primary prevention of skin cancer.

Ageing research: rethinking primary prevention of skin cancer.

Reduced risk of skin cancer and internal malignancies in vitiligo patients: a retrospective population-based cohort study in Taiwan

The relationship between cancer and vitiligo has been explored but with inconsistent results. To examine the long-term cancer risk in vitiligo patients, we conducted a retrospective nationwide cohort study. From the National Health Insurance Research Database of Taiwan, a total of 13,824 vitiligo patients were identified and matched with 55,296 reference subjects without vitiligo by age, gender, and propensity score estimated by major comorbidities from 1997 to 2013. Demographic characteristics and comorbidities were compared between these two groups. Incidence rate ratios and hazard ratios (HRs) were calculated to examine cancer risks. The 16-year incidence rates of overall cancers were 621.06 (566.56–675.55) and 726.99 (697.24–756.74) per 100,000 person-years in the vitiligo and reference groups. Patients with vitiligo showed a significantly decreased risk of overall cancers [adjusted HR, 0.85; 95% confidence interval (CI), 0.77 to 0.93, p < 0.001] compared with reference subjects without vitiligo after adjusting for age, sex, comorbidities, and treatments. The risks of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were significantly reduced (adjusted HR 0.21, 95% CI 0.11–0.38, p < 0.001), as well as internal malignancies (adjusted HR 0.89, 95% CI 0.81–0.99, p = 0.026). The results were consistent across different subgroups of patients, including male gender, ages more than 40 years, and those receiving long-term systemic disease-modifying antirheumatic drugs and phototherapies. Information related to phenotype, disease duration, vitiligo lesion sites, family history of vitiligo or cancer, occupation, and personal lifestyle was not included in the database. Vitiligo is associated with reduced risks of BCC and SCC, as well as internal malignancies.

Interventions to Increase Sunscreen Use in Adults: A Review of the Literature.

Skin cancers are the most common malignancy in Australia. Regular sunscreen use can reduce the incidence of cutaneous squamous cell carcinomas and actinic keratoses and has been associated with reducing the incidence of basal cell carcinomas and melanomas. However, sunscreen effectiveness is limited by the failure of the population to use it routinely. Interventions that promote the daily application of sunscreen may reduce the morbidity, mortality, and economic burden associated with skin malignancies. We reviewed the literature that examines the effectiveness of interventions to increase routine sunscreen use and found that no one strategy has been shown to be clearly effective in adults and that relatively few studies have aimed to increase routine use in groups at extreme skin cancer risk. Future research should consider how interventions can be best designed and how sunscreen use is measured so that cost-effective, feasible strategies that result in improved sunscreen use in adults can be established.

Cancer Risk in a Large Inception Systemic Lupus Erythematosus Cohort: Effects of Demographic Characteristics, Smoking, and Medications.

To assess cancer risk factors in incident systemic lupus erythematosus (SLE). Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (overall risk and most common cancers) included demographic characteristics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and the adjusted mean Systemic Lupus Erythematosus Disease Activity Index 2000 score. Among 1,668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 nonmelanoma skin, 7 lung, 6 hematologic, 6 prostate, 5 melanoma, 3 cervical, 3 renal, 2 each gastric, head and neck, and thyroid, and 1 each rectal, sarcoma, thymoma, and uterine cancers. Half of the cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated that overall cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively associated and antimalarial drugs were negatively associated. Antimalarial drugs and higher disease activity were also negatively associated with nonmelanoma skin cancer risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with nonmelanoma skin cancer risk. Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and nonmelanoma skin cancer. Antimalarials were negatively associated with breast cancer and nonmelanoma skin cancer risk. SLE activity was associated positively with hematologic cancer and negatively with nonmelanoma skin cancer. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.

955 Management of A Progressed SCC Case in the COVID-19 Era

Abstract We herein report the case of an elderly patient who underwent amputation of their hand for a squamous cell carcinoma (SCC) due to lack of timely treatment during the COVID-19 pandemic. The patient had a biopsy-proven SCC of the dorsum of their left hand, first diagnosed in March 2020, before the first lockdown. The lesion was 3cm, mobile, easily excisable, and the defect routinely reconstructable. Unfortunately, a number of appointments were missed and when the patient was eventually seen back in the clinic, the lesion was bigger and firmly fixed to the deeper structures. An urgent wide excision of the lesion with split skin graft reconstruction was planned. Intraoperatively, axillary lymph nodes were identified and a FNAB reported metastatic disease. After a failed attempt to fully resect the hand lesion and salvage the surrounding structures, a joint consultant decision was made that an amputation would give the patient the best chance of survival. Since the patient was lacking capacity, and following a discussion with the family, an above wrist amputation was performed in the patient’s best interests. This case sheds light on the unseen and unrecorded victims of COVID-19. Due to the pandemic, most outpatient follow-up appointments were cancelled, and operating waiting times were significantly increased. National research studies showed that all skin cancer treatments were negatively affected by the COVID-19 pandemic. During this lockdown, there is an urgent need to continue the provision of these services as the risk of untreated skin cancer is even greater.

Testing Multi-Theory Model (MTM) in Explaining Sunscreen Use among Florida Residents: An Integrative Approach for Sun Protection.

Florida residents have the second highest incidence of skin cancer in the nation. Sunscreen usage was found to be the one of the most effective integrative health approaches for reducing risk of skin cancer. Given the limited information on the likelihood of adopting and continuing sunscreen usage behavior, this cross-sectional study aimed to examine the correlates of initiating and sustaining sunscreen usage behavior among Florida dwellers, using the fourth-generation, multi-theory model (MTM) of behavior change. A web-based survey containing 51 questions was emailed to Florida residents aged 18 years or above, who were randomly selected from the state voter file. Psychometric validity of the survey instrument was established using structural equation modeling, and Cronbach’s alpha values were calculated for assessing the internal consistency. An independent-samples-t-test and hierarchical multiple regression tests were used to analyze the data. The results indicated that participants who engaged in sunscreen usage behavior, participatory dialogue (β = 0.062, p < 0.05), behavioral confidence (β = 0.636, p < 0.001), and changes in the physical environment (β = 0.210, p < 0.001) were statistically significant and accounted for 73.6% of the variance in initiating sunscreen usage behavior. In addition, the constructs of emotional transformation (β = 0.486, p < 0.001) and practice for change (β = 0.211, p < 0.001), as well as changes in the social environment (β = 0.148, p < 0.001) were significant predictors of maintaining sunscreen usage behavior and contributed to 59% of variance in sustenance. These findings offer a valuable insight regarding the applicability of MTM models to guiding public health interventions promoting sunscreen usage and preventing UV radiation risk and related skin cancer.

Impact of COVID-19 on dermatologic surgery: experience of a Midwestern academic practice.

The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted clinical practice everywhere. The aim of this study was to quantify the specific impact of COVID-19 on skin cancer treatment at an academic dermatologic surgery practice. We conducted a retrospective chart review to compare metrics such as patient visits, histological upgrading, and Mohs stages per tumor between 60-day periods immediately before and after COVID-19 was declared a pandemic. Out of 1138 total encounters, decreases of 58% in total in-person visits and 38% in Mohs surgeries performed were observed following declaration of the pandemic. More squamous cell carcinoma and squamous cell carcinoma in situ (SCC/SCCIS) and less basal cell carcinoma (BCC) tumors were treated post-declaration compared to pre-declaration. There was a significantly higher histological upgrade rate for total tumors, as well as for the BCC subgroup, but not the SCC/SCCIS subgroup. While the overall number of dermatologic surgeries decreased after declaration of the pandemic, the higher histological upgrade rate reflects an appropriate triage of higher risk skin cancers. These findings may be useful both to assess the effectiveness of protocols for COVID-19 and to prepare for future resource-limited scenarios.

Anti-inflammatory therapy in ischaemic heart disease: from canakinumab to colchicine.

Four large trials have recently evaluated the effects of anti-inflammatory drugs in the secondary prevention of major cardiovascular events (MACE) in over 25 000 patients followed for 1.9–3.7 years. CANTOS tested subcutaneous canakinumab [an anti-interleukin (IL) 1β antibody] 300 mg every 3 months against placebo in patients with a history of myocardial infarction (MI) and serum C-reactive protein (CRP) >2 mg/L, demonstrating efficacy in preventing MACE but increased rates of fatal infections. COLCOT (in patients with recent MI) and LoDoCo2 (in patients with chronic coronary syndromes) tested oral colchicine (an NLRP3 inflammasome inhibitor) 0.5 mg daily vs. placebo, demonstrating prevention of MACE with a slightly increased risk of pneumonia in COLCOT (0.9 vs. 0.4%) but not in LoDoCo2. CIRT tested oral methotrexate (an anti-rheumatic anti-nuclear factor-kB) 15–20 mg per week against placebo in ischaemic heart disease patients with diabetes or metabolic syndrome, without significant reduction in MACE rates or in circulating IL6 or CRP levels, and with increased risk of skin cancers. In summary, canakinumab and colchicine have shown efficacy in preventing MACE in ischaemic heart disease patients, but only colchicine has acceptable safety (and cost) for use in secondary cardiovascular prevention. Clinical results are expected with the anti-IL6 ziltivekimab.

Tre-O1-01 - Characteristics, management and course of mycosis fungoides in solid organ transplant recipients: a retrospective cohort from two cutaneous lymphoma outpatient clinics

<h3>Background:</h3> Primary cutaneous lymphoproliferative disorders in solid organ recipients are rare. Reports of mycosis fungoides (MF) diagnosed in these patients are limited to less than 30 cases, with a heterogeneous disease course. Furthermore, management in terms of type and modulation of the preceding immunosuppressive treatments after MF diagnosis was not uniform. <h3>Objective:</h3> To report the characteristics of MF, treatment response, disease course, and status of immunosuppressive therapy in patients who are solid organ recipients, or under similar immunosuppression. <h3>Methods:</h3> The medical files were retrospectively reviewed for all solid organ transplant patients/patients who are under similar immunosuppression for other indications, who were also diagnosed with MF, and were followed at the cutaneous lymphoma outpatient clinics of 2 tertiary medical centers from 1/2010 to 12/2020. <h3>Results:</h3> The cohort included 11 patients (8 male; median age at organ transplantation/immunosuppressive state, 33 years). Transplanted organs involved the liver (n=5), kidney (n=3), liver and kidney (n=1), or heart (n=1). Patients were treated with mycophenolic acid, tacrolimus, and prednisone (n=5) or tacrolimus (n=5). One patient with nephrotic syndrome received cyclosporine. Median age at diagnosis of MF was 48 years, 45% were diagnosed before the age of 18 years, median time from organ transplantation/immunosuppressive state to diagnosis of MF was 8 years (range 0.5–22 years). Ten patients had early stage, (IA, 5; IB, 5), 50% of whom had early folliculotropic MF (FMF), (in some combined with classic/hypopigmented MF). One patient had advanced MF (IIIA) with folliculotropic erythroderma. Early-stage patients were treated mainly with skin-directed therapies, achieving either partial (50%) or complete response (50%). The erythrodermic patient achieved partial response after being treated with ultraviolet A and narrow-band ultraviolet B with acitretin. Immunosuppressive treatment was modulated in 4/11 patients, (cyclosporine switched to mycophenolic acid, 1; mycophenolic acid stopped and tacrolimus continued, 1; tacrolimus continued at a lower dose, combined with mycophenolic acid and prednisone, 1; tacrolimus stopped, 1). Median time of follow-up was 4 years (range 1–8 years), with no stage progression noted. At the last visit, 6 had no evidence of disease, and 5 had active disease (IA, 4; III, 1). <h3>Conclusions:</h3> Most solid organ recipient MF patients present with early-stage disease, similar to MF in the general population, with over representation of FMF, and over representation among children. Treatment is challenging due to the notorious higher risk of non-melanoma skin cancer in organ transplant recipients. Furthermore, immunosuppressive therapy modifications to improve MF should be balanced against the risk of solid organ rejection. Response to treatment and course do not seem to differ from MF in the general population, although longer follow-up is needed.

Randomized controlled trial of fractionated laser resurfacing on aged skin as prophylaxis against actinic neoplasia.

BACKGROUNDThe loss of insulin-like growth factor 1 (IGF-1) expression in senescent dermal fibroblasts during aging is associated with an increased risk of nonmelanoma skin cancer (NMSC). We tested how IGF-1 signaling can influence photocarcinogenesis during chronic UVB exposure to determine if fractionated laser resurfacing (FLR) of aged skin, which upregulates dermal IGF-1 levels, can prevent the occurrence of actinic keratosis (AK) and NMSC.METHODSA human skin/immunodeficient mouse xenografting model was used to test the effects of a small molecule inhibitor of the IGF-1 receptor on chronic UVB radiation. Subsequently, the durability of FLR treatment was tested on a cohort of human participants aged 65 years and older. Finally, 48 individuals aged 60 years and older with considerable actinic damage were enrolled in a prospective randomized clinical trial in which they underwent a single unilateral FLR treatment of one lower arm. Numbers of AKs/NMSCs were recorded on both extremities for up to 36 months in blinded fashion.RESULTSXenografting studies revealed that chronic UVB treatment with a topical IGF-1R inhibitor resulted in a procarcinogenic response. A single FLR treatment was durable in restoring appropriate UVB response in geriatric skin for at least 2 years. FLR resulted in sustained reduction in numbers of AKs and decreased numbers of NMSCs in the treated arm (2 NMSCs) versus the untreated arm (24 NMSCs).CONCLUSIONThe elimination of senescent fibroblasts via FLR reduced the procarcinogenic UVB response of aged skin. Thus, wounding therapies are a potentially effective prophylaxis for managing high-risk populations.TRIAL REGISTRATIONClinicalTrials.gov (NCT03906253).FUNDINGNational Institutes of Health, Veterans Administration.

The effect of menopausal hormone therapy on melanoma and keratinocyte skin cancer risk: a systematic review and meta-analysis of observational studies

Background:The association between menopausal hormone therapy (MHT) and increased risk of specific neoplasms, such as breast cancer, has been extensively evaluated. However, whether MHT is also associated with increased risk of skin cancer is far less documented, with studies yielding conflicting results.

“Repeatability of Repeatability”: the stability of self‐reported melanoma risk factors in two independent samples

ObjectiveTo determine the test‐retest repeatability of a self‐completed survey with items capturing skin cancer risk factors. MethodsWe invited 238 randomly selected participants of the QSkin II cohort to complete the baseline survey a second time. Responses were compared using kappa statistics and intraclass correlation coefficients to quantify agreement for categorical and continuous variables, respectively. We compared the performance of key items with that observed in an earlier repeatability study using the same survey instrument in an independent cohort. ResultsMeasures of phenotypic characteristics had moderate to almost‐perfect test‐retest repeatability (e.g. eye colour weighted kappa (κw) = 0.87, 95% confidence interval [CI]: 0.81, 0.92). Items measuring sun exposure showed lower agreement (κw range 0.36‐0.54) compared with phenotypic characteristics (κw range 0.59‐0.87). Items relating to treatment of skin cancers demonstrated almost‐perfect test‐retest repeatability (e.g. excisions for skin cancers κw 0.85, 95%CI: 0.80, 0.89). In aggregate, the repeatability of key items was very similar across the two independent repeatability samples. ConclusionFair to almost‐perfect repeatability for self‐reported skin cancer risk factors was robust across independent and temporally distant cohorts. Implications for public healthThese self‐assessed risk factors for skin cancer are repeatable and suitable for use in clinical practice and research.

Changes in sun protection behaviours, sun exposure and shade availability among adults, children and adolescents in New South Wales, 2003–2016

ObjectiveTo inform skin cancer prevention policies and campaigns, we investigated changes over time in sun protection behaviours, sunburn, sun exposure and shade availability in public spaces among people living in New South Wales (NSW), Australia, between 2003 and 2016. MethodsWe analysed cross‐sectional data from the NSW Population Health Survey collected in 2003, 2007, 2014 and 2016, which included approximately 15,000 respondents of all ages in each year. Logistic regression models were used to analyse overall changes over time and for different age, sex and sociodemographic groups. ResultsThe use of sunscreen and protective clothing and the availability of shade increased between 2003 and 2016, but sunburn and sun exposure during peak times of ultraviolet radiation also increased. In subgroup analyses, there was no improvement in sun protection behaviours among adolescents and increases in sunburn and sun exposure were observed only among adults, particularly women and in areas with less social disadvantage. ConclusionsSun protection behaviours have improved over time among some population subgroups, but over‐exposure to ultraviolet radiation remains prevalent. Implications for public healthSkin cancer prevention initiatives that specifically target adolescents and sun exposure during peak times are needed to help reduce population skin cancer risk.

Tirbanibulin: A New Topical Therapy for Actinic Keratoses With a Novel Mechanism of Action and Improved Ease of Use.

Tirbanibulin: A New Topical Therapy for Actinic Keratoses With a Novel Mechanism of Action and Improved Ease of Use.