Secondary Prevention Of Skin Cancer Research Articles

Health Economic Consequences Associated With COVID-19–Related Delay in Melanoma Diagnosis in Europe

The COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet. To determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe. This multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022. COVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks. Primary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure. There were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were $7.65 (range, $3.60 to $20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario. This economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma.

The role of community pharmacists in primary and secondary prevention of skin cancer: an evaluation of a Flemish skin cancer prevention campaign

BackgroundSkin cancer is a leading form of cancer in Belgium. Prevention of skin cancer by community pharmacists can play a role in increasing awareness and promoting sun protection. However, which persons could be reached by community pharmacists for skin cancer awareness in Belgium and whether this increased awareness is associated with increased sun protection and early detection remains unclear.MethodsDemographics of approached persons in Flemish community pharmacies during the months of May-June 2022 and the content of the skin cancer counseling were retrieved from the pharmacy database. Sunscreen purchases and dermatologist visits were evaluated up to 180 days after the skin cancer counseling.ResultsCommunity pharmacists provided skin cancer counseling to a broad population of visitors (n = 822, 69% females, median age of 59 years Q1-Q3: 44–71 years). During the campaign, 822 visitors received a leaflet with skin cancer prevalence and sunscreen importance. On top of that, 335 visitors (41%) received additional counseling: skin type sensitivity was checked for 198 visitors (24%), typical characteristics of melanoma were discussed with 100 visitors (12%) and 37 visitors (5%) were referred to a physician for further information or concerns regarding a skin spot. Overall, one out of three visitors purchased sunscreen on the day of the counseling (33%, increasing up to 38% after 180 days). Among people under 20 years, this was even higher (51%). Additional counseling increased the likelihood of a dermatologist visit within 180 days (OR = 1.80; 95%CI: 1.12–2.88).ConclusionsBy providing skin cancer counseling in Belgian community pharmacies, a broad range of citizens was reached and triggered to purchase sunscreen, often on the same day as the counseling. Notably, young people were likely to purchase sunscreen. Citizens receiving additional counseling were more likely to visit a dermatologist within 180 days.

PD07 Sun exposure and associated risks in 17 countries: UK results

Abstract Primary and secondary prevention of skin cancer varies considerably from one country to another. This survey investigates knowledge and behaviours regarding sun exposure in the UK. This UK survey (n = 1000) was conducted online from 28 September to 18 October 2021 and was part of a worldwide survey (n = 17 001) conducted in 17 countries (five continents). Automated selection from the Ipsos online panel ensured samples of 1000 individuals in each country fit the quotas method based on sex, age, employment status and country regions. Data covered demographics, phototype, exposure habits and practices, and knowledge and understanding of risks. The population comprised 49% men [mean (SD) age 46.6 (15.7) years]; 61% were of skin phototypes I–II. Seventy-six per cent of Britons stated that a tanned skin looks attractive vs. 72% worldwide. Seventy per cent of Britons indicated that a tan gives a healthy look, a different perception compared with worldwide (64%). Most Britons were aware of sun-related skin health issues, a better awareness compared with worldwide (94% vs. 88%). Sixty-one per cent did know that sun protection is useful when the weather is overcast, a similar knowledge as worldwide (61%). Furthermore, 15% indicated it was safe to expose themselves without protection when already tanned, a better knowledge than worldwide (23%). In terms of photoprotection, 15% said they protected themselves from the sun all year round, a lower score compared with worldwide (23%). In detail, Britons were more likely to put sunscreen on their face (71% vs. 60%), on their hands, neck and ears (64% vs. 52%), and on the arms, legs and chest (69% vs. 55%) compared with the global population. However, Britons were less likely to try to stay in the shade (73% vs. 77% worldwide) or avoid midday sun exposure (53% vs. 66%). Of those who applied sunscreen, 69% applied it only once or twice a day – a slightly better practice compared with the worldwide average (74%). In terms of knowledge, 71% did not understand the difference between ultraviolet (UV)A and UVB vs. 70% worldwide. Although the risks of sun exposure are widely recognized, sun protection practice is inadequate. This survey provides insight into the need for additional photoprotection education in the UK.

Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial

Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors. We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors' SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating. This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates. The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention's delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others. ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739. DERR1-10.2196/39640.

Discrepancies in Skin Cancer Screening Reporting Among Patients, Primary Care Physicians, and Patient Medical Records.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. The full-body skin examination (FBSE) is the quintessential tool for secondary skin cancer prevention, but the US Preventive Services Task Force (USPSTF) states there is insufficient evidence to recommend the examination for the general or at-risk population. Variable performance of FBSEs among primary care providers (PCPs) is a barrier to accurate studies, and variability in measurement of that performance can be a major impediment to assessment of FBSEs in practice. To better understand the degree of variability, we performed a multicenter, cross-sectional study of FBSEs reported among 53 PCPs and 3343 patients. The results highlight the need for standardization of FBSEs and more rigorous criteria for skin cancer screening.

Association between melanoma thickness and clinical and demographic characteristics.

The large-scale implementation of primary and secondary skin cancer prevention strategies in recent decades has led to an increase in the diagnosis of thin melanomas and a decrease in the mean thickness of tumours diagnosed. The number of newly diagnosed thick melanomas, however, has remained stable. To investigate associations between melanoma thickness, clinical presentation and demographic and phenotypic characteristics. The study is based on a cross-sectional study of 1,459 patients with melanoma from a dermatology department at a tertiary hospital in Spain between 2000 and 2017. We analysed associations between median Breslow thickness and demographic, phenotypic, and clinical characteristics, including the method of melanoma detection. Age ≥70 years (regression coefficient[RC] = 1.2, 95%CI: 1.1-1.3; p < 0.001), male sex (RC = 0.9, 95%CI: 0.8-0.9; p < 0.001), symptom-based detection (RC = 1.3, 95%CI: 1.1-1.4; p < 0.001), and a history of sunburn at the melanoma site (RC = 0.9, 95%CI: 0.8-0.9; p = 0.04) were all associated with thicker tumours. Melanomas on the lower extremities, by contrast, were significantly thinner (RC = 0.9, 95%CI: 0.8-0.9; p= 0.04). Thick melanomas occur preferentially in older men and show changes such as bleeding or an increase in volume or colour. This information should be incorporated into health training and education programs to design better prevention strategies and minimize diagnostic delays.

Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it?: Results of a nationwide survey among participants of skin cancer screening.

Skin cancer screening (SCS) is an important measure for secondary prevention of skin cancer, which is the most common cancer type worldwide. This study aimed to describe patient-reported quality of SCS in Germany according to the specialization of the performing physician and different patient characteristics. Data from 1260 participants 35-65years of age (54.4% female) who underwent SCS and participated in National Cancer Aid Monitoring in 2019 were evaluated using chi-squared tests. Waiting times for SCS from a dermatologist were significantly longer than those for other physicians (31.1 versus [vs.] 15.7days; P<.001). Each body area examined during the standardized inspection was examined significantly more frequently by dermatologists than by other physicians (eg, upper body, 96.6% vs. 91.7%; P<.001). Dermatologists more often offered consultation for skin cancer prevention (74.0% vs. 67.6%; P=.026) and provided written information (47.8% vs. 34.8%; P<.001). Patients with statutory insurance had to pay more frequently for additional services during SCS from a dermatologist than from other physicians (24.7% vs. 17.1%, P=.012). Results of this study revealed differences in the provision of preventive information and the quality of visual examination during SCS between dermatologists and other physicians. These results highlight the need for quality assurance measures.

16137 Temporal trends in primary and secondary skin cancer prevention in the United States

Background: There are an increasing number of public health campaigns addressing skin cancer prevention to combat rising incidence. We analyzed temporal trends in skin cancer prevention behaviors to examine the impact of such campaigns.

A cross-sectional study of skin cancer secondary prevention in rural general practice.

As a result of the lack of evidence ofreduction in mortality, secondary prevention of melanoma and keratinocyte skin cancers (KSCs) with active screening is not recommended except for individuals at high risk. Limited access to medical professionals for diagnosis and specialised treatment of skin cancers are related to poorer health outcomes for Australians living in rural areas. The aim of this study was to evaluate the secondary prevention of skin cancer in general practice. A clinical audit of 317 melanomas and 5463 KSCs was conducted, examining the nature of consultation and stage of cancer at diagnosis. It was more common for an uncomplicated melanoma ≤1 mm in size to be identified by a general practitioner (GP) during a planned whole-body skin examination than to be the presenting complaint found by the patient (χ2 = 4.2, P <0.05). Half (49%) of KSCs found were the presenting complaint, with 21% an incidental diagnosis during another presentation and 30% found during whole-body skin examinations. Half of all squamous cell carcinomas found were at the intra-epidermal stage. Secondary prevention of skin cancer by GPs is a value proposition for rural populations.

Temporal trends in primary and secondary skin cancer prevention in the United States

Temporal trends in primary and secondary skin cancer prevention in the United States

PROGNOSTIC MODEL OF SKIN CANCER RISK ASSESSMENT

Introduction: Early detection of people at risk of skin cancer will reduce the incidence of disease, lower the cost of health technologies and decrease anxiety level in patients. The aim of the work is to create a prognostic model for identifying people at increased risk of skin cancer development. Material and methods: We used the results of our previous research on identifying risk factors in patients with actinic keratosis (AK), squamous cell carcinoma in situ (SCCis) and cutaneous squamous cell carcinoma (cSCC), who were under dynamic observation at the State Institution of Science "Research and Practical Centre of Preventive and Clinical Medicine" State Administrative Department (hereinafter SIS) in 2014-2017. Results: The prognostic model is valid, AUC = 0.97 (95% CI 0.96 - 0.99) showing a significant association of the risk of skin cancer development with the following factors: patient's age, sunburns, using skin sunscreens, exposure to the sun in recent times, exposure to radiological materials, drug administration (antiarrhythmic drugs, antihypertensive medications, hormonal contraceptives, antibiotics), burdened family history (melanoma, squamous cell cancer). Model sensitivity was 95.1% (95% CI 91.6% - 97.4%), specificity - 88.5% (95% CI 84.6% - 91.8%). Conclusions: The developed and analysed mathematical risk prediction system made it possible to identify 11 factors which are significantly associated with risk of skin cancer development. The prognostic model might be offered for specialists in taking decision at the stage of primary and secondary prevention of skin cancer.

Primary and secondary prevention of skin cancer in mountain guides: attitude and motivation for or against participation.

Outdoor professionals such as mountain guides are at a substantial risk of developing non-melanoma skin cancer (NMSC) due to solar ultraviolet radiation (UVR) exposure. Despite major recent primary prevention efforts, studies on secondary skin cancer prevention efforts are limited and corresponding data on outdoor workers scarce. To assess the sun protective behaviour and individual motivations for or against skin cancer screening examinations in the German mountain guide population to aid in the development of effective awareness and prevention strategies. A cross-sectional study among all registered mountain guides in Germany was conducted using a 35-item online questionnaire on primary and secondary prevention of NMSC as well as perceived barriers for prevention. A total of 145 mountain guides participated in the study in January 2017. Of these, 86.2% reported using sunscreen often or always, 62.1% with a sun protection factor (SPF) of 30-50% and 60.7% had undergone dermatological examination by a medical professional. The most common reasons for using secondary prevention efforts were hope of an early diagnosis (77.3%), fear of skin cancer (73.9%) and the intention to be aware of one's own health (70.5%). The main reasons for not doing so were absence of conspicuous skin conditions (63.2%) and feeling healthy (59.6%). Awareness of prevention strategies recommended by the scientific community is low among affected occupationally high-risk mountain guide populations. Understanding the specific needs of this high-risk group is essential for the development of sustainable awareness and prevention strategies.

Recognizing Latinos' range of skin pigment and phototypes to enhance skin cancer prevention.

Latinos in the United States may have the mistaken assumption that their natural pigmentation protects them from developing skin cancer that, effectively, serves as a barrier to Latinos receiving education in primary and secondary prevention of skin cancer. Latino adults of Mexican or Puerto Rican heritage attending community health fairs in the greater Chicago area responded to a culturally informed and sensitive measure for sunburn and tan, which was previously adapted to capture skin irritation with tenderness from the sun occurring in darker skin types (n=350). By self-reported responses and spectrophotometry assessment of constitutive pigmentation, adapted Fitzpatrick skin types (FST) ranged from skin type I-IV in the Mexican American participants and from II to V in the Puerto Rican participants. The objectively measured proportion of adapted FST II skin type was greater than commonly perceived and demonstrated that many Latinos do indeed have sun-sensitive skin.

Public primary and secondary skin cancer prevention, perceptions and knowledge: an international cross-sectional survey.

BackgroundThe incidence of melanoma and non‐melanoma skin cancer is continuing to increase worldwide, with sun exposure serving as the primary external aetiologic force in its development. Despite noticeable public health efforts, there continue to be gaps in public awareness and primary and secondary prevention mechanisms. This survey study sought to investigate preventative behaviours regarding sun exposure and skin cancer detection at an international scale.MethodsA questionnaire was submitted, both online and by telephone, to a representative sample (based on official demographic statistics on gender, age and region) of people aged from 15 to 65 originating from 23 countries. Questions dealt with demographics, sun exposure and protection, risk knowledge, self‐examination, medical advice seeking. Data were then gathered and analysed at different levels.ResultsA total of 19 569 respondents were recruited. Overall, sunscreen and sunglasses were the most used measures for sun protection. There were however difference between countries and geographical areas. Some high‐risk countries in terms of sun exposure (according to their location to Equator) exhibited higher rates of primary preventative behaviours, in particular Australia, Chile and Greece. There were also discrepancies between countries regarding secondary prevention through self‐examination and medical advice seeking. Young people, men, individuals belonging to a lower socio‐economic class or having a lower education level were all least likely to know or follow primary and secondary preventive measures.ConclusionWe found imperfections and geographical inequality both regarding primary and secondary prevention of skin cancer. Our study provides insights that could help to target populations more effectively through information campaigns embedded into the global needed endeavour aiming to reduce mid‐ and long‐term development of skin cancer.

Effects of Creating Awareness Through Photographs and Posters on Skin Self-Examination in Nursing Students.

Nurses can have an influence on primary and secondary prevention of skin cancer. Therefore, it is important to help them acquire knowledge and skills necessary to modify behavior in relation to skin cancers. The aim of this study was to examine effects of creating awareness through photographs and posters on knowledge and skills of skin self-examination in nursing students. The study had a quasi-experimental design with a pretest and a posttest in a single group. The study population included 249 last-year nursing students in Turkey. Non-probability sampling was used to reach the population. The study sample was composed of 201 students volunteering to participate in the study, and the response rate was 81%. Of the students, 85.1% (n = 171) were female and the mean age of the students was 22.18 ± 0.78years. Of the students, 94.5% did not know the asymmetry, border, color, diameter, evolution (ABCDE) criteria on the pretest, but this rate decreased to 20.9% on the posttest. The mean score for knowledge of symptoms of skin cancer was 10.95 ± 1.37 on the pretest and 11.48 ± 0.90 on the posttest. There was a significant linear increase in the scores for knowledge of the symptoms (F = 7.874, p < 0.001) after the intervention with photographs and posters. The students were observed to learn the ABCDE criteria and had increased knowledge of skin cancer symptoms after the intervention using photographs and posters. Photographs and posters are effective tools which can be used to increase awareness of skin self-examination.

Non-melanoma Skin Cancer in Canada Chapter 3: Management of Actinic Keratoses.

Actinic keratosis (AK) and cheilitis (AC) are lesions that develop on photodamaged skin and may progress to form invasive squamous cell carcinomas (SCCs). To provide guidance to Canadian health care practitioners regarding management of AKs and ACs. Literature searches and development of graded recommendations were carried out as discussed in the accompanying introduction (chapter 1 of the NMSC guidelines). Treatment of AKs allows for secondary prevention of skin cancer in sun-damaged skin. Because it is impossible to predict whether a given AK will regress, persist, or progress, AKs should ideally be treated. This chapter discusses options for the management of AKs and ACs. Treatment options include surgical removal, topical treatment, and photodynamic therapy. Combined modalities may be used in case of inadequate response. AKs are particularly common following the long-term immunosuppression in organ transplant patients, who should be monitored frequently to identify emerging lesions that require surgery.

Clinical prediction rule for nonmelanoma skin cancer

Background: Skin cancer is the most frequent neoplasia in the world. Even though ultraviolet radiation is the main cause, established prevention campaigns have not proved to be effective for controlling the incidence of this disease. Objective: To develop clinical prediction rules based on medical consultation and a questionnaire to estimate the risk of developing nonmelanoma skin cancer. Methods: This study was developed in several steps. They were: Identifying risk factors that could be possible predictors of nonmelanoma skin cancer; their clinical validation; developing a prediction rule using logistic regression; and collecting information from 962 patients in a case and control design (481 cases and 481 controls). We developed independent prediction rules for basal cell and squamous cell carcinomas. Finally, we evaluated reliability for each of the variables. Results: The variables that made up the final prediction rule were: Family history of skin cancer, history of outdoor work, age, phototypes 1-3 and the presence of poikiloderma of civatte, actinic keratosis and conjunctivitis in band. Prediction rules specificity was 87% for basal cell carcinomas and 92% for squamous cell carcinomas. Inter- and intra-observer reliability was good except for the conjunctivitis in band variable. Conclusions: The prediction rules let us calculate the individual risk of developing basal cell carcinoma and squamous cell carcinoma. This is an economic easy-to-apply tool that could be useful in primary and secondary prevention of skin cancer.

Uptake of Skin Self-examination and Clinical Examination Behavior by Outdoor Workers

ABSTRACT This study investigated the association between outdoor work and response to a behavioral skin cancer early detection intervention among men 50 years or older. Overall, 495 men currently working in outdoor, mixed, or indoor occupations were randomized to a video-based intervention or control group. At 7 months post intervention, indoor workers reported the lowest proportion of whole-body skin self-examination (wbSSE; 20%). However, at 13 months mixed workers engaged more commonly in wbSSE (36%) compared with indoor (31%) and outdoor (32%) workers. In adjusted analysis, the uptake of early detection behaviors during the trial did not differ between men working in different settings. Outdoor workers compared with men in indoor or mixed work settings were similar in their response to an intervention encouraging uptake of secondary skin cancer prevention behaviors during this intervention trial.

Sirolimus and Secondary Skin-Cancer Prevention in Kidney Transplantation

BackgroundTransplant recipients in whom cutaneous squamous-cell carcinomas develop are at high risk for multiple subsequent skin cancers. Whether sirolimus is useful in the prevention of secondary skin cancer has not been assessed.MethodsIn this multicenter trial, we randomly assigned transplant recipients who were taking calcineurin inhibitors and had at least one cutaneous squamous-cell carcinoma either to receive sirolimus as a substitute for calcineurin inhibitors (in 64 patients) or to maintain their initial treatment (in 56). The primary end point was survival free of squamous-cell carcinoma at 2 years. Secondary end points included the time until the onset of new squamous-cell carcinomas, occurrence of other skin tumors, graft function, and problems with sirolimus.ResultsSurvival free of cutaneous squamous-cell carcinoma was significantly longer in the sirolimus group than in the calcineurin-inhibitor group. Overall, new squamous-cell carcinomas developed in 14 patients (22%) in the sirolimus group (6 after withdrawal of sirolimus) and in 22 (39%) in the calcineurin-inhibitor group (median time until onset, 15 vs. 7 months; P=0.02), with a relative risk in the sirolimus group of 0.56 (95% confidence interval, 0.32 to 0.98). There were 60 serious adverse events in the sirolimus group, as compared with 14 such events in the calcineurin-inhibitor group (average, 0.938 vs. 0.250). There were twice as many serious adverse events in patients who had been converted to sirolimus with rapid protocols as in those with progressive protocols. In the sirolimus group, 23% of patients discontinued the drug because of adverse events. Graft function remained stable in the two study groups.ConclusionsSwitching from calcineurin inhibitors to sirolimus had an antitumoral effect among kidney-transplant recipients with previous squamous-cell carcinoma. These observations may have implications concerning immunosuppressive treatment of patients with cutaneous squamous-cell carcinomas. (Funded by Hospices Civils de Lyon and others; TUMORAPA ClinicalTrials.gov number, NCT00133887.)

Skin Cancer Prevention: Recent Evidence from Randomized Controlled Trials

Despite the billions of health care dollars spent each year on treating skin cancer, there is a dearth of randomized controlled trials (RCTs) that have evaluated skin cancer prevention. RCTs published in the last 3 years that have directly assessed skin cancer prevention as their primary aim suggest that regular use of sunscreen is cost effective, but prolonged use of topical therapies such as tretinoin and 5-fluorouracil may not be. Sirolimus-based immunosuppression for secondary skin cancer prevention in long-term renal transplant recipients appears effective, but benefits may be offset by the adverse effects. Many RCTs using pre-invasive actinic keratoses (AKs) as endpoints are too small and/or too short to provide evidence on skin cancer prevention. Another stumbling block is the difficulty in reproducibly diagnosing and counting AKs in response to preventive agents. Longer term and better surveillance methods are urgently required to improve the quality of evidence from future RCTs.