Incidence Of Skin Cancer Research Articles

41998 Evaluation of incidental skin cancers found during Mohs micrographic surgery

41998 Evaluation of incidental skin cancers found during Mohs micrographic surgery

Impact of climate change on non-communicable diseases caused by altered UV radiation.

UV radiation can cause serious skin and eye diseases, especially cancers. UV-related skin cancer incidences have been increasing for decades. The determining factor for this development is the individual UV exposure. Climate change-induced changes in atmospheric factors can influence individual UV exposure. On the basis of a topic-specific literature research, a review paper was prepared and supplemented by as yet unpublished results of the authors' own studies. The need for scientific research and development is formulated as well as primary prevention recommendations. Climate change alters the factors influencing UV irradiance and annual UV dose in Germany. First evaluations of satellite data for Germany show an increase in mean peak UV irradiance and annual UV dose for the last decade compared to the last three decades. The climate change-related influences on individual UV exposure and the associated individual disease incidence cannot yet be reliably predicted due to considerable uncertainties. However, the current UV-related burden of disease already requires primary preventive measures to prevent UV-related diseases.

The Multifaceted Opportunities Provided by the Pheomelanin-Inspired 1,4-Benzothiazine Chromophore: A Still-Undervalued Issue.

1,4-Benzothiazines are the main building blocks of the naturally occurring pheomelanin pigments, and their chromophoric properties have been strongly related to the well-known phototoxicity of these pigments, partly responsible for the high incidence of melanoma and other skin cancers in red-haired people. However, some peculiar features of the 1,4-benzothiazine chromophore could be functionally exploited in several sectors. Within this context, in this perspective, an overview of the very recently reported applications of the 1,4-benzothiazine chromophore in pH sensing, filter permeability control, smart packaging, electrochromic device fabrication, bioimaging, photocatalysis, and HPLC detection systems is provided, together with a brief presentation of recently developed synthetic approaches to the 1,4-benzothiazine scaffold, with the aim of emphasizing the still-undervalued multifunctional opportunities offered by this class of compounds.

Wanita 74 Tahun Dengan Metastasis Pada Lobus Parieto-Oksipital Pada Melanoma Maligna

Melanoma is a tumor that is produced by the malignant transformation of melanocyte cells. Melanoma is the leading cause of premature death from cancer. Known risk factors include personal or family history of melanoma, large numbers of naevi and/or dysplastic naevi, congenital melanocytic naevi, sun-damaged skin, history of non-melanoma skin cancer, and immunodeficiency. Based on the Basic Health Research Results (Riskesdas) report, skin cancer as a whole ranks 3rd in Indonesia. Epidemiological studies of skin cancer have reported in Jakarta in 2014–2017, where out of 263 cases of skin cancer, malignant melanoma ranks third with the highest incidence of skin cancer (5.7%). Diagnosis of melanoma can be made by assessing the skin lesions with the naked eye and also by the patient's clinical symptoms. A person's risk of metastases is directly related to the depth of invasion and ulceration of their primary lesion. Among solid tumors, melanoma has one of the highest propensities to cause brain metastases with a proportion of more than 25% of patients. Although the current cancer treatment paradigm may reflect a combination of surgery, chemotherapy, radiotherapy, and immunotherapy with medical management, options for the treatment of metastatic brain cancer remain limited.

The accuracy of artificial intelligence used for non-melanoma skin cancer diagnoses: a meta-analysis

BackgroundWith rising incidence of skin cancer and relatively increased mortality rates, an improved diagnosis of such a potentially fatal disease is of vital importance. Although frequently curable, it nevertheless places a considerable burden upon healthcare systems. Among the various types of skin cancers, non-melanoma skin cancer is most prevalent. Despite such prevalence and its associated cost, scant proof concerning the diagnostic accuracy via Artificial Intelligence (AI) for non-melanoma skin cancer exists. This study meta-analyzes the diagnostic test accuracy of AI used to diagnose non-melanoma forms of skin cancer, and it identifies potential covariates that account for heterogeneity between extant studies.MethodsVarious electronic databases (Scopus, PubMed, ScienceDirect, SpringerLink, and Dimensions) were examined to discern eligible studies beginning from March 2022. Those AI studies predictive of non-melanoma skin cancer were included. Summary estimates of sensitivity, specificity, and area under receiver operating characteristic curves were used to evaluate diagnostic accuracy. The revised Quality Assessment of Diagnostic Studies served to assess any risk of bias.ResultsA literature search produced 39 eligible articles for meta-analysis. The summary sensitivity, specificity, and area under receiver operating characteristic curve of AI for diagnosing non-melanoma skin cancer was 0.78, 0.98, & 0.97, respectively. Skin cancer typology, data sources, cross validation, ensemble models, types of techniques, pre-trained models, and image augmentation became significant covariates accounting for heterogeneity in terms of both sensitivity and/or specificity.ConclusionsMeta-analysis results revealed that AI is predictive of non-melanoma with an acceptable performance, but sensitivity may become improved. Further, ensemble models and pre-trained models are employable to improve true positive rating.

Maintenance lenalidomide in newly diagnosed transplant eligible and non-eligible myeloma patients; profiling second primary malignancies in 4358 patients treated in the Myeloma XI Trial

Early trials of long-term lenalidomide use reported an increased incidence of second primary malignancy (SPM), including acute myeloid leukaemia and myelodysplastic syndrome. Later, meta-analysis suggested the link to be secondary to lenalidomide in combination with melphalan. Myeloma XI is a large, phase III randomised trial in-which lenalidomide was used at induction and maintenance, in transplant eligible (TE) and non-eligible (TNE) newly diagnosed patients (NCT01554852). Here we present an analysis of SPM incidence and profile the SPM type to determine the impact of autologous stem cell transplantation (ASCT) and lenalidomide exposure in 4358 patients treated on study. Data collection took place from the start of the trial in May 2010, to May 2019, as per the protocol timeline. The Median follow-up following maintenance randomisation was 54.5 and 46.1 months for TE and TNE patients, respectively. In the TE pathway, the overall SPM incidence was 7.7% in lenalidomide maintenance patients compared to 3.2% in those being observed (p=0.006). Although the TNE lenalidomide maintenance patients had the greatest SPM incidence (15.4%), this was not statistically significant when compared to the observed patients (10%, p=0.10).The SPM incidence was higher in patients who received lenalidomide at induction and maintenance (double exposure), when compared to those treated with lenalidomide at one time point (single exposure). Again, this was most marked in TNE patients where the overall SPM incidence was 16.9% in double exposed patients, compared to 11.7% in single exposed patients, and 11.2% in patients who did not receive lenalidomide (p=0.04). This is likely an effect of treatment duration, with the median number of cycles being 27 in the TNE double exposed patients, vs 6 in the single exposure patients.Haematological SPMs were uncommon, diagnosed in 50 patients (incidence 1.1%). The majority of cases were diagnosed in TE patients treated with lenalidomide maintenance (n=25, incidence 2.8%), suggesting a possible link with melphalan. Non-melanoma skin cancer incidence was highest in patients receiving lenalidomide maintenance, particularly in TNE patients, where squamous cell carcinoma and basal cell carcinoma were diagnosed in 5.5% and 2.6% of patients, respectively. The incidence of most solid tumour types was higher in lenalidomide maintenance patients.Mortality due to progressive myeloma was reduced in patients receiving lenalidomide maintenance, noted to be 16.6% compared 22.6% in those observed in TE patients and 32.7% compared to 41.5% in TNE patients. SPM related mortality was low, 1.8% and 6.1% in TE and TNE lenalidomide maintenance patients, respectively, compared to 0.4% and 2.8% in those being observed. This provides reassurance that long-term lenalidomide treatment is safe and associated with improved outcomes in TE and TNE populations, although monitoring for SPM development should be incorporated into clinic review processes. Primary financial support was from Cancer Research UK [C1298/A10410].

Recent Advances in Clinical Research for Skin Cancer Chemoprevention.

Neoplasm arising from the keratinocytes or melanocytes in the skin is the most prevalent type of cancer in the United States and worldwide. Since ultraviolet (UV) radiation may be a causing factor for several types of skin cancer, effective strategies to manage skin cancer include preventive measures such as minimizing exposure to UV and applying sunscreens. However, the effect of sunscreen in reducing skin cancer incidence remains uncertain. An alternative approach to prevent skin cancer is chemoprevention, which is defined as using either natural products or synthetic compounds to inhibit, delay, or reverse the development of cancer. Preclinical studies have demonstrated the effectiveness of multiple pharmacological agents and dietary supplements. However, whether preclinical findings can be translated into clinical application is unknown. This review evaluates the state of recent clinical trials investigating chemopreventive agents focusing on skin cancer to compare the target populations, interventions, endpoints, and outcomes of these trials. The ClinicalTrials and PubMed databases were searched for their available literature using the key words "skin cancer" and "chemoprevention". The objective of this review is to provide updated information on the effectiveness and side effects of promising chemopreventive agents in human subjects and to identify research gaps.

Reinforcing Photoprotection for Skin of Color: A Narrative Review.

Skin of color (SOC) is characterized by increased tendency for tanning and decreased likelihood of sunburns due to the attenuation of sunlight by epidermal melanin. Although this contributes to the decreased incidence of skin cancer among SOC populations, individuals with SOC remain susceptible to various health consequences associated with sun exposure, including non-melanoma skin cancer, photoaging, pigmentary disorders, and photodermatoses - many of which not only present differently, but also disproportionately affect SOC. Prior epidemiological studies have found lower prevalence of sun protection behaviors among individuals with SOC, particularly in sunscreen use, signifying an unmet area for improvement in the prevention of sun-induced dermatologic conditions in these populations. The objective of this narrative review was to summarize the biology and health consequences of sun exposure in SOC, as well as cognitive and behavioral factors that affect the practice of photoprotection behaviors in SOC populations. We also review prior interventions that have been used to enhance photoprotection knowledge and behaviors among individuals with SOC, either in racially and ethnically diverse communities or within specific SOC populations.

An immunomodulating peptide to counteract solar radiation-induced immunosuppression and DNA damage

Ultraviolet radiation (UVR) induces immunosuppression and DNA damage, both of which contribute to the rising global incidence of skin cancer including melanoma. Nucleotide excision repair, which is activated upon UVR-induced DNA damage, is linked to expression of interleukin-12 (IL-12) which serves to limit immunosuppression and augment the DNA repair process. Herein, we report an immunomodulating peptide, designated IK14800, that not only elicits secretion of IL-12, interleukin-2 (IL-2) and interferon-gamma (IFN-γ) but also reduces DNA damage in the skin following exposure to UVR. Combined with re-invigoration of exhausted CD4+ T cells, inhibition of UVR-induced MMP-1 release and suppression of B16F10 melanoma metastases, IK14800 offers an opportunity to gain further insight into mechanisms underlying the development and progression of skin cancers.

Are foundation doctors equipped with the skills necessary for the assessment and referral of the patient presenting with a suspected facial skin malignancy?

The incidence of Skin Cancer (SC) has increased in recent years with it being the most common cancer within the UK. The management of SC requires a multi-disciplinary approach involving dermatologists and surgical specialities. The current study aimed to assess the confidence of current foundation trainees (FT) in the assessment of facial skin cancers and referral for surgical management and reconstruction. An online survey was distributed via social media and completed by 142 FT across 13 deaneries. Two higher training respondents were excluded. 50% of trainees had only examined one or two SC patients and 25% had no experience in SC assessment. Most FTs were not confident in performing a full skin examination (90%), formulating differential diagnoses for a pigmented facial lesion (45%), or investigating a facial SC (87%). Facial defects requiring reconstruction (87%) were more likely to be referred to PS. Foundation trainees were not confident in performing full skin examinations nor formulating diagnoses for pigmented lesions. This is concerning given that the majority of FT will enter general practise and therefore exposure to SC will be common. This may in turn place greater burden on secondary care services such as dermatology and allied surgical specialities resulting in a greater caseload on an already stretched service. The integration of the British Association of Dermatology undergraduate syllabus into the medical school curriculum will improve confidence in the detection and management of SC at both undergraduate and postgraduate levels.

The surveillance of arsenic levels in the drinking water of primary schools and the assessment of the potential cancer-related health risks of children in Multan, Pakistan

To investigate the levels of arsenic (As) in the groundwater and drinking water of primary schools and their potential impact on human health is main objective of this study. To assess risk, the following parameters i.e., carcinogenic indices (CI), hazardous indexes (HI), carcinogenic risk (CR), and hazardous quotient (HQ) have been measured for both dermal and oral arsenic exposure. This study has been focused on primary schools located in four tehsils of Multan, where water samples were collected. Arsenic levels, with concentrations ranging from 3.31 to 191 mg/l, exceeding the safe limit set by the World Health Organization (WHO) have been detected in 99.9% of the samples. The results show that arsenic content ranged from 3.31 to 191 mg/l, with 99.9% of the samples exceeding the World Health Organization's safe limit of 10 mg/l. The CR and CI exceeded the USEPA limit of 10–6 in all four tehsils ranged from 2.6 × 10-6 to 9.4 × 10-6 and 0.00023 to 0.0009 respectively in both dermal and oral cases. , Multan Sadar (1.51, 1.39) and Multan City (1.76, 1.71) exhibited HI and HQ values that surpassed the threshold of 1.0, signaling a significant likelihood of chronic and cancer-causing health consequences for individuals who are exposed to polluted water causing health. The findings suggest that the groundwater in the Multan district poses a significant health risk to humans due to high levels of arsenic contamination. This contamination is associated with an increased risk of mortality from internal cancers (including liver, kidney, lung, and bladder), as well as a higher HI & CI incidence of skin cancer. Furthermore, pregnancy outcomes are affected, with associations found between arsenic exposure and lower birth weight, and infant mortality. The researchers propose that water supply organizations and educational institutions promptly take measures to ensure that the affected areas have access to arsenic-free drinking water for the well-being of students and residents.

Time to reconsider skin cancer-related follow-up visits.

BCC, cSCC and melanoma have very intense follow-up schedules, which are mostly based on expert opinion and on recurrence rates. We found that as the incidence of skin cancer rises it is followed by a three-to-eightfold larger number of follow-up consultations, depending on the type of skin cancer, which will seriously impact dermatological care capacity. A reconsideration and further evaluation of the follow-up schedules will be necessary to keep dermatological care accessible to all patients.

Understanding the Factors Associated with US Dermatology Resident Trainees' Diagnostic Confidence and Skill for Skin of Color Pathology

Background: Inequities in dermatologic health outcomes translate to worsened clinical outcomes for minority groups. For example, despite a lower incidence of skin cancer overall, African Americans are diagnosed at later stages with greater degrees of lymph node involvement. This has been shown to lead to disproportionate mortality when compared to lighter skinned individuals. Medical education materials contain a significantly lower percentage of skin of color (SOC) images than of lighter skin and research has indicated lower diagnostic accuracy of dermatologic conditions in darker skin by U.S. medical students. The objective of this study was to explore U.S. resident dermatologists’ ability to accurately identify skin pathology among SOC patients verus lighter skin to potentially identify gaps in training that may contribute to this disproportionate morbidity and mortality. Methods: A cross-sectional electronic REDCap survey open to all U.S. dermatology residents asked participants their basic demographics (e.g., level of training, racial and ethnic identity) and program characteristics (e.g., geographical location, proportion of patients by Fitzpatrick type, presence of a dedicated SOC clinic). This data was correlated with participant visual diagnostic accuracy on a 22-item multiple choice quiz (images selected by a senior academic dermatologist) of characteristic nonmalignant and malignant conditions in lighter skin and SOC. Results: Residents preferentially misdiagnosed malignant lesions in SOC over lighter skin (p <.0001) and preferentially misdiagnosed malignant lesions in SOC over nonmalignant lesions in SOC (p <.001). None of the residents’ basic demographic or program characteristic variables had significant relationships with any assessment of performance. Conclusion: Dermatologists should maintain a high clinical suspicion for malignant conditions in patients with darker skin types, given that these lesions are the most preferentially misdiagnosed and the fact that these lesions carry higher risks for morbidity and mortality. Dermatology residency programs should instill efforts to emphasize correct detection of malignant lesions amongst those with skin of color.

Skin Cancer Associated With Chronic Leg Ulcers in the Population of Olmsted County, Minnesota

Malignant skin tumors in the setting of chronic leg ulcers (CLUs) are often underdiagnosed which may contribute to treatment delay and poor outcomes. The aims of our study were to determine the incidence and clinical characteristics of skin cancers in leg ulcers in the Olmsted County population from 1995 to 2020. We used the Rochester Epidemiology Project (a collaboration between health care providers) infrastructure to describe this epidemiology, allowing “population-based” research. Electronic medical records of adult patients with International Classification of Diseases diagnosis codes for leg ulcers and skin cancers on the legs were queried. Thirty-seven individuals with skin cancers in nonhealing ulcers were identified. The cumulative incidence of skin cancer over the 25-year period was 37:7864 (0.47%). The overall incidence rate was 470 per 100,000 patients. Eleven (29.7%) men and 26 (70.3%) women were identified with mean age of 77 years. History of venous insufficiency was present in 30 (81.1%) patients and diabetes in 13 (35.1%) patients. Clinical characteristics of CLU with skin cancer included abnormal granulation tissue in 36 (94.7%) and irregular borders in 35 (94.6%) cases. Skin cancers among CLUs included 17 (41.5%) basal cell carcinomas, 17 (41.5%) squamous cell carcinomas, 2 (4.9%) melanomas, 2 (4.9%) porocarcinomas, 1 (2.4%) basosquamous cell carcinoma, and 1 (2.4%) eccrine adenocarcinoma. The apparent association between chronic wounds and subsequent biopsy-proven skin cancer of the same site was primarily observed in elderly patients; malignant transformation of wounds favored basal cell carcinoma and squamous cell carcinoma. This retrospective cohort study further characterizes the association between skin cancers and chronic leg wounds.

BT19 Teledermatology preserves the number needed to biopsy for diagnosis of skin cancer

Abstract In order to ensure a high sensitivity and prevent a missed skin cancer diagnosis, specificity is sacrificed. The number needed to biopsy (NNB) describes the number of benign lesions excised in order to diagnose one skin cancer. Published NNBs are highly variable, but a 2020 meta-analysis reported the overall NNB for melanoma to be 9.6 (Petty AJ, Ackerson B, Garza R et al. Meta-analysis of number needed to treat for diagnosis of melanoma by clinical setting. J Am Acad Dermatol 2020; 82:1158–65). The overall NNB is reported to be 3 for any skin cancer and 1.6 for nonmelanoma skin cancer (Matsumoto M, Secrest A, Anderson A et al. Estimating the cost of skin cancer detection by dermatology providers in a large health care system. J Am Acad Dermatol 2018; 78:701–9). The incidence of skin cancer is rising significantly in the UK, placing increased pressures on dermatology departments. A growing body of evidence suggests that the diagnostic accuracy of teledermatology is similar to that of face-to-face (F2F) care and many trusts now employ teledermatology for triage of 2-week wait (2WW) referrals. Our trust uses a teledermatology model where all patients referred via the 2WW pathway complete a digital form with details of the lesion. Both clinical and dermoscopic images are taken by a trained medical photographer and reviewed by a consultant dermatologist. Lesions felt to be suspicious for malignancy are triaged directly for biopsy. We aimed to evaluate the effectiveness of our teledermatology service by calculating the NNB, as well as the number of appointments where a biopsy was not performed following F2F assessment. Over a 2-month period, 251 lesions in 221 patients were triaged for biopsy via teledermatology, and 212 were biopsied following a F2F assessment. Of these, 54 (25.5%) were histologically diagnosed as skin cancer [11 melanoma, nine squamous cell carcinoma (SCC) and 33 basal cell carcinoma (BCC)]. When comparing the teledermatology diagnosis with the histological diagnosis, the overall NNB for skin cancer was 3.9. The NNB varied depending on the type of lesion suspected (7 for melanoma, 7.1 for SCC and 1.6 for BCC). When examining our NNB, it seems the accuracy of our teledermatology service is in keeping with data published from other centres. Furthermore, only a small proportion of lesions (10%) were not biopsied following a F2F assessment, demonstrating that teledermatology probably has a similar accuracy to F2F assessment. Although this is a small study from one centre, it further demonstrates that teledermatology is an efficient use of resources with no clear reduction in diagnostic accuracy.

PD08 Sun protection practices of men in the west of Ireland

Abstract Irish men get more skin cancer than women, especially of the head and neck area. They typically get more sun exposure and are less likely to wear sun protection factor (SPF). Little is known about the types of hats men wear, or photoprotective practices regarding the lips. We carried out an observational study, using a questionnaire, on men aged > 18 years attending dermatology for any reason. Fitzpatrick skin type and Norwood classification for male pattern baldness was documented. Sixty-one men [mean (SD) age 56 (16.9) years] were involved. Forty-nine per cent were attending for the assessment of skin lesions. Thirty-eight per cent were on immunosuppression. Sixty-four per cent worked outdoors currently or in the past, 79% have or had spent > 3 h outdoors daily. Twenty-six per cent had a Norwood classification of ≥ 3v (vertex of scalp showing). The majority (71%) was of Fitzpatrick skin types I and II. Seventy-nine per cent wore SPF, 19% daily and 17% during the summer. Only 15% of men reported wearing lip SPF. Sixty-eight per cent reported wearing a hat on a ‘sunny day’. Of these, 54% wear baseball (BB) caps, 20% wear a wide-brimmed hat (WBH), 20% a narrow-brimmed hat, 4% a wool or traditional cap and 2% a total face covering. Age did not influence whether a hat was worn, but it did influence the type, with younger men more likely to wear BB caps and older men more likely to wear WBH. Those with hair thinning were more likely to wear a hat (87% vs. 67%). Non-hat-wearers were also less likely to wear SPF. Despite the incidence of skin cancer in sun-exposed sites in men, few studies have focused on photoprotective practices of the head and neck. Our study demonstrates that while Irish men wear SPF, few wear SPF on their lips. Additionally, Irish men often wear a hat type that would not be considered to provide adequate photoprotection to the head and neck. Hat type varied with age, with younger patients wearing less photoprotective hats. When considering photoprotection campaigns, factors such as age, fashion trends and education regarding lip SPF should be considered.

Management of Cutaneous Head and Neck Squamous and Basal Cell Carcinomas for Immunocompromised Patients.

The incidence of non-melanoma skin cancer (NMSC) continues to rise, and more than one million cases are diagnosed in the United States each year. The increase in prevalence has been attributed to increased lifespan and improvements in survival for conditions that increase the risk of these malignancies. Patients who are immunocompromised have a higher risk of developing NMSC compared to the general population. In immunosuppressed patients, a combination of prevention, frequent surveillance, and early intervention are necessary to reduce morbidity and mortality. In this review, we collate and summarize current knowledge regarding pathogenesis of head and neck cutaneous SCC and BCC within immunocompromised patients, examine the potential role of the immune response in disease progression, and detail the role of novel immunotherapies in this subset of patients.

007 Vitiligo is associated with a reduction in incidence of melanoma and nonmelanoma skin cancer: UK population-based cohort study

Abstract Vitiligo is a common, acquired depigmenting skin disease. There have been concerns that vitiligo and its treatment may increase the risks of skin cancer. In a large UK population-based study, we aimed to establish whether vitiligo is associated with an increased risk of skin cancer. We used routinely collected electronic medical records of adults contributing to the Optimum Patient Care Research Database (2010–2020). Cases of vitiligo were identified using specific diagnosis codes. Those with other depigmenting conditions were excluded. Vitiligo cases were age and sex matched with up to four controls registered at the same general practice and with at least one primary care interaction in the preceding year. The primary outcome was risk of skin cancer; comprisied of melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Individual skin cancers and actinic keratoses (AK) were included as secondary outcomes. Associations between vitiligo and skin cancer were estimated using Cox regression, with adjustment for age, sex, socioeconomic deprivation, ethnicity, body mass index, smoking and alcohol status, immunotherapy, phototherapy and 13 common comorbidities. Prespecified subgroup analysis comprised stratification by sex, age group (18–45 years, 45–65 years and > 65 years), ethnicity (White and non-White) and socioeconomic deprivation. In total, 14 976 patients with vitiligo were matched to 54 392 controls. Over the 10-year study period, 133 patients with vitiligo and 783 controls developed new-onset skin cancer. Vitiligo was associated with a 38% reduced risk of any new-onset skin cancer [adjusted hazard ratio (aHR) 0.62, 95% confidence interval (CI) 0.51–0.74; P < 0.001]. This risk reduction was observed for all individual skin cancer types: melanoma (aHR 0.38, 95% CI 0.23–0.64; P < 0.001), SCC (aHR 0.65, 95% CI 0.48–0.87; P = 0.004), BCC (aHR 0.65, 95% CI 0.51–0.83; P < 0.001) and AK (aHR 0.86, 95% CI 0.75–0.98; P = 0.028). In a subgroup analysis, vitiligo was associated with a reduction in skin cancer risk in people identifying as White (aHR 0.68, 95% CI 0.55–0.84; P < 0.001), but there was no association in those identifying as non-White (aHR 0.93, 95% CI 0.44–1.98). Vitiligo-associated reductions in skin cancer risk were consistently observed in the other prespecified subgroups. Vitiligo is associated with a strong protective effect against common types of skin cancer. Vitiligo-associated risk reduction is most marked for melanoma (62% lower risk). Protective effects associated with vitiligo may be restricted to people with light skin, although skin cancers in the those with darker skin were uncommon, which requires further study. FundingThis research was sponsored by Pfizer. Medical writing and statistical support was provided by Momentum Data and was funded by Pfizer.

1386-P: Dipeptidyl Peptidase-4 Inhibitors and the Risk of Skin Cancer among Patients with Type 2 Diabetes—Population-Based Cohort Study

Introduction: The dipeptidyl peptidase-4 (DPP-4) enzyme influences carcinogenic pathways in the skin, although its exact role remains uncertain. The objective of this study was to determine whether DPP-4 inhibitors are associated with the incidence of melanoma and nonmelanoma skin cancer, compared with sulfonylureas. Research Design and Methods: Using the United Kingdom Clinical Practice Research Datalink, we assembled two new-user active comparator cohorts for each skin cancer outcome from 2007 to 2019. For melanoma, the cohort included 96,739 DPP-4 inhibitor users and 209,341 sulfonylurea users, and 96,411 DPP-4 inhibitor users and 208,626 sulfonylurea users for nonmelanoma skin cancer. Propensity score fine stratification weighted Cox proportional hazards models were to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of melanoma and nonmelanoma skin cancer, separately. Results: Overall, DPP-4 inhibitors were associated with a 23% decreased risk of melanoma compared with sulfonylureas (49.7 vs. 65.3 per 100,000 person-years, respectively; HR 0.77, 95% CI 0.61-0.96). The HR progressively reduced with increasing cumulative duration of use (0-2 years HR 1.14, 95% CI 0.84-1.54; 2.1-5 years HR 0.44, 95% CI 0.29-0.66; >5 years HR 0.33, 95% CI 0.14-0.74). In contrast, these drugs were not associated with the incidence of nonmelanoma skin cancer, compared with sulfonylureas (448.1 vs. 426.1 per 100,000 person-years, respectively; HR 1.06, 95% CI 0.98-1.15). Conclusions: In this large, population-based cohort study, DPP-4 inhibitors were associated with a reduced risk of melanoma but not nonmelanoma skin cancer, compared with sulfonylureas. Disclosure R.Pradhan: None. L.Azoulay: Advisory Panel; Pfizer Inc., Consultant; Pfizer Inc., Speaker's Bureau; Roche Diagnostics. R.W.Platt: Advisory Panel; Pfizer Inc., Consultant; Boehringer Ingelheim (Canada) Ltd., Biogen, Merck & Co., Inc., Nant Pharma, Other Relationship; Boehringer Ingelheim Inc. O.Yu: Consultant; Novo Nordisk. Funding Canadian Institutes of Health Research (FDN143328)

Correlation of Ultraviolet Radiation Levels With the Incidence of Cutaneous Squamous Cell and Merkel Cell Carcinomas in Non-sunbelt Locales in the United States: 2010-2017.

Non-melanoma skin cancer (NMSC) is the most common human malignancy worldwide, with increasing incidence in the United States (US). Recent environmental data have shown that ultraviolet radiation (UVR) levels have increased in the US, particularly in the higher latitudes, but the potential impact of this on NMSC incidence is not well known, despite estimates that 90% of NMSC is due to sun exposure. Our exploratory study synthesizes environmental data with demographic and clinical data to determine whether UV indices (UVIs) and non-sunbelt (non-SB) locale (latitudes >40 degrees, which comprises most of the US) might contribute to incidence rates of two types of NMSC: cutaneous squamous cell and Merkel cell carcinomas. UVIs from 2010 to 2017 were obtained from the National Oceanic and Atmospheric Administration database and meshed with corresponding locales in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database (version 8.4.0.1). Four SB and five NSB locales contained sufficient data for analysis. Linear mixed modeling was performed with the outcome variable of the age-adjusted incidence of NMSC cancer (comprised of cutaneous squamous cell carcinoma of the head and neck (CSCCHN) and Merkel cell carcinoma (MCC)), the two most common types of NMSC contained within SEER). Non-SB locale and percent of days with UVI >3 were independent variables. Percent of days with UVI >3 increased during this period, as did the overall NMSC (combined CSCCHN and MCC) skin cancer incidence, though MCC incidence alone did not increase during our study period.Environmental factors that significantly contributed to the age-adjusted overall NMSC (combined CSCCHN and MCC) cancer incidence (per 100,000 individuals) included NSB locale (b=1.227, p=0.0019) and percent of days with UVIs >3 (b=0.028, p<0.0001), as well as clinical factors of percent white race and percent male, by linear mixed modeling. Our results are limited by the completeness of the NOAA and SEER databases, and do not include basal cell carcinoma. Nevertheless, our data demonstrate that environmental factors, such as latitude in NSB locale and UVI indices, can affect the age-adjusted overall NMSC (defined as CSCCHN and MCC in this study) incidence even in this relatively short period of time. Prospective studies over longer time periods are needed to identify the extent to which these findings are clinically significant so that increased educational efforts to promote sun-safe behaviors can be maximally effective.