ArticleLiterature Review

An overview of skin cancers. Incidence and causation

February 1995
Cancer 75(2 Suppl):607-12

February 1995
75(2 Suppl):607-12

DOI:10.1002/1097-0142(19950115)75:2<607::AID-CNCR2820751402>3.0.CO;2-8

Source
PubMed

Authors:

The incidence and mortality rates of skin cancer are rising in the United States and in many other countries. Concerns about stratospheric ozone depletion adding to the problem have made many organizations look at public and professional health programs as a possible solution. Early detection can reduce the problem in the short term, because mortality due to melanoma is clearly related to the depth of invasion of the tumor when it is removed. This is the factor which is amenable to change in an education program on early detection. Exposure to sunlight is clearly related to risk of development of skin cancer, including both melanoma and nonmelanoma skin cancers. This is the component of the equation of constitutional predisposition plus exposure to environmental risk factors leading to skin cancer that is amenable to change as a result of educational programs. On the basis of available data, there is a case for further development, provision, and evaluation of public and professional education programs designed to control what is becoming a major public health problem in the community.

FCN-Based DenseNet Framework for Automated Detection and Classification of Skin Lesions in Dermoscopy Images

Article

Full-text available

Aug 2020

Skin Lesion detection and classification are very critical in diagnosing skin malignancy. Existing Deep learning-based Computer-aided diagnosis (CAD) methods still perform poorly on challenging skin lesions with complex features such as fuzzy boundaries, artifacts presence, low contrast with the background and, limited training datasets. They also rely heavily on a suitable turning of millions of parameters which often leads to over-fitting, poor generalization, and heavy consumption of computing resources. This study proposes a new framework that performs both segmentation and classification of skin lesions for automated detection of skin cancer. The proposed framework consists of two stages: the first stage leverages on an encoder-decoder Fully Convolutional Network (FCN) to learn the complex and inhomogeneous skin lesion features with the encoder stage learning the coarse appearance and the decoder learning the lesion borders details. Our FCN is designed with the sub-networks connected through a series of skip pathways that incorporate long skip and short-cut connections unlike, the only long skip connections commonly used in the traditional FCN, for residual learning strategy and effective training. The network also integrates the Conditional Random Field (CRF) module which employs a linear combination of Gaussian kernels for its pairwise edge potentials for contour refinement and lesion boundaries localization. The second stage proposes a novel FCN-based DenseNet framework that is composed of dense blocks that are merged and connected via the concatenation strategy and transition layer. The system also employs hyperparameters optimization techniques to reduce network complexity and improve computing efficiency. This approach encourages feature reuse and thus requires a small number of parameters and effective with limited data. The proposed model was evaluated on publicly available HAM10000 dataset of over 10000 images consisting of 7 different categories of diseases with 98% accuracy, 98.5% recall, and 99% of AUC score respectively.

Modélisation stochastique et estimation de la croissance tumorale

Thesis

Full-text available

Dec 2019

Modibo Diabate

Cette thèse porte sur la modélisation mathématique de la dynamique du cancer ; elle se divise en deux projets de recherche.Dans le premier projet, nous estimons les paramètres de la limite déterministe d'un processus stochastique modélisant la dynamique du mélanome (cancer de la peau) traité par immunothérapie. L'estimation est réalisée à l'aide d'un modèle statistique non-linéaire à effets mixtes et l'algorithme SAEM, à partir des données réelles de taille tumorale mesurée au cours du temps chez plusieurs patients. Avec ce modèle mathématique qui ajuste bien les données, nous évaluons la probabilité de rechute du mélanome (à l'aide de l'algorithme Importance Splitting), et proposons une optimisation du protocole de traitement (doses et instants du traitement).Nous proposons dans le second projet, une méthode d'approximation de vraisemblance basée sur une approximation de l'algorithme Belief Propagation à l'aide de l'algorithme Expectation-Propagation, pour une approximation diffusion du modèle stochastique de mélanome observée chez un seul individu avec du bruit gaussien. Cette approximation diffusion (définie par une équation différentielle stochastique) n'ayant pas de solution analytique, nous faisons recours à une méthode d'Euler pour approcher sa solution (après avoir testé la méthode d'Euler sur le processus de diffusion d'Ornstein Uhlenbeck). Par ailleurs, nous utilisons une méthode d'approximation de moments pour faire face à la multidimensionnalité et la non-linéarité de notre modèle. A l'aide de la méthode d'approximation de vraisemblance, nous abordons l'estimation de paramètres dans des Modèles de Markov Cachés.

Atrous Convolution with Transfer Learning for Skin Lesions Classification

Preprint

Full-text available

Aug 2019

Skin cancer is a crucial public health issue and by far the most usual kind of cancer specifically in the region of North America. It is estimated that in 2019, only because of melanoma nearly 7,230 people will die, and 192,310 cases of malignant melanoma will be diagnosed. Nonetheless, nearly all types of skin lesions can be treatable if they can be diagnosed at an earlier stage. The accurate prediction of skin lesions is critically challenging task even for vastly experienced clinicians and dermatologist due to a little distinction between surrounding skin and lesions, visual resemblance between melanoma and other skin lesions, fuddled lesion border, etc. A well-grounded automated computer-aided skin lesions detection system can help clinicians vigorously to prognosis malignant skin lesion in the earliest possible time. From the past few years, the emergence of machine learning and deep learning in the medical imaging has produced several image-based classification systems in the medical field and these systems perform better than traditional image processing classification methods. In this paper, we proposed a popular deep learning technique namely atrous or, dilated convolution for skin lesions classification, which are known to be better as it enhances accuracy with the same amount of computational cost compared to tradition CNN. To implement atrous convolution we choose the transfer learning technique with several popular deep learning architectures such as VGG16, VGG19, MobileNet, and InceptionV3. To train, validation, and test our proposed models we utilize HAM10000 dataset which contains total 10015 dermoscopic images of seven different skin lesions (melanoma, melanocytic nevi, Basal cell carcinoma, Benign keratosis-like lesions, Dermatofibroma, Vascular lesions, and Actinic keratoses). Four of our proposed dilated convolutional frameworks show promising outcome on overall accuracy and per-class accuracy. For example, overall test accuracy achieved 87.42%, 85.02%, 88.22%, and 89.81% on dilated VGG19, dilated VGG16, dilated MobileNet, and dilated IncaptionV3 respectively. These dilated convolutional models outperformed existing networks in both overall accuracy and individual class accuracy. Among all the architectures dilated InceptionV3 shows superior classification accuracy and dilated MobileNet is also achieving almost impressive classification accuracy like dilated InceptionV3 with the lightest computational complexities than all other proposed model. Compared to previous work, for skin lesions classification we have experimented one of the most complicated open-source datasets with class imbalances and achieved better accuracy (dilated inceptionv3) than any known methods to the best of our knowledge.

Cutaneous Cancers in Irrua, Edo State, Nigeria: A Six Year Review

Article

Full-text available

Jan 2017

A new SVM solver applied to Skin Lesion Classification

Article

Apr 2024

We present a unified framework for solving the nonlinear Support Vector Machines (SVM) training problems. The framework is based on an objective function approximation so that the Problem becomes separable, with low computational cost root-finding methods to solve the resulting subproblems. Because of the diagonalization of the objective function in the first stage of the framework, we named the new SVM solver DiagSVM. To test the performance of the DiagSVM, we reported preliminary numerical experiments with benchmark datasets. From the results, we chose the best combination used in the framework to solve the Skin Lesion Classification (SLC) problem. Since melanoma (skin cancer) is the most dangerous and deadliest disease that affects the skin, the application of the DiagSVM can be integrated into several Computer-Aided Diagnosis (CAD) systems to help them detect skin cancer and significantly reduce both morbidity and mortality associated with this disease. Machine learning (ML) and deep learning (DL) based approaches have been widely used to develop robust skin lesion classification systems. For the SLC problem, three pre-trained convolutional neural networks (CNN), Xception, InceptionResNetV2 and DenseNet201, were employed as feature extractors and their dimension was reduced using Principal Component Analysis (PCA), Kernel Principal Component Analysis (KPCA) and Independent Component Analysis (ICA). Finally, the samples were fed into two SVM solvers: DiagSVM and Libsvm. The experiment shows that using PCA, KPCA, or ICA, the SVM can perform better than without feature reduction. The classification performance of the proposed methodology is analyzed on the ISIC2017 and PH2 datasets. The benchmark and SLC results indicate a promising proposal for accuracy, specificity and sensitivity metrics.

Identification of A1286C Methylenetetrahydrofolate Reductase Gene Polymorphism in Orbital Region Basal Cell Carcinoma Patients

Article

Jan 2016

Background: The development of basal cell carcinoma (BCC) shows variations among individuals. The risk factor for development of BCC related to environtmental factor especially exposure to ultraviolet radiation and individual factor. The one of internal risk factor contribute to basal cell carcinoma developmental is genetic instability include defects in folic acid synthesis or DNA synthesis. The critical enzim that participate in the process is regulated by Methylenetetrahydrofolate Reductase (MTHFR) gene. Method: This study was descriptive observational with case study involved 10 orbital region basal cell carcinoma. The diagnosis was based on histopathologic examination of the tumor. Genotype frequencies of A1286C polymorphism were studied by Polymerase Chain Reaction (PCR), amplification and restriction fragment length polymorphism analyses using MboII enzyme. Result: In the present study, from 10 subjects we found male was 7 people (70%) and female was 3 people (30%). Majority of subjects have history of having a job in the sunlight. The most commont of the BCC is nodular (80%). There is one subject with recurrent case. Analysis result of A1286C MTHFR gene show wild type in all cases. Conclusion: Thereâ€™s no A1286C substitution methylenetetrahydrofolate reductase gene were identified. The whole subjects are wild type.Keywords: basal cell carcinoma, orbital region, folic acid, polymorphism, A1286C MTHFR gene, polymerase chain reaction (PCR), wild type

Current status of skin cancers with a focus on immunology and immunotherapy

Article

Full-text available

Aug 2023
Canc Cell Int

Skin cancer is one of the most widespread cancers, with a significant global health effect. UV-induced DNA damage in skin cells triggers them to grow and proliferate out of control, resulting in cancer development. Two common types of skin cancer include melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC). Melanoma is the most lethal form of skin cancer, and NMSC includes basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and other forms. The incidence of skin cancer is increasing in part owing to a demographic shift toward an aging population, which is more prone to NMSC, imposing a considerable financial strain on public health services. The introduction of immunostimulatory approaches for cancer cell eradication has led to significant improvements in skin cancer treatment. Over the last three decades, monoclonal antibodies have been used as powerful human therapeutics besides scientific tools, and along with the development of monoclonal antibody production and design procedures from chimeric to humanized and then fully human monoclonal antibodies more than 6 monoclonal antibodies have been approved by the food and drug administration (FDA) and have been successful in skin cancer treatment. In this review, we will discuss the epidemiology, immunology, and therapeutic approaches of different types of skin cancer

Topical drug delivery of 5-fluorouracil proniosomal gel for the treatment of skin cancer: in vitro and in vivo evaluation

Article

Full-text available

Jan 2021

Skin Cancers of the Auricle: A Retrospective Analysis of 41 Patients

Article

Full-text available

Sep 2020

Objective: Skin cancers of the auricle usually present with challenges because of the unique anatomy and topography of the auricle and the behavior of the tumor. The purpose of this study was to evaluate the clinical and histopathological characteristics and the surgical outcomes in patients with skin cancer of the auricle. Methods: Medical records of patients who underwent surgery for a skin cancer of the auricle at two different tertiary medical centers during 2010 to 2020 were reviewed retrospectively. Sociodemographic data of patients, tumor location and size, histopathological type and subtype, T-stage, recurrence, and reconstructive technique were evaluated. Results: The study included 41 patients with skin cancers of the auricle. Thirty-six (87.8%) were male and five (12.2%) were female; with a male-to-female ratio of 7.2:1. The mean age of the patients was 71.4 (46-92) years. Eighteen (43.9%) tumors were basal cell carcinoma (BCC) and 17 (41.5%) tumors were cutaneous squamous cell carcinoma (cSCC). The most common subunit for tumor location was the helix (n=17, 41.5%). Wedge resection plus primary closure was the most common surgical technique (58.5%). Recurrent disease was detected in five patients (12.1%). Conclusion: The frequency of the skin cancers of the auricle was remarkably high in men, and the helix was the most common subunit. Both BCC and cSCC were the most common histopathological types. Poor prognostic factors such as lymph node metastasis, perineural invasion, and recurrence were relatively common in patients with cSCC of the auricle.

Development of an efficient fractal based texture analysis technique for improved classification of dermoscopic images

Conference Paper

Jan 2016

Dermoscopy, a non-invasive imaging technique has been significantly used by the doctors and radiologists for the early diagnosis of the various skin disorders. The characteristically similar nature of the melanocytic skin lesions specifically melanoma and dysplastic nevi make the diagnosis more subjective and time consuming, even for expert clinicians. Computer aided diagnostic system has a great impact on the notable discrimination of two closely similar classes of skin diseases by extracting a large number of effective features. In this reported work fractal geometry has been used for both skin lesion border irregularity measurement and texture features extraction. Here, in fractal based texture analysis technique the dermoscopic images have been decomposed into a set of binary images to extract more effective texture features from different grey regions of the image. From each of the image grey region, some statistical features have been extracted along with the fractal dimension measurement to quantify the intensity variation in that region. In this paper it has been established that the extraction of texture information from different small sub regions of the original image using fractal texture analysis increases the classification performance for both the classes. An analysis of the dependence of the performance of classifier using fractal based texture analysis, on the number of decomposed binary images, has been discussed. The highest classification sensitivity of 93.75% and 91.66% have been achieved for melanoma and dysplastic nevi respectively, using support vector machine (SVM) classifier by extracting fractal based texture features from forty grey scale regions of the dermoscopic images.

MUCM-Net: A Mamba Powered UCM-Net for Skin Lesion Segmentation

Preprint

Full-text available

May 2024

Skin lesion segmentation is key for early skin cancer detection. Challenges in automatic segmentation from dermoscopic images include variations in color, texture, and artifacts of indistinct lesion boundaries. Deep learning methods like CNNs and U-Net have shown promise in addressing these issues. To further aid early diagnosis, especially on mobile devices with limited computing power, we present MUCM-Net. This efficient model combines Mamba State-Space Models with our UCM-Net architecture for improved feature learning and segmentation. MUCM-Net's Mamba-UCM Layer is optimized for mobile deployment, offering high accuracy with low computational needs. Tested on ISIC datasets, it outperforms other methods in accuracy and computational efficiency, making it a scalable tool for early detection in settings with limited resources. Our MUCM-Net source code is available for research and collaboration, supporting advances in mobile health diagnostics and the fight against skin cancer. In order to facilitate accessibility and further research in the field, the MUCM-Net source code is https://github.com/chunyuyuan/MUCM-Net

Promoting Healthier Behaviors, Attitudes, and Beliefs Toward Sun Exposure in Parents of Young Children

Article

Full-text available

Dec 1996

James R Rodrigue

The present study examined the impact of a conceptually driven intervention designed to increase skin cancer knowledge and promote healthier, “sun-safe” attitudes, beliefs, and behaviors about sun exposure in mothers of children ages 6 months to 10 years old. Participants (N = 55) were assigned to a comprehensive prevention program (CPP), information-only condition (IOC), or a no-information control group (NIC). An assessment battery measuring skin cancer knowledge, sun-safe behaviors, and sun exposure attitudes and beliefs was administered at baseline, 2 weeks postintervention, and 12 weeks postintervention. Consistent with prediction, mothers in the CPP and IOC groups showed significant increases in skin cancer knowledge; however, only those in the CPP condition showed increases in sun-safe behaviors, attitudes, and beliefs that were maintained at the 12-week follow-up. Also, results provide support for the influence of perceived severity, self-efficacy, response-efficacy, and perceived barriers on sun-safe behaviors.

Comparative study and analysis on skin cancer detection using machine learning and deep learning algorithms

Article

Full-text available

Aug 2023
MULTIMED TOOLS APPL

Exposure to UV rays due to global warming can lead to sunburn and skin damage, ultimately resulting in skin cancer. Early prediction of this type of cancer is crucial. A detailed review in this paper explores various algorithms, including machine learning (ML) techniques as well as deep learning (DL) techniques. While deep learning strategies, particularly CNNs, are commonly employed for skin cancer identification and classification, there is also some usage of machine learning and hybrid approaches. These techniques have proven to be effective classifiers of skin lesions, offering promising results for early detection. The paper analyzes various researchers’ reviews on skin cancer diagnosis to identify a suitable methodology for improving diagnostic accuracy. A publicly available dataset of dermoscopic images retrieved from the ISIC archive has been trained and evaluated. Performance analysis is done, considering metrics such as test and validation accuracy. The results indicate that the RF(random forest) algorithm outperforms other machine learning algorithms in both scenarios, with accuracies of 58.57% without augmentation and 87.32% with augmentation. MobileNetv2, ensemble of Dense Net and Inceptionv3 exhibit superior performance. During training without augmentation, MobileNetv2 achieves an accuracy of 88.81%, while the ensemble model achieves an accuracy of 88.80%. With augmentation techniques applied, the accuracies improved to 97.58% and 97.50%, respectively. Furthermore, experiment with a customized convolutional neural network (CNN) model was also conducted, varying the number of layers and applying various hyperparameter tuning methodologies. Suitable architectures, including a CNN with 7 layers and batch normalization, a CNN with 5 layers, and a CNN with 3 layers were identified. These models achieved accuracies of 77.92%, 97.72%, and 98.02% on the raw data and augmentation datasets, respectively. The experimental results suggest that these techniques hold promise for integration into clinical settings, and further research and validation are necessary. The results highlight the effectiveness of transfer learning models, in achieving high accuracy rates. The findings support the future adoption of these techniques in clinical practice, pending further research and validation.

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

Article

Full-text available

Jun 2023

Simple Summary Non-melanoma skin cancer affects a significant portion of the population in the United States, with over one million cases diagnosed each year. Skin cancers in the head and neck are considered high risk for locoregional spread and recurrence, requiring close monitoring and multidisciplinary management by head and neck surgeons, oncologists, radiation oncologists, and many others. In this study, we performed an extensive literature review to summarize current knowledge regarding the etiology, disease course, and management of head and neck skin cancers in immunocompromised patients. We draw attention to the role of newly developed immunotherapies being used in this subset of patients. Abstract 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.

BASAL CELL CARCINOMA OF HEAD AND NECK REGION: AN ANALYSIS OF 120 CASES

Article

Full-text available

Jan 2023

Background: Skin cancer is the most common malignancy and makes upto about one third of all cancers diagnosed. The common skin cancers include nonmelanoma skin cancers and melanoma. The majority of skin cancers of the head and neck are nonmelanoma skin cancers[1]. Out of which BCC is the most common. Basal cell carcinoma accounts for approximately 75% of all cases of nonmelanoma skin cancers. Older age and male sex are associated with higher risk of developing basal cell carcinoma. Basal cell cancer occurs mostly on face , head, scalp, neck and hands. Aims And Objectives: To analyze the presentations of basal cell carcinoma, different areas involved and treatment modalities. Material And Method: Retrospective study from January 2008 to May 2013. Prospective study from June 2013 to June 2015. A total of 120 cases were examined. All retrospective record was retrieved from pathology and plastic surgery department and along with new cases were analysed. Results: A total of 120 cases of BCC were examined out of which 76( 64%) were male and44 (36%) were female. Giving male to female ratio of 1.7:1. Cheek (29%) is the most common site involved. Mean age at presentation was 58.7 years and median age was 60 years with a range of 60 years from 25-85 years. Nodular lesion was seen in 46.07 % cases followed by pigmented 18% and superficial lesion in 15% cases. Conclusion: Basal cell carcinoma is the most common skin cancer of the head and neck region affecting mainly elderly males. Increased incidence is most likely due to the increased ultraviolet radiations, increased outdoor activities, changes in clothing style and ozone depletion. Surgery is the main stay of treatment. Adjuvant treatment is given mostly to stage 3 and stage 4 disease patients and in some patients with positive resection margins.

Malignant Melanoma: Skin Cancer-Diagnosis, Prevention, and Treatment

Article

May 2022

Melanoma is a skin cancer caused by a malignancy of melanocytes. Incidence of melanoma is rapidly increasing worldwide, which results in public health problems. Primary extracutaneous melanomas can be ocular, gastro-intestinal, mucosal, leptomeningeal, genitourinary, and lymphatic. The relationship between exposure to ultraviolet (UV) light and development of melanoma is intensively acute and complex, and intermittent sun exposure greatly increases the risk of melanoma. It is the fifth most common type of cancer in men number and the sixth most common in women. The diagnosis of melanoma is made through clinical assessment of the pigmented by health care professionals. Architectural features of malignant melanoma including asymmetry, confluence of growth, marked cellularity, and poor circumscrip-tion. The cytological feature of malignant melanoma include an irregular and thick nuclear membrane and prominent nucleoli. The preventive measures include reducing exposure to UV light and the sun. The early detection of skin cancer greatly reduces both short-and long-term morbidity and mortality. The treatment and follow-up with the doctor for mel-anoma patients may differ because of the stage of the tumor and the primary lesion. The typical therapy for malignant melanoma is surgical excision, immunotherapy such as interleukin 2 (IL-2), gene therapy, and biochemotherapy.

Efficient unsupervised drift detector for fast and high-dimensional data streams

Article

Full-text available

Jun 2021
KNOWL INF SYST

Stream mining considers the online arrival of examples at high speed and the possibility of changes in its descriptive features or class definitions compared with past knowledge (i.e., concept drifts). The fast detection of drifts is essential to keep the predictive model updated and stable in changing environments. For many applications, such as those related to smart sensors, the high number of features is an additional challenge in terms of memory and time for stream processing. This paper presents an unsupervised and model-independent concept drift detector suitable for high-speed and high-dimensional data streams. We propose a straightforward two-dimensional data representation that allows the faster processing of datasets with a large number of examples and dimensions. We developed an adaptive drift detector on this visual representation that is efficient for fast streams with thousands of features and is accurate as existing costly methods that perform various statistical tests considering each feature individually. Our method achieves better performance measured by execution time and accuracy in classification problems for different types of drifts. The experimental evaluation considering synthetic and real data demonstrates the method’s versatility in several domains, including entomology, medicine, and transportation systems.

Gut–Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions

Article

Full-text available

Feb 2021

The microbiome plays an important role in a wide variety of skin disorders. Not only is the skin microbiome altered, but also surprisingly many skin diseases are accompanied by an altered gut microbiome. The microbiome is a key regulator for the immune system, as it aims to maintain homeostasis by communicating with tissues and organs in a bidirectional manner. Hence, dysbiosis in the skin and/or gut microbiome is associated with an altered immune response, promoting the development of skin diseases, such as atopic dermatitis, psoriasis, acne vulgaris, dandruff, and even skin cancer. Here, we focus on the associations between the microbiome, diet, metabolites, and immune responses in skin pathologies. This review describes an exhaustive list of common skin conditions with associated dysbiosis in the skin microbiome as well as the current body of evidence on gut microbiome dysbiosis, dietary links, and their interplay with skin conditions. An enhanced understanding of the local skin and gut microbiome including the underlying mechanisms is necessary to shed light on the microbial involvement in human skin diseases and to develop new therapeutic approaches.

Pathologic Quiz Case: An 84-Year-Old Woman With a Skin Cyst Containing Ziehl-Neelsen–Positive Structures

Article

Mar 2005

Simple, green, ultrasound-assisted preparation of novel core–shell microcapsules from octyl methoxycinnamate and oligomeric proanthocyanidins for UV-stable sunscreen

Article

Full-text available

Feb 2021

Without sunscreens, UV rays in sunlight cause skin damage, ranging from dark spots and premature aging to skin cancer. Present sunscreens, however, are readily photodegraded, producing highly reactive radicals that can damage cells. To address this problem, we have now used ultrasound to prepare core–shell microcapsules, which offer improved protection against UV light and improved UV stability. The composite microcapsules have oligomeric proanthocyanidins (OPCs), which are amphiphilic plant-derived secondary metabolites, as the shell and octyl methoxycinnamate (OMC), which is a UVB absorber, as the core. The polyphenolic flavonoid structure of OPCs improves the UV stability of OMC and thus avoids the skin damage caused by OMC photodegradation products. In the microcapsules, π–π stacking interactions between OPCs and OMC molecules enhance the ability of OMC to absorb UV radiation and extend the absorption range from the UVB region (280–320 nm) to include the UVA and UVC regions (200–400 nm). The composite microcapsules were shown to be stable on storage and to be non-irritant to human skin. The ultrasound-assisted preparation of OMC/OPCs composite microcapsules is simple, efficient and green and provides a feasible strategy for the development of novel, more effective, sunscreens.

Invited Review UV Doses Worldwide {y

Article

Full-text available

Jan 2005

Dianne Godar

UV radiation affects human health. Human exposure to UV radiation causes a few beneficial health effects like vitamin D 3 formation but it causes many detrimental health effects: sunburn, ocular damage, photoaging, immune suppression, DNA damage and skin cancer. In countries with fair-skinned populations, skin cancer is the most diagnosed of all cancers. In the United States in 2002, there were over one million new skin cancer cases. That means one out of every 285 people got skin cancer. Skin cancer of fair-skinned individuals is increasing at an alarming rate (4-6% per year) around the world and has now reached so-called ''pandemic'' proportions. Thus, it is important to know what UV doses people around the world get throughout their lives. This review covers how the outdoor UV doses are weighted for different biological effects, the most commonly used measuring devices for terrestrial and personal UV doses, the natural and other effects on terrestrial and personal UV doses, the time people spend outside, their ambient exposures and the terrestrial and personal UV doses of adult outdoor and indoor workers as well as children and adolescents around the world. Overall, outdoor-working adults get about 10%, while indoor-working adults and children get about 3% (2-4%) of the total available annual UV (on a horizontal plane). People's UV doses increase with increasing altitude and decreasing latitude; most indoor-working adult Europeans get 10 000-20 000 J/m 2 per year, Americans get 20 000-30 000 J/m 2 per year and Australians are estimated to get 20 000-50 000 J/m 2 per year (excluding vacation, which can increase the dose by 30% or more).

Unsupervised Drift Detection on High-speed Data Streams

Conference Paper

Full-text available

Dec 2020

Changes in data distribution of streaming data (i.e., concept drifts), constitute a central issue in online data mining. The main reason is that these changes are responsible for outdating stream learning models, reducing their predictive performance over time. A common approach adopted by real-time adaptive systems to deal with concept drifts is to employ detectors that indicate the best time for updates. However, an unrealistic assumption of most detectors is that the labels become available immediately after data arrives. In this paper, we introduce an unsupervised and model-independent concept drift detector suitable for high-speed and high-dimensional data streams in realistic scenarios with the scarcity of labels. We propose a straightforward two-dimensional representation of the data aiming faster processing for detection. We develop a simple adaptive drift detector on this visual representation that is efficient for fast streams with thousands of features and is accurate as existing costly methods that perform various statistical tests. Our method achieves better performance measured by execution time and accuracy in classification problems for different types of drifts, including abrupt, oscillating, and incremental. Experimental evaluation demonstrates the versatility of the method in several domains, including astronomy, entomology, public health, political science, and medical science.

Histopathological Diagnosis Patterns of Oro-Facial Tumours: A Ten-Year Survey

Article

Full-text available

Jan 2020

Mabel O Etetafia

Melanoma and non-melanoma skin cancer among patients who attended at King Khalid University Hospital in Riyadh, Saudi Arabia from 2007 - 2018

Article

Full-text available

Jul 2020

Objectives: To assess the prevalence of melanoma and non-melanoma skin cancer for patients attended King Khalid University Hospital, Riyadh, Saudi Arabia. We are also assessing the most common category of skin cancer to be encountered among those patients. Methods: The authors conducted a retrospective study including all patients (Saudi and non-Saudi) who attended King Khalid University Hospital (KKUH) at the period of (2007-2018). Data were collected from archives of Pathology Department at KKUH and categorized into: melanoma skin cancer (MSC), non-melanoma skin cancer (NMSC), which included: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), pre-neoplastic lesions, and non-neoplastic skin lesions. Results: A total of 111 patients were reported to have skin cancer out of 9828 cases, which had other skin pathology. Majority of cases were basal cell carcinoma with a total number of 76 (68.5%) of all cases. 18 patients (16.2%) were diagnosed with MSC. The remaining 17 patients (15.3%) were diagnosed with squamous cell carcinoma. Conclusion: Skin cancer prevalence and incidence is increasing worldwide. In our study, BCC was the most common type of skin cancer to be reported in our institute, which is similar to the majority of other international studies.

Possible role of the multidrug resistance‐associated protein (MRP) in chemoresistance of human melanoma cells

Article

Mar 1997
INT J CANCER

Human malignant melanoma is characterised by unresponsiveness to conventional chemotherapy. Melanoma‐derived cell lines are often markedly chemoresistant, suggesting that cellular mechanisms mediate the multidrug resistance (MDR) phenotype. The multidrug resistance‐associated protein (MRP) is a drug transporter protein associated with resistance to a broad spectrum of lipophilic drugs. To investigate whether MRP is involved in intrinsic drug resistance of human melanoma, we analysed expression and functional activity of MRP as well as its impact on chemoresistance in 40 melanoma cell lines (35 established by us from primary and metastatic lesions and 5 obtained from international sources), as well as in one dysplastic naevus‐derived cell line and in normal melanocytes. By reverse transcriptase‐polymerase chain reaction various levels of MRP mRNA were detected in all melanoma cell lines, and by immunoblot the corresponding protein in a high percentage of them. Functional activity of MRP was assayed by analysing cellular accumulation of ³H‐daunomycin (³H‐DM) and calcein in response to MRP‐modulators by β‐spectrometric and fluorescence‐activated cell sorter analysis, respectively. Probenecid (PRO), N‐eth‐ylmaleimide (NEM) and benzbromarone (BB) moderately (≤ 1.43‐fold) but significantly enhanced intracellular accumulation of MRP substrate probes corresponding to MRP expression. Moreover, the sensitivity of melanoma cell lines to daunomycin (DM) and doxorubicin (DOX), but not to vinblastine (VBL), etoposide (VP‐16) and cisplatin (CDDP), analysed by an MTT‐based survival assay, were inversely correlated with MRP‐gene expression. Our results imply that MRP may be a component of the intrinsic chemoresistance phenotype characteristic of human malignant melanoma. Int. J. Cancer, 71:108–115, 1997. © 1997 Wiley‐Liss, Inc.

Alterations and prognostic significance of p16 and p53 protein expression in subgroups of cutaneous melanoma

Article

Oct 1997
INT J CANCER

The role of p16 and p53 alterations in cutaneous melanoma has been recently discussed, but it remains to be clarified. In the present immunohistochemical study, the expression of p16 and p53 proteins and their possible prognostic relevance have been examined in 102 melanomas of the aggressive nodular type. Twelve percent showed a strong expression of p53 protein, and these cases were significantly more frequent in the head/neck area compared with other sites (32% vs. 6%). Expression of p16 protein was negative or weak in 9% of the cases, and this tended to be less frequent in head/neck tumors compared with the others (0% vs. 12%). Whereas p53 staining was not prognostically important, loss of p16 staining was significantly associated with markedly reduced recurrence free and patient survival in univariate analysis (product‐limit method). In multivariate analysis, lack of p16 staining was significantly associated with recurrent disease (p = 0.013). Our findings indicate an important role of altered p16 protein expression in a subgroup of melanoma patients. Int. J. Cancer 74:535–539, 1997. © 1997 Wiley‐Liss, Inc.

Evaluation of residual tumors and recurrence rates of malignant melanoma and non-melanoma skin cancer of head and neck region

Article

Full-text available

Oct 2019

Objective: In this study, we aimed to evaluate residual tumors and recurrence rates of malignant melanoma (MM) and a non-melanoma skin cancer of (NMSC) head and neck region. Patients and Methods: Medical data of a total of 398 lesions of 323 patients who underwent surgical excision for a basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM) were retrospectively analyzed. All patients were classified according to age, sex, location of the tumor, histopathological diagnosis, lesion diameter, excision diameter, surgical margin status, and residual lesions and recurrence rates. Results: There were 244 lesions (61.3%) in 189 males and 154 lesions (38.7%) in 134 females. The most common type of skin cancer was BCC in 268 lesions (67%), followed by SCC in 122 (31%), and MM in eight (2%), respectively. Recurrence was seen in 3% of the NMSC cases and in 25% of the MM cases. There was a statistically significant correlation between the histopathological diagnosis and recurrence rates. Compared to NMSC, MM cases had a higher risk for recurrence (p=0.029). Conclusion: Our study results suggest that recurrence is associated with the localization and type of the tumor, but not with the age or sex of the patient.

Modern view on epidermal dysplasia carcinogenesis

Article

Full-text available

Sep 2019

Squamous cell carcinoma of the skin develops from the spectrum of facultative precancerous conditions, which in the course of malignant transformation through cancer stage in situ without early treatment fully transform into invasive squamous cell carcinoma. According to classical model of carcinogenesis, the transformation of actinic keratosis into squamous cell carcinoma of the skin occurs due to a mutation in one gene, more often a tumor suppressor, and undergoes a stage of development with lack of control of cell cycle. The aim of the research is to supplement current knowledge of genetic determination of pathogenetic mechanisms of epidermal dysplasia of the skin by studying the genetic determinant in the skin lesion of varying degrees of malignancy. Materials and methods: We analyzed 85 skin bioptates of patients with epidermal dysplasia of the skin (Gr 1 - 43 patients with actinic keratosis; Gr 2 - 21 patients with non-invasive squamous cell carcinoma of the skin; Gr 3 - 21 patients with invasive squamous cell carcinoma of the skin) by molecular genetic testing of gene polymorphisms: TP53 (G13494A), L-myc (T3109G), TNF-α (G308A) in tumor tissue. The histological examination revealed the levels of dysplasia of the epidermis. Results: In case of the same disease duration in patients of Gr1/Gr3, L-myc (3109TT) is a genetic component of malignant transformation of epithelial skin cells (p = 0.004) and the development of invasive squamous cell carcinoma. Other variants of 3109TG and 3109GG genes do not have such prognostic value for the risk of skin cancer compared to 3109TT. Significant differences were found in the distribution of (13494GA) when comparing Gr 1 with Gr 3 (p = 0.014) and Gr 2 with Gr 3 (p = 0.038). A significant increase in the distribution of 13494GA genotype was revealed in patients with invasive form of keratinocyte intraepidermal neoplasia. 13494A allele was more likely to be detected in patients of Gr 3 compared to Gr 2 (p = 0.030) that proves the association of this allele with the development of invasive malignancies of the skin. The association of 308GG genotype and TNF-α (308G) allele with the development of malignant skin lesions was found. Comparing the distribution of 308G allele in patients of Gr 1 and Gr 2, we found its significant increase in patients of Gr 1. Comparative analysis of gene polymorphism with tumor invasion level showed a significant difference only in 308GG genotype between patients with grade III of KIN (keratinocyte intraepidermal neoplasia) in Gr 2 and patients with KIN III of Gr 1 (p = 0.007), and 308GA between patients with KIN III of Gr 2 and KIN III of Gr 1 (p = 0.027). Conclusions: Our work has supplemented modern vision of genetic component in pathogenetic mechanism of the development of epidermal dysplasia of the skin. Thus, the association of L-myc (3109TT) with the development of malignant skin lesions of different invasiveness and the modifying effect of TNF-α (G308A) and TP53 (G13494A) gene variants on pathological transformation in the focus of EDS depending on the level of epithelial dysplasia was revealed.

Stellenwert der Vitamin D-Versorgung von Kindergartenkindern bei Eltern und Erziehern und Implikationen für das Sonnenschutzverhalten

Thesis

Full-text available

Jan 2019

Katharina Schröder

Hintergrund und Ziele Sonnenschutz im Kindesalter stellt einen entscheidenden Beitrag zur Primärpräven-tion von Hautkrebs dar. Gleichzeitig ist Sonnenstrahlung auch für die körpereigene Bildung von Vitamin D notwendig. Für eine optimale Entwicklung sind Kinder auf eine ausreichende Versorgung mit diesem Vitamin angewiesen. Die verstärkte Aufmerksamkeit für die positiven Gesundheitswirkungen des Vitamin D sowie Ver-öffentlichungen über die schlechte Versorgungslage bei Kindern könnten das Son-nenschutzverhalten negativ beeinflussen. Das Ziel dieser Arbeit war es daher, den Stellenwert der Vitamin D-Versorgung für den kindlichen Sonnenschutz bei Eltern und Erziehern zu ermitteln, die Bedeutung verschiedener Einflussgrößen für die Einstellung zum Vitamin D zu erheben und Zusammenhänge zwischen der Vitamin D-Einstellung und dem Sonnenschutzverhalten gegenüber den Kindern zu analysie-ren. Methoden Im Sommer 2016 wurde in 208 Nürnberger Kindergärten eine Befragung der Kin-dergartenleitungen und der Eltern von drei- bis sechsjährigen Kindergartenkindern durchgeführt. Die Erhebung der Daten erfolgte bei den Leitern der jeweiligen Ein-richtung im Rahmen eines standardisierten Interviews; die Befragung der Eltern wurde mittels eines anonymen, selbst auszufüllenden Fragebogens durchgeführt. An der Studie beteiligten sich insgesamt 190 Kindergartenleitungen (Responserate Erzieherbefragung 64,2%) und 3.220 Eltern (Responserate Elternbefragung 37,7%). Für die Analysen der vorliegenden Arbeit wurden sowohl die Angaben der Eltern als auch der Kindergartenleitungen berücksichtigt. Ergebnisse und Beobachtungen Die Vitamin D-Versorgung der Kinder war nur für einen geringen Anteil der Teil-nehmer bei Entscheidungen zum Sonnenschutz relevant. Dabei wurde die Vitamin D-Versorgung im Kollektiv der Eltern häufiger beachtet als im Erzieherkollektiv (30,0% vs. 11,0%). Weitere 27,0% der teilnehmenden Eltern und 11,6% der Erzie-her fühlten sich zum Thema Vitamin D nicht ausreichend informiert. Die Beachtung der kindlichen Vitamin D-Versorgung unterlag verschiedenen Ein-flussfaktoren. In der Befragung der Erzieher war sie assoziiert mit einem höheren Alter der Teilnehmer. In der Elternbefragung zeigte sich eine positive Assoziation zwischen der Berücksichtigung der Vitamin D-Versorgung und einem Migrations-hintergrund. Teilnehmer mit einem akademischen Bildungsabschluss beachteten die Vitamin D-Versorgung der Kinder dagegen seltener. Aufmerksamkeit gegenüber Vitamin D war darüber hinaus assoziiert mit einer Bräunungsintention der Eltern, geringeren Erfahrungen mit Hautkrebs und besseren Kenntnissen zum UV-Index. Die Beachtung der Vitamin D-Versorgung hatte keine negativen Auswirkungen auf das Sonnenschutzverhalten. Unter Berücksichtigung des Einflusses der soziodemo-graphischen Faktoren zeigte sich sogar ein positiver Effekt der Aufmerksamkeit gegenüber Vitamin D auf die Summe der bei den Kindern praktizierten Sonnen-schutzmaßnahmen. Es ergab sich außerdem eine kürzere Aufenthaltsdauer im Freien sowie ein selteneres Auftreten von Hautrötungen bei Kindern Vitamin D-sensitiver Eltern. Schlussfolgerungen Die Studie zeigt, dass der Stellenwert der kindlichen Vitamin D-Versorgung bei Sonnenschutzentscheidungen für die Betreuungspersonen eher gering ist und ein nicht unerhebliches Informationsdefizit besteht. Es bedarf daher bei Erziehern und Eltern intensiver Aufklärungsarbeit zum Thema Vitamin D. Diese sollte in Form von Fortbildungen und Elterninformationsabenden im Kindergarten erfolgen und mit Aufklärung zum Thema Sonnenschutz kombiniert werden, um die Vereinbarkeit der beiden Themen deutlich zu machen. Weitere Untersuchungen sollten unter anderem die Beweggründe für die unter-schiedlichen Einstellungen zum Vitamin D erheben und konkrete Wissenslücken zur Thematik ermitteln, um Hindernisse in der praktischen Umsetzung erkennen und zukünftige Informationskampagnen zielgerichtet gestalten zu können. Die Ergeb-nisse der vorliegenden Arbeit geben dabei keinen Anlass zu der Sorge, dass eine vermehrte Thematisierung der Vitamin D-Versorgung zu einer Vernachlässigung der UV-Protektion und damit zu einer möglichen Hautschädigung führt.

Cytotoxicity and apoptosis induction in breast cancer, skin cancer and glioblastoma cells by plant extracts

Article

Full-text available

Oct 2019
MOL BIOL REP

Medicinal plants can be candidate as a common alternative for cancer treatment according to natural landscaping and native plants in each country. The aim of this study was the evaluations of cytotoxicity, apoptosis, and cell cycle arrest induction by using seven leaves extracts of Catharanthus roseus, Calystegia sepium, Berberis integerrima, Mahonia fortunei, Melia azedarach, Plantago major, Betula pendula and one bulb extract of Narcissus tazetta. Extracts were assessed on three cancer cell lines including MCF-7 breast cancer cells, A431 epidermal cell line, and U87-MG glioma cell line that were compared to HGF-1 as normal cells. According to analysis of MTT, methanolic extract of C. sepium leaves increased significantly the rate of cell death in all cancer cell lines when compared to HGF-1 as normal cells. Among different extracts, methanolic extract of C. roseus leaves and methanolic extract of C. sepium leaves indicated a crucial role in apoptosis of cancer cells according to evidences from MTT assay, cell cycle analysis, and apoptosis assay. Doxorubicin has been used as standard drug to compare with IC50 s of different extracts. In addition, the encapsulation of methanolic and ethanolic extracts in small unilamellar vesicles form (SUV) increased the cytotoxicity on cancer cell lines and normal cells. Our results indicated that different extracts can differently affect the cytotoxicity rate in variety of cancer cell lines.

Deri Kanseri Hastalarının Serum Oksidatif Stres Parametrelerinin Değerlendirilmesi

Article

Dec 2018

Giriş ve amaç: Deri kanserleri en sık görülen kanserlerden biridir. Bu kanserler non melanomve melanom olarak genellikle iki grup altında incelenir ve çoğu nonmelanomadır. Deri kanserlerinininsidansı ve mortalite oranları tüm dünyada giderek artmaktadır. Bu çalışmada hücre içiantioksidanlar olan superoksit dismutaz (SOD), katalaz (CAT), redükte glutatyon (GSH), glutatyonredüktaz (GR), glutatyon peroksidaz (GPx) gibi moleküller ile oksidatif stres belirteci olan malondialdehit(MDA) değerlerini deri kanseri hastalarında incelemek istedik.Materyal ve metod: Prospektif çalışma modifiye edilen Dünya Helsinki Deklarasyonu'na göreuygulandı. Bu çalışma üniversite hastanesinin dermatoloji departmanında yapıldı. Çalışmaya 30deri kanseri hastası ve 30 sağlıklı gönüllü alındı. Çalışmaya katılanların serumlarında hücre içiantioksidantlar ve malondialdehit seviyeleri değerlendirildiBulgular: Çalışma 33 erkek (%55), 27 kadın (%45) olmak üzere toplam 60 kişi ile gerçekleştirilmiştir.Çalışmaya katılan kişilerin hasta ve kontrol grubuna göre yaş ve cinsiyet değişkenlerikarşılaştırılmış aralarında anlamlı farklılık saptanmamıştır (p>0.05). GPx, GR, GSH, SOD, MDA,CAT değerlerinin, hasta ve kontrol grup ortalamaları arasındaki fark istatistik olarak önemli bulunmuştur(p<0.05).Sonuç: Bu çalışma deri kanseri hastalarında antioksidan serum düzeylerinin azaldığını ve oksidatifstres belirteci olan MDA’nın yüksek olduğunu göstermiştir.Anahtar Sözcu¨kler: Deri kanseri; Superoksit dismutaz; KatalazABSTRACTIntroduction and objectives: Skin cancers are one of the most common cancers. Thesecancers are usually examined under two groups as non-melanomas and melanomas, and mostnonmelanomas are . The incidence and mortality rates of skin cancers are increasing all over theworld. In this study, we want to investigated the intracellular antioxidants such as superoxidedismutase (SOD), catalase (CAT), reductase glutathione (GSH), glutathione reductase (GR),glutathione peroxidase (GPx) and malondialdehyde (MDA) values, which are oxidative stressmarkers, in skin cancer patientsMaterial and method: The prospective study was carried out according to the modified WorldHelsinki Declaration. This study was done in the dermatology department of the universityhospital. Thirty skin cancer patients and 30 healthy volunteers were included in the study.Intracellular antioxidants and levels of malondialdehyde were evaluated of participants in thestudyResults: The study consisted of 33 men (55%) and 27 women (45%). There was no significantdifference between the age and gender variables of the study participants according to thepatient and control group (p>0.05). The difference between GPx, GR, GSH, SOD, MDA, CATvalues, patient and control group averages were statistically significant (p<0.05).Conclusion: This study has shown that antioxidant serum levels are decreased in skin cancerpatients and MDA, an oxidative stress marker, is high.Keywords: Skin cancer; Superoxide dismutase; CatalaseBu çalışma Yüzüncüyıl Üniversitesi Bilimsel Araştırma Başkanlığı tarafından, 2015-TF-B321 numaralıproje ile desteklenmiştir.

Isolated limb perfusion for unresectable extremity cutaneous squamous cell carcinoma; an effective limb saving strategy

Article

Full-text available

Jul 2018

Background: A small minority of patients present with locally advanced cutaneous Squamous Cell Carcinoma (cSCC). The aim of this study was to evaluate the effectiveness of Tumour necrosis factor α (TNF) and melphalan based isolated limb perfusion (TM-ILP) as a limb saving strategy for locally advanced extremity cSCC. Methods: A retrospective search from prospectively maintained databases, at two tertiary referral centers, was performed to identify patients treated with TM-ILP for locally advanced cSSC of an extremity between 2000 and 2015. Results: A total of 30 patients treated with TM-ILP for cSCC were identified, with a median age of 71 years (36-92) and 50% female. Response could not be evaluated in 3 patients. After a median follow up of 25 months, the overall response rate was 81% (n = 22), with 16 patients having a complete response (CR, 59%). A total of 7 patients developed local recurrence, with a median time to recurrence of 9 months (Interquartile Range 7-10). Progressive disease was observed in 5 patients (19%). Limb salvage rate was 80%. The overall 2-year survival was 67%. Conclusions: TM-ILP should be considered as an option in patients with locally advanced cSCC in specialised centers, resulting in a high limb salvage rate.

Comprehensive Study to Decline the Burden of Skin Cancer

Article

Full-text available

Mar 2018

Skin cancer is the most common malignancy worldwide, including malignant melanoma and Non-malignant melanoma. The progressive increase in the incidence of skin cancers is observed, mainly in cutaneous melanomas over the last few decades. UV exposure is the most common cause of skin cancer, which occurs due to mutations in the DNA of skin cells. The mutation in MAPK pathway was the main cause of the skin cancer, in which BRAF gene undergoes 75 somatic mutations. The mutation in DNA suppressed the tumor suppressor gene p53, inactivates DNA repair gene and causes mutation in proto-oncogene results in the formation of oncogene which promote the cell growth, cell proliferation and cell reproduction by affecting the process of apoptosis. Skin cancer can be prevented by healthy dietary intervention and regular physical activity. In the current review, we highlight recent global trends in the treatments of skin cancer which involve chemotherapy, radiotherapy, photodynamic therapy, biological therapy and surgery. These therapies show the effectiveness by improving the survival rate and quality of life.

Near-Infrared Responsive PEGylated Gold Nanorod and Doxorubicin Loaded Dissolvable Hyaluronic Acid Microneedles for Human Epidermoid Cancer Therapy

Article

May 2018

Currently, epidermoid cancer is one of the most common malignancies among Caucasians. Traditional treatment may yield uncomfortable side effects for the patient. In order to solve these problems, the authors develop a near‐infrared (NIR) responsive PEGylated gold nanorod (GNR‐PEG) and doxorubicin (DOX) loaded dissolvable hyaluronic acid (HA) microneedle (GNR‐PEG&DOX@HA MN) for human epidermoid cancer therapy. The as‐made GNR‐PEG&DOX@HA MNs has good skin penetration capability and heating ability. The heating can be transferred to the center of the tumor sites and the temperature is shown to rise up to 60 °C within 5 min. Meanwhile, the release behavior of the DOX from GNR‐PEG&DOX@HA MNs can be controlled by NIR light. The GNR‐PEG&DOX@HA MNs shows good cell inhibition, and the photothermal effect is shown to completely destroy A431 cells in vitro. For in vivo antitumor study, the group treated with GNR‐PEG&DOX@HA MNs transcutaneously reveals a remarkable antitumor efficacy, such that all mice are cured without recurrence under only one treatment. Hence, this novel transdermal drug delivery strategy offers hope to human epidermoid cancer therapy, and GNR‐PEG&DOX@HA MN may serve as a promising candidate in clinical translation for human epidermoid cancer therapy.

Paleo-oncology: Taking stock and moving forward

Article

Feb 2018

This article serves as an introduction to the International Journal of Paleopathology's special issue, Paleo-oncology: Taking Stock and Moving Forward. Reflecting the goals of the special issue, this paper has been designed to provide an overview of the current state of paleo-oncology, to introduce new and innovative paleo-oncological research and ideas, and to serve as a catalyst for future discussions and progress. This paper begins with an overview of the paleo-oncological evidence that can be found in ancient remains, followed by a summary of significant paleo-oncological findings and methodological advances to date. Thereafter, challenges in estimating past prevalence of cancer are highlighted and recommendations are made for future advancements in paleo-oncological research. The ground-breaking studies included in the special issue and referenced throughout this introduction embody the many ways in which progress can be made in the field of paleo-oncology.

Optimal selection of features using wavelet fractal descriptors and automatic correlation bias reduction for classifying skin lesions

Article

Oct 2017
BIOMED SIGNAL PROCES

The non-invasive computerized image analysis techniques have a great impact on accurate and uniform evaluation of skin abnormalities. The paper reports a method for the texture and morphological feature extraction from skin lesion images to differentiate common melanoma from benign nevi. In this work, a 2D wavelet packet decomposition (WPD) based fractal texture analysis has been proposed to extract the irregular texture pattern of the skin lesion area. On the whole 6214 features have been extracted from each of the 4094 skin lesion images, by analyzing the textural pattern and morphological structure of the lesion area. For the identification of the most efficient feature set, an improved correlation bias reduction method has been introduced in combination with support vector machine recursive feature elimination (SVM-RFE). An automatic selection of correlation threshold value has been introduced in this proposed work to eliminate the correlation bias problem associated with SVM-RFE algorithm. With these selected features, the support vector machine (SVM) classifier with radial basis function is found to achieve the classification performance of 97.63% sensitivity, 100% specificity and 98.28% identification accuracy. The results show that the scheme presented in this paper surpasses the performance of the other state-of-the art techniques for the differentiation of melanoma from other skin abnormalities.

ADA-07 Suppresses Solar Ultraviolet–Induced Skin Carcinogenesis by Directly Inhibiting TOPK

Article

Jun 2017

Cumulative exposure to solar ultraviolet (SUV) irradiation is regarded as the major etiologic factor in the development of skin cancer. The activation of the mitogen-activated protein kinase (MAPK) cascades occurs rapidly and is vital in the regulation of SUV-induced cellular responses. The T-LAK cell-originated protein kinase (TOPK), an upstream activator of MAPKs, is heavily involved in inflammation, DNA damage, and tumor development. However, the chemopreventive and therapeutic effects of specific TOPK inhibitors in SUV-induced skin cancer have not yet been elucidated. In the current study, ADA-07, a novel TOPK inhibitor, was synthesized and characterized. Pull-down assay results, ATP competition and in vitro kinase assay data revealed that ADA-07 interacted with TOPK at the ATP-binding pocket and inhibited its kinase activity. Western blot analysis showed that ADA-07 suppressed SUV-induced phosphorylation of ERK1/2, p38, and JNKs, and subsequently inhibited AP-1 activity. Importantly, topical treatment with ADA-07 dramatically attenuated tumor incidence, multiplicity, and volume in SKH-1 hairless mice exposed to chronic SUV. Our findings suggest that ADA-07 is a promising chemopreventive or potential therapeutic agent against SUV-induced skin carcinogenesis that acts by specifically targeting TOPK.

Spatial Analysis of Skin Cancer Incidence in Iran

Article

Full-text available

Jun 2016
ASIAN PAC J CANCER P

Skin cancer is one of the most common cancers worldwide, including in Iran. Variations in its incidence rate among geographical areas are due to various contributing factors. Since there has been a lack of studies on this topic in our country, the present spatial analysis of skin cancer incidence in Iran in 2009 was conducted using data from the cancer registry system for the country. The reported incidences of the disease were standardized on the basis of the World Health Organization population and the direct method. Then the data were inserted into the GIS software, and finally, using the analysis of hot spots (Getis-Ord Gi), high-risk areas were drawn. Provinces that were 1.9 SD higher or lower than the national average were considered hot spots or cold spots, with significance at the level of 0.05. In 2009, a total of 9,964 cases of skin cancer occurred, 3,696 in women and 6,268 in men (standardized incidence rates of 15.8 and 22.6, respectively). The results of the study showed that in men and women, the disease demonstrated high incidence in the central provinces and desert regions. In women, Yazd Province and in men, Qom Province had significant hot spots (p =0.05). While Isfahan, Markazi, Tehran and Kurdistan provinces were expected to be hot spots, the differences from the national average were not significant at the 0.05 level. As well, the provinces of Sistan Va Baluchistan, Kerman, and Hormozgan were identified as cold or low-risk disease regions (p <0.05). The central provinces of the country due to hot weather conditions, more solar radiation, and closer vicinity to the central desert of Iran demonstrated higher incidence rates for skin cancer, so further epidemiological studies into the etiology and early detection are essential in these areas.

Mohs Micrographic Surgery for Treatment of Non-Melanoma Skin Cancer Involving the Nipple-Areola Complex: A Case Series of 8 Patients

Article

Oct 2023

Retinoic acid metabolism in cancer: potential feasibility of retinoic acid metabolism blocking therapy

Article

Jan 2023

Retinoic acid (RA) is an active metabolite of vitamin A, which is an essential signaling molecule involved in cell fate decisions, such as differentiation, proliferation, and apoptosis, in a wide variety of cell types. Accumulated data have demonstrated that expression of RA-metabolizing enzymes, CYP26A1, B1, and C1 (cytochrome P450, family 26A1, B1, and C1, respectively), protects cells and tissues from exposure to RA through restriction of RA access to transcriptional machinery by converting RA to rapidly excreted derivatives. CYP26 enzymes play similar but separate roles in limiting the consequences of fluctuations in nutritional vitamin A. Recently, we found that RA depletion caused by expression of CYP26A1 promotes malignant behaviors of tumor cells derived from various tissues, implicating CYP26A1 as a candidate oncogene. We also showed that the expression levels of CYP26 enzymes are elevated in various types of cancer. We have provided evidence for oncogenic and cell survival properties of CYP26 enzymes, indicating that these molecules are possible therapeutic targets for CYP26-expressing malignancies.

A nationwide study of the incidence and trends of first and multiple basal cell carcinoma in the Netherlands and prediction of future incidence

Article

Nov 2021

Background Basal cell carcinoma (BCC) is the most frequently diagnosed malignancy worldwide and an ever increasing annual incidence is observed. However, nationwide registries of BCCs are very rare and often extrapolation of the data was necessary to estimate the absolute number of diagnoses. Since September 2016, all histopathologically confirmed BCCs are registered in the Netherlands, due to developments in automatic notification and import in the Netherlands cancer registry. This offers the unique possibility to assess the nationwide population-based incidence of first and multiple BCC. Objectives The current study aims to assess nationwide incidence and trends of first and multiple BCC in the Netherlands and to predict incidence rates up to 2029. Methods All patients with histopathologically confirmed BCC between 2001 and 2019 were selected from the population-based Netherlands Cancer Registry. Age-standardized incidence rates were calculated and trends were analyzed with use of the estimated annual percentage change. Prediction of BCC incidence rates up to 2029 was based on a regression model. Results In total, 601,806 patients were diagnosed with a first BCC over the period 2001-2019. The age-standardized incidence rates for both men and women with a first BCC increased over these years from 158 to 304 and 124 to 274 per 100,000 person-years, respectively. For male and female patients aged between 30-39 years, decreases in annual incidences of -3.6% and -3.0% were found in recent years, respectively. For patients aged 50 years or older an ever increasing trend was found. A quarter of the patients with a first primary BCC developed one or more subsequent BCCs within three years. Increases in incidence of 30.4% (male) and 25.3% (female) is expected in the next 10 years. Conclusions BCC incidence doubled over the past decades. Trends seemed to stabilize in recent years for patients aged below 50 years. This might be a first sign of a decreasing trend. The incidence keeps rising in patients aged 50 years and older. In the next decade a further increase in BCC incidence is expected.

Melanoma Detection Computer System Development with Deep Neural Networks

Chapter

Jan 2020

This paper examines the problem of detecting skin malignancies, in particular, melanoma, from the analysis of dermoscopic images using deep learning methods. For this purpose, a deep convolutional neural network architecture was developed, which was used to process dermoscopic images of various skin lesions contained in the HAM10000 data set. The studied images were previously cleared of noise and other contaminants for processing by neural networks. In addition, since the disease classes are unbalanced, a number of transformations have been made to balance them. At the first stage, the images were divided into two classes: melanoma and benign tumor. At the second stage, all images of skin injuries were grouped into seven classes. Computer experiments on the use of the constructed deep neural network on the data obtained in this way have shown that the proposed approach provides 91%.

Molecular Biology of Basal and Squamous Cell Carcinomas

Article

Sep 2020
ADV EXP MED BIOL

The prevalent keratinocyte-derived neoplasms of the skin are basal cell carcinoma and squamous cell carcinoma. Both so-called non-melanoma skin cancers comprise the most common cancers in humans by far. Common risk factors for both tumor entities include sun exposure, DNA repair deficiencies leading to chromosomal instability, or immunosuppression. Yet, fundamental differences in the development of the two different entities have been and are currently unveiled. The constitutive activation of the sonic hedgehog signaling pathway by acquired mutations in the PTCH and SMO genes appears to represent the early basal cell carcinoma developmental determinant. Although other signaling pathways are also affected, small hedgehog inhibitory molecules evolve as the most promising basal cell carcinoma treatment options systemically as well as topically in current clinical trials. For squamous cell carcinoma development, mutations in the p53 gene, especially UV-induced mutations, have been identified as early events. Yet, other signaling pathways including epidermal growth factor receptor, RAS, Fyn, or p16INK4a signaling may play significant roles in squamous cell carcinoma development. The improved understanding of the molecular events leading to different tumor entities by de-differentiation of the same cell type has begun to pave the way for modulating new molecular targets therapeutically with small molecules.

The Cell Biology Of Basal Cell Carcinoma. Relationship To Histology And Clinical Outcome.

Thesis

Jan 1999

Nigel Horlock

Basal cell carcinomas presents with extremely diverse clinical and histological appearances and behaviour. Currently there is little understanding of the biological processes that determine these variations. In an attempt to understand these differences, this thesis evaluated some aspects of the cell biology of BCC both a prospective series and in archival specimens. A variety of measurements were assessed in combination with patient factors (age, presentation etc.) and medical factors (type and adequacy of treatment). The cell kinetics of BCC was studied in vivo following administration of bromodeoxyuridine, which was analysed by flow cytometry. The growth fraction (Ki-67 immunohistochemistry) and the contribution of cell loss to the overall tumour kinetics were studied by evaluating apoptosis (morphologically) and the bcl-2, bax and p53 protein expression, using immunohistochemistry, in both the prospective and archival specimens (including non recurrent, recurrent and horrifying BCCs). It was apparent that BCCs are highly proliferative tumours with a median Ts of 7.6 hours (range 5.0-14-6), Tpot 2.8 days (range 4.0-18.3 days), LI 14%, and Gf 32%. Cell production rates were related to the histological growth pattern with infiltrative and morpheic tumours having a higher Gf than the nodular tumours (p<0.01) and a shorter Tc and Tpot. Cell proliferation was not related to differentiation status. The median apoptotic index was 1% (range l%-5%) and in the absence of apoptotic rate measurements, it was difficult to equate the contribution of apoptosis to the paradox of the slow clinical growth of BCCs. However, the concept of a high apoptotic rate was not supported by bcl-2 and bax protein expression. 88% of BCCs expressed bcl-2 and 23% expressed bax. The relationship between p53 expression and apoptosis was unclear since there was no correlation of p53 with bax, bcl-2 or apoptosis. The apoptotic parameters displayed some relationship to the histological growth patterns. The infiltrative and morpheic tumours exhibited the least apoptosis and least bcl-2 expression (p=0.02), but p53 did not correlate with tumour histology. The contribution of biological factors in determining outcome (the development of recurrence or a horrifying tumour) in BCC are limited because patient factors (late presentation) and treatment factors are dominant. Incomplete excision was associated with recurrence and the development of a horrifying tumour when compared to non recurrent tumours (p<0.01). Primary radiotherapy was also associated with the development of a horrifying tumour (p<0.01). A novel treatment modality, the optomechanically flash scanned carbon dioxide laser, was evaluated to assess its ability to completely ablate BCCs. Complete ablation was associated with ablation depth (p<0.01) and tumour type (p=0.01). Superficial BCCs were most suitable for this modality but required lasering to the middle dermis or deeper for complete eradication. Identification of problem BCCs at an early stage still requires further research but this thesis highlights the need for further improvement in surgical treatment.

Whole-Exome and Transcriptome Analysis of UV-Exposed Epidermis and Carcinoma In Situ Reveals Early Drivers of Carcinogenesis

Article

Jul 2020

Squamous cell carcinoma in situ (SCCIS) is a prevalent precancerous lesion that can progress to cutaneous squamous cell carcinoma (cSCC). Although SCCIS is common, its pathogenesis remains poorly understood. To better understand SCCIS development, we performed laser-captured microdissection of human SCCIS and adjacent epidermis to isolate genomic DNA and RNA for next generation sequencing. Whole exome sequencing (WES) identified UV-signature mutations in multiple genes including Notch 1-3 in the epidermis and SCCIS and oncogenic TP53 mutations in SCCIS. Gene families, including SCHLAFEN genes, contained UV/oxidative-signature disruptive (UVD) epidermal mutations that manifested positive selection in SCCIS. The frequency and distribution of NOTCH and TP53 mutations indicate that NOTCH mutations may precede TP53 mutations. RNA sequencing identified 1166 differentially expressed genes; the top 5 enriched GO biological processes included: 1) immune response, 2) epidermal development, 3) protein phosphorylation, 4) regulation of catalytic activity, 5) cytoskeletal regulation. The NEURL1 ubiquitin ligase, which targets Notch ligands for degradation, was upregulated in SCCIS. Neuralized 1 protein was found to be elevated in SCCIS suggesting that increased levels could represent a mechanism for downregulating Notch during UV-induced carcinogenesis. The data from DNA and RNA sequencing of epidermis and SCCIS provide insights regarding SCCIS formation.

Radiothdrapie et tumeurs cutankes

Article

Jun 2020

Role of community pharmacists in skin cancer screening: A descriptive study of skin cancer risk factors prevalence and photoprotection habits in Barcelona, Catalonia, Spain

Article

Full-text available

Aug 2019

Background: Skin cancer incidence is increasing alarmingly, despite current efforts trying to improve its early detection. Community pharmacists have proven success in implementing screening protocols for a number of diseases because of their skills and easy access. Objective: To evaluate the prevalence of skin cancer risk factors and the photoprotection habits with a questionnaire in community pharmacy users. Methods: A research group consisting of pharmacists and dermatologists conducted a descriptive cross-sectional study to assess photoprotection habits and skin cancer risk factors by using a validated questionnaire in 218 community pharmacies in Barcelona from May 23rd to June 13th 2016. All participants received health education on photoprotection and skin cancer prevention. Patients with ≥1 skin cancer risk factor were referred to their physician, as they needed further screening of skin cancer. Results: A total of 5,530 participants were evaluated. Of those, only 20.2% participants had received a total body skin examination for skin cancer screening in the past by a physician and 57.1% reported using a SPF 50+ sunscreen. 53.9% participants presented ≥1 skin cancer risk factor: 11.8% participants reported having skin cancer familial history and 6.2% reported skin cancer personal history; pharmacists found ≥10 melanocytic nevi in 43.8% participants and chronically sun-damaged skin in 21.4%. Lesions suspicious for melanoma were reported in 10.9% of the participants and urgent dermatological evaluation was recommended. Conclusions: Pharmacists can detect people with skin cancer risk factors amongst their users. This intervention can be considered in multidisciplinary strategies of skin cancer screening.

Actinic keratosis area and severity index (AKASI) is associated with the incidence of squamous cell carcinoma

Article

Nov 2017
J EUR ACAD DERMATOL

Background: Actinic keratoses (AKs) are commonly diagnosed clinically. Actinic keratosis area and severity index (AKASI) is a new easy-to-use tool to assess the severity of AK on the head. Objective: To determine the association between chronically UV-induced tumours such as basal cell carcinomas (BCC) or squamous cell carcinomas (SCC) and AKASI. Methods: We performed a retrospective analysis of patients who had undergone oncological surgery due to UV-induced tumours and who were assessed for AKASI and Physician's Global Assessment (PGA) prior to surgery. Statistical analysis was performed to evaluate correlation between AKASI, PGA and invasive carcinomas. Results: Of the 210 patients included, 26 patients had histologically diagnosed SCCs and presented with a median (range) AKASI of 6.9 (0 - 13.0) and PGA of 2 (0 - 4). In contrast, the 82 patients with BCCs showed a median (range) AKASI of 3.3 (0 -15.2) and PGA of 1 (0 - 4). The Mann-Whitney U test showed significant differences (p= 0.0018) between AKASI of patients with SCC and BCC. In addition, we found a significantly higher AKASI in patients with SCC compared to patients with non-invasive lesions like AK and Bowen disease (BD) (p= 0.0275). Spearman's coefficient of rank correlation between AKASI and PGA indicates that these measures of AK severity were strongly correlated (p< 0.0001; r = 0.90; 95%CI 0,865 to 0,920). Conclusions: Patients with SCC show significantly higher AKASI than patients with BCC or patients without invasive tumours. Hence, AKASI may be used to stratify risk for developing invasive SCC. This article is protected by copyright. All rights reserved.

NSAIDs in Dermatologic Therapy: Review and Preview

Article

Sep 2002

Background Nonsteroidal anti-inflammatory drugs (NSAIDs) have been an important therapy in the treatment of a large number of cutaneous pathologies for more than three decades. Objective In this retrospective review, we document the use of NSAIDs in more than 15 common and uncommon dermatoses, including acne, psoriasis, sunburn, erythema nodosum, cryoglobulinemia, Sweet's syndrome, systemic mastocytosis, as well as urticarial, livedoid, and nodular vasculitis. NSAIDs act mainly by inhibiting prostaglandin synthesis by the cyclooxygenase (COX) pathway. Conclusion Recent studies link prostaglandin to cutaneous carcinogenesis, thus expanding the dermatologic use of NSAIDs. They may be effective in the treatment and prevention of non-melanoma skin cancer, and specific COX-2 inhibitors promise safer, broader, long-term use of these pharmacologically innovative drugs.

“Turn on” fluorescence response of monomethine cyanines caused by noncovalent binding to ct-DNA

Article

May 2017

Monomethine cyanines have been extensively studied for their use as probes for nucleic acids among other biological systems. Four monomethine cyanine dyes were synthesized with various heterocyclic moieties including quinoline, benzoxazole, benzothiazole, and 3,3-dimethylindolenine adjoining benz[c,d]indol-1-ium, which was found to directly influence their optical and energy profiles. The dyes were characterized by ¹H and ¹³C NMR and HRMS. In this study the twisted conformation unique to monomethine cyanines was exploited in DNA binding studies where the benzoxazole containing sensor displayed up to 700-fold increase in fluorescence when bound to the DNA compared to the unbound form.

Incidence of non—melanotic skin cancer in Australia

Article

Full-text available

Feb 1988

In 1985, as part of a national random household omnibus survey by a market research company, 30,976 Australians (mostly of European origin) were asked whether they had ever been treated by a doctor for skin cancer. The treating doctor or hospital was then approached for confirmation of the diagnosis of all those people who claimed to have been so treated within the past 12 months. Demographic data were also collected, permitting analysis by age, sex, country of birth, current residence, and skin reaction to strong sunlight. Melanomas accounted for less than 5% of the tumours treated. The world standardised incidence of melanoma was 19/100,000 population. The standardised incidence of treated non-melanocytic skin cancer in Australia was estimated to be 823/100,000. The standardised rates for basal cell carcinoma and squamous cell carcinoma were 657 and 166/100,000 respectively, yielding a standardised rate ratio of about 4:1. Standardised rates based on medically confirmed cases only were 555, 443, and 112/100,000 for all non-melanocytic skin cancers, basal cell carcinomas, and squamous cell carcinomas respectively. Significant differences and trends in incidence were noted with respect to age and sex. Rates in men were higher than those in women but significantly so only after the age of 60. People born in Australia had a rate of 936/100,000 compared with 402/100,000 in British migrants. Rates for non-melanocytic skin cancer showed a gradient with respect to latitude within Australia. The rate in people residing north of 29 degrees S was 1242/100,000 compared with a rate of 489/100,000 in those living south of 37 degrees S. A person's skin reaction to strong sunlight was a good indicator of the risk of skin cancer, tanning ability being inversely related to its incidence. The rate in those who always burnt and never tanned when exposed to strong sunlight was 1764/100,000 compared with a rate of 616/100,000 in those who always tanned and never burnt. These findings have important implications for public education programmes in relation to exposure to sunlight in Australia.

High risk of malignant melanoma-prone families with dysplastic nevi

Article

Full-text available

May 1985

The risk of hereditary cutaneous malignant melanoma was evaluated in 401 members of 14 families with an autosomal dominant form of melanoma. We documented 127 primary melanomas in 69 family members, including 39 new melanomas diagnosed in 22 study participants from the time of first examination through a maximum of 8 years of follow-up. The 39 newly diagnosed melanomas occurred only in family members with dysplastic nevi, a known precursor of familial melanoma. Of 77 patients with dysplastic nevus syndrome without prior melanomas, 4 developed their first melanoma during prospective follow-up, as compared with 0.03 cases expected. The prospective age-adjusted incidence for melanoma was 14.3/1000 patients with dysplastic nevus per year, with a cumulative melanoma risk (+/- SE) of 7.2% (+/- 3.6) at 8 years. The actuarial probability of melanoma developing in family members with dysplastic nevi was 56.0% (+/- 10.1) from age 20 to age 59. This study confirms that dysplastic nevi are clinical markers of high risk for, and precursors of, hereditary melanoma.

Malignant melanoma: Social status and outdoor work

Article

Full-text available

Jun 1980

The incidence of, and mortality from, malignant melanoma of skin in whites are strongly influenced by socio-economic conditions. Professional and administrative workers have the highest rates of all. Clerks and salesmen have higher rates than skilled manual workers, who have higher rates than unskilled workers. Women, when classified by the occupation of their husbands, show a similar relationship to social status. The biases of incidence data from systems of cancer registration, and mortality data from death certificates are different, and the consistency of the data from different periods and from different populations suggests that the relationship is real. The bulk of the data is from Britain, but there is sufficient from the U.S. to indicate that the effect is not restricted to one country. No consistent increase in risk was found in outdoor workers compared with indoor workers of similar socio-economic status.

Reduction of Solar Keratoses by Regular Sunscreen Use

Article

Full-text available

Nov 1993

The incidence of and mortality from skin cancer are increasing in many countries. In view of the added concern about ozone depletion, many organizations are promoting the regular use of sunscreens to prevent skin cancer, despite the absence of evidence that these products have this effect. Solar (actinic) keratosis is a precursor of squamous-cell carcinoma of the skin. We conducted a randomized, controlled trial of the effect on solar keratoses of daily use of a broad-spectrum sunscreen cream with a sun-protection factor of 17 in 588 people 40 years of age or older in Australia during one summer (September 1991 to March 1992). The subjects applied either a sunscreen cream or the base cream minus the active ingredients of the sunscreen to the head, neck, forearms, and hands. The mean number of solar keratoses increased by 1.0 per subject in the base-cream group and decreased by 0.6 in the sunscreen group (difference, 1.53; 95 percent confidence interval, 0.81 to 2.25). The sunscreen group had fewer new lesions (rate ratio, 0.62; 95 percent confidence interval, 0.54 to 0.71) and more remissions (odds ratio, 1.53; 95 percent confidence interval, 1.29 to 1.80) than the base-cream group. There was a dose-response relation: the amount of sunscreen cream used was related to both the development of new lesions and the remission of existing ones. Regular use of sunscreens prevents the development of solar keratoses and, by implication, possibly reduces the risk of skin cancer in the long-term.

Keratoacanthoma in Kauai, Hawaii: The First Documented Incidence in a Defined Population

Article

Full-text available

Apr 1993
ARCH DERMATOL

A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii, from 1983 through 1987 to investigate the frequency of keratoacanthoma in white residents. A total of 53 residents, 36 men and 17 women, were identified with an initial episode of keratoacanthoma during the 5-year study. The average annual incidence rate per 100,000 Kauai residents, standardized to the US white population, was 144 for men and 73 for women, with a combined rate of 104. The average patient age was 63.5 years. The limbs, particularly the hands and arms, were the most common anatomic site, with the trunk second. Only one patient developed a new subsequent keratoacanthoma, and no recurrent lesions were observed. Three patients had two keratoacanthomas when they first presented, and 13 patients had concurrent skin cancer. Sixty percent (32) of our patients developed skin cancer at one time or another. We report the first population-based keratoacanthoma incidence rates documented in the United States, which are almost equal to those of squamous cell carcinoma. Keratoacanthoma also shares many common epidemiological features with squamous cell carcinoma, such as increasing incidence in progressively older age groups.

DEATH RATES OF MALIGNANT-MELANOMA AMONG WHITE MEN - UNITED-STATES, 1973-1988

Article

Apr 1992
ARCH DERMATOL

High Risk of Malignant Melanoma in Melanoma-Prone Families with Dysplastic Nevi

Article

Apr 1985

Mark H Greene

Cutaneous malignant melanoma, Scotland, 1979-89

Article

Apr 1992

The Scottish Melanoma Group (SMG) was established in 1979 to assess mortality from and incidence, features, pathological data, and management of cutaneous malignant melanoma in Scotland. Incidence during the first five years and five-year survival have already been reported. We now have data about incidence and mortality over eleven years in relation to anatomical site and pathological types. From 1979 to 1989, 1354 male and 2459 female patients with primary cutaneous malignant melanomas were first diagnosed in Scottish residents. The incidence rate per 100 000 population per year has increased from 3·4 in 1979 to 7·1 in 1989 for men, and from 6·6 to 10·4 for women. The overall increase over eleven years is 82% (7·4% per year). The greatest rates of increase are seen in lesions of the superficial spreading histogenetic type, arising on the female leg and the male trunk. Following public education programmes started in 1985, the proportion of all melanomas less than 1·5 mm thick has shown a sustained and significant increase. Mortality data for 1661 patients for whom a minimum of five-year follow-up is available shows five-year survival of 71º6% overall (77·6% for women, 58·7% for men). The survival advantage for women persists when appropriate statistical adjustment is made for thickness, ulceration, and histogenetic type. These data are useful in designing public education programmes aimed at both primary and secondary prevention of melanoma and in auditing changes in trends that might result from such education.

An action spectrum for UV photocarcinogenesis

Article

Mar 1986

Abstract— Hairless mice were irradiated repeatedly by exposure to unfiltered black-light (FR74T12 PUVA) fluorescent lamps and the time to development of skin tumors was determined. For several groups of animals the treatment variable was the size of the weekly dose. A similar approach had been used previously to determine dose-response characteristics for other ultraviolet radiation emitting sources: a xenon arc solar simulator (with a series of five cut-off filters producing five source spectra), and a fluorescent (FS40T12) “sunlamp”. The median tumor latent period (time period for just more than one half of the animals to develop at least one tumor each) was accurately predicted for all these ultraviolet radiation emitting sources by a mathematical equation incorporating the spectral source description and a spectral weighting function. The weighting function judged most appropriate for ultraviolet radiation-induced photocarcinogenesis was the action spectrum, determined previously, for acute (single dose) skin edema in hairless mice. The mathematical equation assigns no effectiveness to wavelengths greater than 330 nm. There was no evidence for wavelength interaction in the spectral range of 26MW nm. Our data, combined with results of others, lead us to conclude that radiation with wavelength greater than 330 nm has an average relative efficacy (297 nm =1.0) less than 0.0002, and that this efficacy is not detectable with sources in which at least 2% of the UV radiation is in the UV-B range.

Do all melanomas come from “moles”? A study of the histological association between melanocytic naevi and melanoma

Article

Aug 1990
AUSTRALAS J DERMATOL

S ummary Histological examination of 1101 melanomas (990 superficial spreading and HI nodular melanomas) from 1098 people revealed that 23.3% showed an associated melanocytic naevus. Of these, 56.5% were classified histologically as common acquired, 37.7% as dysplastic and 5.8% as congenital. Of the superficial spreading melanomas, 25.7% showed an associated naevus. By contrast, only 2.7% of nodular melanomas showed histological evidence of a coexisting naevus. When the superficial spreading melanomas were analysed by level, the presence of a naevus varied from 31.3% of level I melanomas to 21.3% of level IV melanomas. When thickness was measured, an associated naevus was found in 27.0% of superficial spreading melanomas less than 1.0mm thick, and 14.8% of melanomas with a thickness of 1.0mm or greater. These data suggest that most melanomas do not arise in pre‐existing naevi, and accordingly public educational programs for the early detection of melanoma should focus on looking for changes in previously normal skin as well as in pre‐existing moles.

Metastases in Dermatological patients with squamous cell carcinoma

Article

Jul 1979
ARCH DERMATOL

Two hundred eleven patients in whom squamous cell carcinoma (SCC) of the skin had been diagnosed between 1950 and 1959 were followed up from Jan 1, 1976, to establish the incidence of metastases. A systemic study was carried out through follow-up examinations and tracing through population registers. We found 3.3% metastases in 153 patients with skin SCC and 11% metastases in 55 patients with labial SCC. Three patients with genital SCC were free of metastases. These results and the available literature on patients with SCC of osteomyelitic foci and scars from burns or x-ray treatment indicate that sharp distinctions must be made among three groups of SCC; mucocutaneous, primary cutaneous, and cutaneous SCC secondary to inflammatory and degenerative processes. The incidence of metastases in the three groups is approximately 11%, 3%, and 10% to 30%, respectively. Percentages found are important to dermatology clinics because skin SCC should be considered a malignant tumor with a higher incidence of metastases than previously assumed.

Cutaneous malignant melanoma, Scotland, 1979-89. The Scottish Melanoma Group

Article

May 1992

The Scottish Melanoma Group (SMG) was established in 1979 to assess mortality from and incidence, features, pathological data, and management of cutaneous malignant melanoma in Scotland. Incidence during the first five years and five-year survival have already been reported. We now have data about incidence and mortality over eleven years in relation to anatomical site and pathological types. From 1979 to 1989, 1354 male and 2459 female patients with primary cutaneous malignant melanomas were first diagnosed in Scottish residents. The incidence rate per 100,000 population per year has increased from 3.4 in 1979 to 7.1 in 1989 for men, and from 6.6 to 10.4 for women. The overall increase over eleven years is 82% (7.4% per year). The greatest rates of increase are seen in lesions of the superficial spreading histogenetic type, arising on the female leg and the male trunk. Following public education programmes started in 1985, the proportion of all melanomas less than 1.5 mm thick has shown a sustained and significant increase. Mortality data for 1661 patients for whom a minimum of five-year follow-up is available shows five-year survival of 71.6% overall (77.6% for women, 58.7% for men). The survival advantage for women persists when appropriate statistical adjustment is made for thickness, ulceration, and histogenetic type. These data are useful in designing public education programmes aimed at both primary and secondary prevention of melanoma and in auditing changes in trends that might result from such education.

A reversal in the long-term increase in deaths attributable to malignant melanoma

Article

May 1992

For a few years in the 1980s, United States mortality rates suggested a plateau in the long-term increase for malignant melanoma. However, temporary plateaus in the increase of the age-adjusted rate by year of death have occurred in previous decades, only to be followed by a continued upward increase, with a long-term rise of about 2% per year. To determine whether a cessation in the long-term increase might be in progress, death rates were analyzed by year of birth, age at death, and year of death: (1) the long-term patterns of change are best described by birth cohort rather than by time period of death, indicating that analyses by a year of birth are key to a better understanding of the long-term trends; (2) in both men and women, evidence for a change in slope begins among those born in the early 1930s; (3) the decline in the rates begins among women born since the early 1930s and among men born since the early 1950s: the slope for men is -0.2661 (95% confidence limits [CL] = -0.380 to -0.152), and, for women, the slope is -0.02354 (95% CL = -0.041 to -0.005); (4) long-term Connecticut and US mortality trends were similar in pattern and direction, and long-term Connecticut incidence rates showed a persistent increase through the 1955 to 1965 birth cohorts. These analyses suggest a persistent cessation in the long-term increase and a downward trend in death rates from this cancer.

Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip

Article

Jul 1992
J AM ACAD DERMATOL

We reviewed all studies since 1940 on the prognosis of squamous cell carcinoma (SCC) of the skin and lip. The following variables are correlated with local recurrence and metastatic rates: (1) treatment modality, (2) prior treatment, (3) location, (4) size, (5) depth, (6) histologic differentiation, (7) histologic evidence of perineural involvement, (8) precipitating factors other than ultraviolet light, and (9) host immunosuppression. Local recurrences occur less frequently when SCC is treated by Mohs micrographic surgery. This local recurrence rate differential in favor of Mohs micrographic surgery holds true for primary SCC of the skin and lip (3.1% vs 10.9%), for ear SCC (5.3% vs 18.7%), for locally recurrent (previously treated) SCC (10% vs 23.3%), for SCC with perineural involvement (0% vs 47%), for SCC of size greater than 2 cm (25.2% vs 41.7%), and for SCC that is poorly differentiated (32.6% vs 53.6%).

Mortality from Melanoma in Migrants to Australia: Variation by Age at Arrival and Duration of Stay

Article

Jun 1992
AM J EPIDEMIOL

All death records in Australia during the period 1964-1985 were analyzed to compare mortality from melanoma in immigrants and Australian-born individuals, and to investigate changes in risk in the immigrants according to their duration of stay and age at arrival. About 450,000 deaths were from cancer, and risks of melanoma were estimated by logistic regression relative to those of the Australian-born, with deaths from other cancers used as controls. Estimates were adjusted for age at death, time period, birth cohort, and state of registration of death in Australia. Region of birth was defined as New Zealand, other Oceania, England, Ireland/Scotland/Wales (including Northern Ireland and the Republic of Ireland), Central Europe, Eastern Europe, Southern Europe, Western Asia, or Eastern Asia, bearing in mind that many migrants born in Asia were of European descent. Overall, migrants from outside Oceania were at lower risk than the Australian-born, and the lowest risks in males were in Southern Europeans and Eastern Asians, reflecting the protective effect of a darker complexion. Risk of melanoma was related both to duration of stay in Australia and to age at arrival; although their relative importance cannot be measured, the patterns of change suggested that childhood migration may be more important in determining risk than number of years in Australia. The authors believe this study to be based on the largest data set ever used in migrant studies, and note that the previously found differences in melanoma risk between immigrants and Australian-born remained after adjustment for major temporal and geographic confounders. The results confirm the importance of the interaction between environmental and genetic risk factors in the etiology of melanoma.

PUVA and cancer: a large-scale epidemiological study

Article

Aug 1991

There is concern about the long-term carcinogenic effects of psoralen and ultraviolet A radiation (PUVA) therapy for treatment of skin disorders. A study of 4799 Swedish patients (2343 males, 2056 females; mean age at first treatment 45.3 years, range 6-93; mean follow-up 6.9 years males, 7.2 years females) who received PUVA between 1974 and 1985 showed a dose-dependent increase in the risk of squamous cell cancer of the skin. Male patients who had received more than 200 treatments had over 30 times the incidence of squamous cell cancer found in the general population. Significant increases (p less than 0.05) were also found in the incidences of respiratory cancer in males and females, pancreatic cancer in males, and kidney and colonic cancer in females. This study confirms previous reports of a dose-dependent increase in the incidence of squamous cell cancer in patients treated with PUVA.

Cutaneous Melanoma

Article

Aug 1991

Howard Koh

This article has no abstract; the first 100 words appear below. CUTANEOUS melanoma has become a common form of cancer.¹ Decades of steady increases in the incidence and mortality rates of cutaneous malignant melanoma have sparked global interest in the nature of this cancer.²³⁴⁵⁶ Recent research has advanced our understanding of cutaneous melanoma and its biology, natural history, and treatment.⁷ This article reviews the current state of knowledge of melanoma and outlines approaches to treatment and control. Epidemiology The incidence of melanoma continues to rise throughout the world (Table 1). In the United States, the incidence of melanoma has almost tripled in the past four decades, growing faster than that of . . . Supported in part by the Herman and Teddie Topoff Melanoma Research Fund at the Boston University School of Medicine and a grant (5K07–CA01380–03) from the National Institutes of Health. Dr. Koh is the recipient of the Preventive Oncology Academic Award from the National Cancer Institute. I am indebted to Alan Geller, M.P.H., and Mary Beth Mercer, M.P.H., for their invaluable assistance; to Drs. Bob Lew, Don Miller, Barbara Gilchrest, Amal Kurban, Gary Rogers, Jag Bhawan, Mina Yaar, Robert Beazley, Paul Hesketh, Adele Green, and Harry Goldsmith for their thoughtful comments on this manuscript; to Cynthia Barber, M.P.H., for her careful review of this article; and to Dr. Claudia Arrigg for unending encouragement and support. Source Information From the Departments of Dermatology and Medicine and the Section of Epidemiology and Biostatistics, Boston University Schools of Medicine and Public Health, and the Skin Oncology Program, University Hospital, all in Boston. Address reprint requests to Dr. Koh at the Boston University Medical Center, 88 E. Newton St., Boston, MA 02118.

Indications of future decreasing trends in skin-melanoma mortality among Whites in the United States

Article

Oct 1991

Trends in skin melanoma death rates during a 35-year period, 1950-84, were analyzed according to age, sex, and birth cohort for whites in the United States. In contrast to upward trends observed for older men and women (i.e., over 40), downward trends were noted for younger age groups. The risk of dying from skin melanoma appears to have peaked for male cohorts born during the 1950s and for female cohorts born during the 1930s. Assuming no future environmental or lifestyle changes, the upward trend in age-adjusted mortality rates, which averaged 2 to 3% per annum since 1950, is projected to discontinue and bend downward by the second decade of the 21st century. Skin melanoma incidence data, which was limited to a series of 12 years (1973-84) and inadequate for cohort analyses, were included to demonstrate that trends in age-specific rates were comparable with those observed for mortality during the overlapping time period. Incidence trends according to anatomical site are also described. These results indicate that baseline data necessary for assessing the potential effects on this disease from future depletions of the ozone layer, and predicted increases of solar ultra-violet radiation exposure, would be improved with the inclusion of cohort data and age-specific trend analyses.

Temporal trends in the incidence of cutaneous malignant melanoma among Caucasians in the San Francisco-Oakland MSA

Article

Oct 1991

Temporal changes in the incidence of cutaneous malignant melanoma (CMM) were examined in the San Francisco-Oakland (California, United States) Metropolitan Statistical Area (MSA) between 1976 and 1987, using data from the population-based cancer registry. This analysis was conducted after the completion of a project designed to eliminate bias in the reporting of CMM due to changes in medical practice. The incidence of CMM is higher in the San Francisco-Oakland MSA than nationally. From 1976 through 1987, the incidence of invasive CMM increased from 9.8 +/- 0.9 to 16.5 +/- 1.1 per 100,000 (P = 0.0001) among men and from 9.3 +/- 0.8 to 12.7 +/- 0.9 per 100,000 (P = 0.001) among women. Age-specific, histologic-specific, and anatomic site-specific trends were also evaluated. The temporal patterns of CMM suggest that the recent increases are not accounted for solely by ascertainment bias due to reporting practices. The observed trends are consistent with early detection efforts and with changes in the prevalence of risk factors.

Article

Jun 1991

To identify any characteristics of patients that are associated with presentation with thick primary melanoma. This was a retrospective survey of the clinical records of 1300 patients attending the Newcastle Melanoma Unit. Characteristics of 131 patients with thick melanomas (defined as 3 mm or greater in thickness) were compared with those of 543 patients with thin melanomas (defined as 0.75 mm or less in thickness). Comparisons were made using contingency table analysis, Wilcoxon rank sum tests, log rank analysis and logistic regression. The Newcastle Melanoma Unit is a tertiary referral centre for the treatment of primary melanoma. We surveyed all 1300 patients attending the Newcastle Melanoma Unit over the years 1981-1990. They represented approximately 90% of the patients in the Hunter region of New South Wales who developed melanoma during this period. Excluded from analysis were 39 patients with occult primary melanomas, 79 with multiple primary melanomas, 51 with primary melanomas of unknown thickness and seven with incomplete records, leaving 1124 patients in the study. These were selected before the results were known. The hypothesis was generated following analysis of the data. Patients with thick primary melanoma were more likely to be men (68% men and 32% women in the thick melanoma group, compared with 45% and 55% respectively in the thin melanoma group, P less than 0.005) over 60 (75% were over 50 years of age in the thick group versus 33% in the thin melanoma group, P less than 0.001) with nodular melanoma (62%, versus 2% in the thin melanoma group, P less than 0.001) and with melanoma on the head and neck (27%, versus 12% in patients with thin melanoma, P less than 0.005). The time from detection of a change in skin to diagnosis was not longer for those with thick compared to those with thin melanomas. The greatest problem of those with thin melanomas. The greatest problem of detecting melanoma at an early (surgically curable) stage appears to be in patients over the age of 50 who have nodular melanoma, particularly in the head and neck.

Gallagher RP, Ma B, McLean DI, Yang CP, Ho V, Carruthers JA, Warshawski LMTrends in basal cell carcinoma, squamous cell carcinoma, and melanoma of the skin from 1973 through 1987. J Am Acad Dermatol 23: 413-421

Article

Oct 1990
J AM ACAD DERMATOL

Major increases have occurred in the incidence of basal cell carcinoma and squamous cell carcinoma of the skin, as well as in cutaneous malignant melanoma during the period 1973 through 1987 in British Columbia. The greatest increases in basal and squamous cell carcinomas are on the head and neck. This indicates that exposure to sunlight is the major causative factor. The greatest increase in melanoma is on the trunk in men and on the lower limbs in women. The dramatic increases in nonmelanoma skin cancers in British Columbia, a relatively low sunlight area, suggest that major prevention programs are needed in areas that are not considered "sunspots."

The role of childhood sunlight exposure in the development of solar keratoses and non-melanoma skin cancer

Article

Feb 1990

The age-standardized proportion of persons with solar keratoses in 1232 Australian-born persons who were aged 40 years and older was 44.5% compared with a proportion of 15.7% in 1332 British persons who had migrated to Australia at various ages. Stratification of the British migrants into those who had arrived in Australia between one and 20 years of age and those who had arrived in Australia after the age of 20 years revealed that the proportion of persons with solar keratoses in the latter group never reached the proportion in Australian-born persons of the same age, in spite of many years in Australia after migration. Those persons who arrived in Australia between one and 20 years of age showed a lower proportion with solar keratoses in the younger age-groups, but with increasing age the proportion with solar keratoses equalled or exceeded that which was seen in Australians. These results suggest that a reduction in exposure to sunlight in childhood will reduce substantially the incidence of solar keratoses, and by implication, squamous-cell carcinomas, in adulthood.

Skin cancer in Geraldton, Western Australia: A survey of incidence and prevalence

Article

May 1990

A survey of the incidence and prevalence of non-melanocytic skin cancer in Geraldton, Western Australia, was undertaken in November 1987. All residents aged 40 to 64 years whose names were on the electoral roll on August 1, 1987 were invited to undergo a whole-body skin examination by a dermatologist. When a skin cancer was suspected, participants were referred for treatment to their usual medical practitioner. Subjects were asked to recall incident skin cancers over the preceding two years, and medical records were searched for confirmatory evidence. Histological confirmation of all lesions, both prevalent and incident, was sought and sections were obtained for a standardized review. The prevalence of confirmed non-melanocytic skin cancer in those aged 40 to 64 years was 7.0% in men and 4.7% in women. The prevalence of basal-cell carcinoma (BCC) was 6.5% in men and 4.5% in women while the prevalence of squamous-cell carcinoma (SCC) was 1.2% in men and 0.3% in women. The estimated incidence rate of non-melanocytic skin cancer in this age group was 1560 per 100,000 person-years. The estimated incidence rate of BCC in men was 1335 per 100,000 person-years, and in women 817 per 100,000, while in men the estimated incidence rate of SCC was 890 per 100,000 person-years, and in women it was 289 per 100,000 person-years.

Apparent absence of a benign precursor lesion: Implications for the pathogenesis of malignant melanoma

Article

Oct 1989
J AM ACAD DERMATOL

Peter Maimon Ross

This review relates concepts derived from the study of chemically induced skin cancer in animal models to the pathogenesis of malignant melanoma in humans. Most chemically induced experimental cancers in animals, including melanomas in rodents, arise within a benign precursor lesion. The initiation-promotion-progression sequence is a central concept in animal models for carcinogenesis. Many human melanomas appear to arise from epidermal melanocytes, with no associated precursor lesion. This article considers why there is no apparent precursor in many human melanomas and the consequences of this absence. Melanocyte physiology and factors that govern escape from defenses such as DNA repair, local tissue environment, and immunity presumably influence melanocyte conversion to melanoma. These factors may determine the absence of a precursor lesion in primary melanomas. In addition, it is possible that some human melanomas arise by cellular mechanisms different from those causing cancer in rodent models. Both molecular and prospective clinical studies will be required to explain this apparent paradox in the pathogenesis of melanoma. A similar approach may help to explain the origin of basal cell carcinoma and perhaps other human cancers that appear to arise directly from normal cells. From a clinical point of view, the absence of an identifiable, benign precursor lesion requires even greater emphasis on melanoma prevention. Research on mechanisms of ultraviolet carcinogenesis indicates that appropriate postexposure treatments may be useful in preventing long-term consequences of sunburn, including melanoma.

The incidence of non-melanocytic skin cancers in an Australian population: Results of a five-year prospective study

Article

Jun 1989

Two thousand, six hundred and sixty-nine persons who were aged 40 years and older attended for examination of the light-exposed areas of the head and neck, forearms and dorsa of the hands during a skin-cancer survey of the population of Maryborough, which was conducted annually for five years from 1982-1986 inclusive. Sixty (2.25%) persons--12 persons each with a squamous-cell carcinoma and 48 persons with a total of 51 basal-cell carcinomas--had at least one non-melanocytic skin cancer at the first examination. One thousand, nine hundred and eighty-one (74% of the study population) persons were seen on more than one occasion, which allowed for 6288 person-years of follow-up for the determination of the incidence of new cancers. The findings showed a calculated minimal age-standardized incidence rate of 873 non-melanocytic skin cancers/100,000 population each year. The minimal incidence rate for basal-cell carcinomas was 672 cases/100,000 population each year and for squamous-cell carcinomas was 201 cases/100,000 population each year. The rate ratio of the incidence of basal-cell carcinomas to that of squamous-cell carcinomas was 3.34 to one. Age, sex, skin reaction to sunlight and occupation all were significant factors in the determination of the risk of developing non-melanocytic skin cancers. The enormous costs that are involved in the treatment of non-melanocytic skin cancers and related lesions suggest that more time, effort and money need to be spent to reduce what has become a major public-health problem in Australia.

The emerging epidemic of melanoma and squamous cell skin cancer

Article

Nov 1989

Squamous cell skin cancer, though common, remains largely unreported and unstudied, with little known about its incidence and time trends. We have used a unique resource--a continuous population-based registry of cases of squamous cell skin cancer within a single prepaid health plan-to describe basic epidemiologic features of this malignancy and compare it with the more widely studied melanoma. Both malignancies are considerably more common in this population than we expected based on previous reports from the general population. From the 1960s to the 1980s, the incidence of squamous cell skin cancer increased 2.6 times in men and 3.1 times in women, while incidence of melanoma rose 3.5-fold and 4.6-fold in men and women, respectively. Skin cancers of both types involving the head and neck or the extremities increased essentially in parallel over these 27 years. Melanomas of the trunk, however, appeared to increase at a faster rate in both sexes. These observations are consistent with the impression that the rising incidence of both malignancies may be attributable to increased voluntary exposure to the sun over an extended period.

Ozone depletion and cancer risk

Article

Sep 1987

R. Russell Jones

Constatation d'une deperdition inquietante en ozone stratospherique, mesuree notamment au-dessus de l'Antarctique, depassant de beaucoup les previsions. Facteurs responsables. Consequences previsibles: manque d'absorption des UV, risques accrus de cancer. Autres consequences difficiles a prevoir. Avenir incertain

Risk Factors for the Development of Malignant Melanoma-I: Review of Case-Control Studies

Article

May 1988
J Dermatol Surg Oncol

Data concerning risk factors for the development of cutaneous malignant melanoma (MM) were abstracted from published case-control studies. Relative risks (more appropriately "odds ratios") and 95% confidence intervals were quoted or calculated for each risk factor in each study. Those risk factors that were reported to be significant in over half of the studies include: phenotypic factors (blue eyes, blond or red hair, light complexion, freckles, sun sensitivity, and inability to tan); personal history of non-melanoma cutaneous cancer or precancer; higher socioeconomic status; increased numbers of nevocytic nevi; and bursts of sun exposure. Further study is needed on family history and personal history of MM; these were not found to be significant risk factors in over half the reviewed case-control studies. This review leaves out other undoubtedly important risk factors such as dysplastic nervus syndrome and race, which need investigation by the case-control method. Determination of risk factors allows the identification of that subset of the population most at risk for the development of MM. Given the continued increase in the incidence of MM, these data can help to focus preventive measures on the more susceptible subgroups of the population.

The Relationship of Basal Cell Carcinomas and Squamous Cell Carcinomas to Solar Keratoses

Article

Aug 1988
ARCH DERMATOL

Six thousand four hundred sixteen people aged 40 years and over from three different locations in Victoria (Australia) were examined on the hands, forearms, head, and neck for the presence of solar keratoses and basal (BCCs) and squamous cell carcinomas (SCCs). Analysis of the relationship between these tumors revealed that the factors which predicted the likelihood of developing a solar keratosis were essentially the same as those that predicted the likelihood of developing a BCC and/or an SCC. These were age, sex, years of residence in Australia, indoor or outdoor occupation, tanning ability, propensity to sunburn, and location of residence. The presence of a coexisting solar keratosis was necessary for the development of an SCC in contrast to the development of a BCC. The findings suggest that unlike BCCs, the majority of SCCs in light-exposed areas may arise from preexisting solar keratoses. Whereas the prevalence of BCCs and SCCs was relatively constant in the three locations, the prevalence of solar keratoses differed markedly in direct relation to the degree of isolation. This suggests that solar keratoses are a more sensitive indicator of sunlight exposure than invasive carcinoma.

Epidemiology of Malignant Melanoma: Intermittent or Total Accumulated Exposure to the Sun?

Article

Sep 1988
J Dermatol Surg Oncol

Bruce K Armstrong

In accordance with the sunlight hypothesis for its etiology, the incidence of malignant melanoma generally increases with increasing proximity to the equator. There are exceptions to this pattern, prominent among which is the tendency for incidence to increase with increasing distance from the equator beyond latitude 50 degrees north in Europe. This anomaly is probably explicable in terms of climatic factors, geographic variation in skin pigmentation, and the sun-seeking behavior of those in the north. The incidence of malignant melanoma is increasing at about 5% a year in most white populations, while there is no consistent tendency for it to increase in black populations. This difference suggests that the increase is due to increasing sun exposure. Evidence from recent case-control studies is consistent with both intermittent intense exposure and total accumulated exposure to the sun causing an increase in risk of malignant melanoma. Reconciliation of these two different patterns of effect of sun exposure may lie in more careful measurement of sun exposure and analysis of exposure specific to the site at which each melanoma is observed to occur.

Squamous cell carcinoma of the skin. Accuracy of clinical diagnosis and outcome of follow-up in Australia

Article

Apr 1986

The accuracy of the clinical diagnosis of 1292 non-melanotic skin tumours that were submitted to a private pathology service in 1980-1981 was determined. The clinical diagnosis that was written on the pathology slip which was submitted with the tumour was correlated with the histological diagnosis and the type of medical practitioner submitting the lesion. The clinical diagnosis was most accurate in the case of basal cell carcinoma; dermatologists most often reached this diagnosis correctly. For squamous cell carcinoma, although most frequently the lesions were diagnosed correctly clinically by dermatologists, their clinical diagnosis was confirmed in only 51% of cases. On average, 36% of squamous cell carcinomas were diagnosed clinically as basal cell carcinomas. The clinical course of 299 patients with a total of 305 squamous cell carcinomas that were selected from the squamous cell carcinomas that were submitted in 1980-1981 was traced. Four tumours (1.6%) which occurred in sun-exposed areas of the body metastasized, and 18 (7.5%) recurred locally. We conclude that those non-melanotic skin tumours which have the most potential to metastasize (squamous cell carcinomas) are those which are most poorly diagnosed clinically. It is recommended that patients with non-melanotic skin cancers should undergo biopsy as a routine to confirm the clinical diagnosis. Those who have a squamous cell carcinoma removed should be followed up for at least two years after the initial treatment.

Number of melanocyte nevi as a major risk factor for cutaneous melanoma

Article

Oct 1987
J AM ACAD DERMATOL

A study of 121 melanoma patients and 139 control subjects from the University of California, San Francisco clinics was conducted among whites to examine the relationship between number of melanocytic nevi and cutaneous melanoma. Nevi that measured 2 mm or more in diameter were counted over the body by a dermatologist and a dermatology fellow. The average number of nondysplastic melanocytic nevi that were 2 mm or greater in diameter was 97 for melanoma patients and 36 for control subjects (p less than 0.001). Relative risks were 1.6 (p = 0.43) for 11 to 25 nevi, 4.4 (p = 0.01) for 26 to 50 nevi, 5.4 (p = 0.008) for 51 to 100 nevi, and 9.8 (p = 0.001) for more than 100 nondysplastic melanocytic nevi. Relative risks were 3.8 (p = 0.001) for 1 to 5 dysplastic nevi and 6.3 (p = 0.003) for 6 or more of these lesions. Report of blistering sunburns or of a previous skin cancer and having red or blond hair at the age of 20 were also independently associated with an increased risk of cutaneous melanoma. If confirmed in larger studies, the results presented on number of nevi and melanoma risk suggest a readily identifiable melanoma-prone group that could be followed to detect early malignant melanoma.

Cutaneous melanoma in association with other skin cancer

Article

Jun 1985

A case-control study of 232 cases of cutaneous malignant melanoma and 232 matched controls was performed to assess the association of the disease with nonmelanotic skin tumors--basal cell carcinomas, squamous cell carcinomas, and solar keratoses. There was a fourfold increase in risk of melanoma of all types when actinic tumors were present on the face. The risk was not restricted to the lentigo malignant melanoma class as might be expected but was significantly raised for superficial spreading melanoma and nodular melanoma as well (relative risk, 2.8; 95% confidence interval, 1.1-7.2). This relationship with lesions known to be associated with high-dose solar UV irradiation was supported by quantitative evidence that heavy sun exposure was associated with an increased risk of malignant melanoma.

Non-melanoma skin cancer among Caucasians in four areas of the United States

Article

Nov 1974

A survey of the incidence of non-melanoma skin cancer was undertaken in four areas which included about ten million people. Complete reporting of all newly diagnosed cases of skin cancer which occurred during the survey period of September 1, 1971 to February 29, 1972 was obtained by canvassing dermatologists, radiotherapists, pathologists, and other physicians seeing and treating skin cancer. Rates among Caucasians were found two to three times higher than any ever reported before in these area. An estimate of 300,000 new cases of skin cancer per year would amount to about one-half the total for all other forms of cancer combined in the United States. In all areas, there was an excess liability in males of about 2 to 1. Highest rates were observed in the Dallas-Ft. Worth area, where increased solar radiation is suspected as a carcinogenic agent.

Boyle J, MacKie RM, Briggs JD, Junor BJ, Aitchison TCCancer, warts, and sunshine in renal transplant patients. A case-control study. Lancet 1:702-705

Article

Apr 1984

94 renal transplant patients were examined for the presence of cutaneous malignancies, actinic keratoses, warts, and cutaneous fungal infection, and a history was taken of infection with herpes simplex and herpes zoster. Each patient had a control matched for age, sex, and sun exposure. Of the 17 patients with high exposure to sunshine (more than 3 months in a tropical or subtropical climate or more than 5 years in an outdoor occupation), 2 had squamous cell carcinoma and 7 actinic keratoses. These lesions did not occur in the other renal transplant patients or the control group. The immunosuppressive effect of ultraviolet radiation in the sunburn spectrum (290-320 nm) in man and animals may be related to the increased incidence of cutaneous malignancy, actinic keratoses, and warts. Transplant patients should be under regular surveillance for the early detection and treatment of premalignant cutaneous lesions, and they should receive advice on avoiding sun exposure.

Estimating Increases in Skin Cancer Morbidity Due to Increases in Ultraviolet Radiation Exposure

Article

Feb 1983

It is generally accepted that if ozone levels in the stratosphere are depleted, greater amounts of shortwave ultraviolet radiation (UVB) will reach the earth's surface, resulting in increased morbidity of nonmelanoma skin cancer. The incidence and UVB data are now available from a new epidemiologic study of skin cancer conducted at eight locations of the United States. We found that either a simple power function or a simple exponential function could be used to describe these new data. According to estimates based on the power model, should the amount of exposure to UVB increase by 30%, then the incidence of skin cancer will increase by 60% in males and 45% in females. Estimates based on the exponential model vary by location, (53-96)% in males and (39-68)% in females. These estimates are somewhat lower than those based only on earlier data. We emphasize that skin cancer rates also depend on variables other than UVB which may be location specific.

Socio-economic status, indoor and outdoor work, and malignant melanoma

Article

Jul 1984

Among New Zealand non-Maori men, professional, technical, administrative and managerial workers had the highest incidence and mortality rates for malignant melanoma of the skin; labourers and workers in production and transport had the lowest rates. Reclassification of occupations, in terms of both socio-economic status and a three-step scale of outdoor exposure during work, suggested that differences between occupational groups were determined by differences in socio-economic status. Outdoor work exposure seemed to have little effect on the risk of melanoma.

Epidemiology of Pre-invasive and Invasive Malignant Melanoma in Western Australia

Article

Mar 1980

The annual incidence rates of melanoma in Western Australia in 1975 and 1976 were estimated, by reference to hospital and pathology records. They were 4.4/ 100,000 in males and 6.2/100,000 in females for pre-invasive lesions and 18.6/100,000 and 18.8/100,000 for invasive lesions. Rates specific to particular body sites showed two distinct patterns of change with age - a progressive rise beginning about age 40 years (shown by Hutchinson's melanotic freckle and invasive melanoma of the head and neck) and an early rise beginning about age 20 years with a peak in middle-life and subsequent stabilization or decline (shown by superficial spreading melanoma, non-invasive and invasive melanoma of the lower limbs and, less typically, trunk and upper limbs). Incidence rates were highest in native-born Australians and higher in immigrants of British origin than in other immigrants. The rates in British immigrants were more than double those in the British Isles. The incidence was highest in residents of high social class areas, and in in-door rather than outdoor workers. Rates were also highest in the capital city, Perth, and the south-west corner of the State, rather than in the north where exposure of the population to ultra-violet light might be expected to be highest. In most of these respects the patterns for pre-invasive and invasive lesions were similar. Aspects of these data are inconsistent with the solar hypothesis of melanoma aetiology. It is suggested, however, that some of these inconsistencies may be explained if intermittent, intense exposure to the sun were more relevant to the aetiology of melanoma than continuous exposure.

Nonmelanoma Skin Cancer Mortality in the United States, 1969 Through 1988

Article

Nov 1993
ARCH DERMATOL

Martin A Weinstock

Nonmelanoma skin cancer is the most common malignancy in the United States. Despite its importance, patterns of mortality from this cause are poorly documented. Recent insights into sources of misclassification allow for more accurate estimation of these patterns. This investigation describes nonmelanoma skin cancer mortality in the United States during 1969 through 1988 on the basis of routine death certification and adjusts reported mortality data for two major sources of misclassification. Nonmelanoma skin cancer mortality rates decreased by approximately 20% to 30% for both men and women and for both whites and blacks, although the decline among blacks was less consistent than among whites. Mortality was greater among men than among women and greater among whites than among blacks, although the most pronounced difference was between white men and the other three racial/gender groups studied. Approximately 1200 deaths per year are attributable to nonmelanoma skin cancer. Nonmelanoma skin cancer mortality is diminishing despite increasing incidence. Mortality rates among blacks are extraordinarily high in comparison with their incidence rates. More careful attention to misclassification in mortality statistics is crucial for an accurate assessment of the public health burden of nonmelanoma skin cancer.

Cancer Statistics, 1994

Article

Jan 1994

Changes in sun-related attitudes and behaviours, and reduced sunburn prevalence in a population at high risk of melanoma

Article

Dec 1993
EUR J CANCER PREV

This study aimed to determine trends in exposure to sunlight in the context of a melanoma prevention programme by monitoring the prevalence of sunburn and sun-related attitudes and behaviours. Telephone interviews were conducted in a baseline summer (December 1987 to February 1988) and two subsequent summers after the introduction of the SunSmart health promotion campaign. Interviewing a sample of 4,428 adult residents of the Australian city of Melbourne took place throughout summer on Monday evenings. Behavioural and sunburn data were reported for the previous weekend and relevant attitudinal data were collected. After adjusting for ambient ultraviolet radiation levels and temperature, survey month, age, sex and skin type, a significant reduction in sunburn was found. The crude proportion of sunburnt dropped from 11% to 10% to 7% over 3 years and the adjusted odds ratios (and 95% confidence intervals) were as follows: Year 1/Year 2; 0.75 (CI 0.57-0.99) and Year 1/Year 3; 0.59 (CI 0.43-0.81). Substantial attitudinal shifts occurred over the 3 years. Hat wearing increased significantly each year (19%, 26%, 29%), as did sunscreen use (12%, 18%, 21%). However, the trends in mean proportion of body surface area covered by clothing were less clear cut (0.67, 0.64, 0.71). It is concluded that melanoma risk factor exposure of populations can change fairly rapidly and that well-conducted health promotion campaigns can play a part in producing such change.

Basal cell carcinoma in Kauai, Hawaii: The highest documented incidence in the United States

Article

Aug 1993
J AM ACAD DERMATOL

In Kauai, Hawaii, we observed an exceedingly high incidence of basal cell carcinoma in an earlier 1-year study. Our purpose was to report the incidence of basal cell carcinoma in a defined population in Hawaii. A prospective 5-year population-based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of basal cell carcinomas in Caucasian residents. A total of 242 residents, 161 men and 81 women, were identified with an initial episode of basal cell carcinoma during the 5-year period. The average annual incidence per 100,000 Kauai Caucasian residents standardized to the 1980 U.S. white population was 576 for men and 298 for women with a combined incidence of 422. The average patient age was 56.5 years, and men had a significantly higher incidence of cancer than women (p < 0.000001). The head and neck was the most common site. The trunk was the second most common site, representing one third of lesions. Subsequent new basal cell carcinomas occurred in 16.9% of patients. Only 3.3% of patients had recurrent carcinomas after treatment. Kauai's incidence rates of basal cell carcinoma are the highest yet documented in the United States. As an unexpected finding, a decreasing incidence trend was noted in the study's later years and may warrant further investigation. Finally, a significant number of basal cell carcinomas developed on the trunk, suggesting and reinforcing the expectation that sun exposure is not limited to the face and neck in this Hawaiian population.

Trends in non-melanocytic skin cancer treated in Australia: the Second National Survey

Article

Feb 1993

An Australia-wide survey in 1985 recorded the highest rates of medically treated non-melanocytic skin cancer (NMSC) ever reported. We report the findings of a repeat survey conducted in 1990. This second survey confirmed the differences, by age, sex, body site, latitude, country of birth and skin reaction to strong sunlight, that were observed in 1985. Over the 5-year period certain changes were noted: the incidence of NMSCs increased by 19%, of basal-cell carcinomas (BCC) by 11% and of squamous-cell carcinomas (SCC) by 51%. With advancing age, men and women differed in their incidence, and this difference was greater for SCC than for BCC. Log-linear modelling, however, failed to detect either a cohort or a survey effect between the 2 surveys. The proportional distribution of BCCs and SCCs by body site indicated an increase in BCCs on the trunk in both men and women, and half the proportion of SCCs on the head and neck in women as compared with men. The latitudinal gradients observed in 1985 were even stronger in 1990; the population living north of 37 degrees S experienced a 30% increase in the incidence of treated NMSC between 1985 and 1990, while the population living south of 37 degrees S had a 25% decrease. The implications of these findings for cancer-control initiatives are discussed.

Dennis LK, White E, Lee JARecent cohort trends in malignant melanoma by anatomic site in the United States. Cancer Causes Control 4:93-100

Article

Apr 1993

The incidence of malignant melanoma has been increasing steadily in the United States. The increase may be due to lifestyle changes in subsequent generations or birth cohorts. The nine population-based tumor registries in the Surveillance, Epidemiology, and End Results program (SEER) have been in existence for a sufficient time to begin to investigate cohort trends for the US population. Cases were the 18,787 Caucasians aged 20 to 84 years, who reported to SEER registries with a diagnosis of melanoma in 1974-86. Among men born between 1890 and 1919, each subsequent five-year birth cohort experienced 45 to 57 percent increases in age-adjusted melanoma incidence of the arm and trunk, and 14 to 20 percent increases were experienced across each site (arm, leg, head, and trunk) for the 1920-44 cohorts of men. Among women born between 1890 and 1919, 24 to 29 percent increases were seen for melanoma of the trunk, arms, and legs for each subsequent five-year birth-cohort, followed by six to 29 percent increases in the 1920-44 cohorts. Recent birth cohorts, 1945-64, have shown stabilizing rates, even after an attempt to adjust for the increasing tendency for diagnoses to be made in doctors' offices. Thus, the dramatic birth-cohort effects appear to have ended beginning with those born in 1945. However, melanoma rates will continue to rise until those born after 1945 represent the majority of the population. Furthermore, for the most recent cohorts, the trunk has become the most common site (per square meter of body surface) for men and the second most common site for women.(ABSTRACT TRUNCATED AT 250 WORDS)

An overview of skin cancers. Incidence and causation

Abstract

No full-text available

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