Ultraviolet A and melanoma: a review

Latitude gradient for melanoma incidence by anatomic site and gender in Norway 1966-2007

Latitude gradients and time trends for cutaneous malignant melanoma (CMM) were analyzed using incident cases from the Norwegian Cancer Registry for the period 1966-2007. Sex and various anatomic regions of the body were taken into account, for better understanding of the role of ultraviolet radiation in CMM etiology. There is a latitude gradient for CMM on all body sites included in the present study, with 2-2.5 times higher incidence rates in the south. The latitude gradients seem to be largest for the trunk. Melanomas on sites intermittently exposed to the sun (like the trunk) dominate both in the north and in the south and this distribution has not changed over the years. A leveling off of the incidence rates are observed for both sexes and for all sites studied, after 1985-1995, slightly more in the south than in the north, except for the head and neck where the incidence rates have continued to increase slowly in the north as well as in the south. The leveling off of melanoma trend is probably associated with melanoma prevention campaigns and with increasing awareness, although vitamin D could play a role.

Effects of UVA on TNF-alpha, IL-1beta, and IL-10 expression levels in human keratinocytes and intervention studies with an antioxidant and a JNK inhibitor

OBJECTIVE

To understand the expressions and transduction pathways of cytokines in ultraviolet (UV)A-irradiated keratinocytes.

METHODS

We cultured human keratinocytes of the HaCaT cell line and investigated both mRNA and protein expressions of cytokines in cells that were not irradiated or were exposed to 2.4 J/cm(2) UVA, with or without an antioxidant (beta-carotene) or a c-Jun N-terminal kinase (JNK) inhibitor (SP600125).

RESULTS

We demonstrated that the expression levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta were up-regulated in irradiated cells. IL-10 was not detected in non-irradiated cells, but was observed in irradiated cells. JNK was activated in irradiated cells and this could be antagonized by beta-carotene. The UVA-induced up-regulation of these cytokines was also antagonized by beta-carotene. SP600125 inhibited the UVA-induced increase in the expression of TNF-alpha mRNA and protein and in the expression of IL-1beta mRNA.

CONCLUSIONS

The results suggest that oxidative stress may be an early intermediate effect in JNK-dependent UVA induction of cytokine expression in human keratinocytes in vitro.

Cyclobutane pyrimidine dimers are photosensitised by carprofen plus UVA in human HaCaT cells

Every year in the UK about 75,000 cases of non-melanoma skin cancer (NMSC) are registered, and about 9500 people are diagnosed with cutaneous melanoma (CM). The main risk factor for these cancers is exposure to sunlight. The effects of light on skin are wavelength dependent, with wavelengths in the UVB waveband (280-315 nm) being the most carcinogenic. UVB is directly absorbed by DNA, producing dimeric pyrimidine photoproducts including cyclobutane pyrimidine dimers (CPD) and pyrimidine (6-4) pyrimodone photoproducts (6-4PP). However UVA (315-400 nm) can also produce CPD, induce skin tumours in mice, and has been shown to be mutagenic in cell culture. Although the precise role of UVA in human skin cancer remains to be elucidated, it comprises the major portion of solar UV radiation, transmits through window glass and can be delivered in high doses from tanning lamps. Non-steroidal anti-inflammatory drugs (NSAIDs), in particular the 2-aryl propionic acid derivatives, are a well-documented group of photosensitising chemicals producing clinical phototoxic and photoallergic reactions. We have used carprofen, a model compound from this group to see if it could amplify the effects of UVA and contribute to the formation of CPD by UVA. Preliminary work has shown that carprofen combined with low doses of UVA (lambda(max): 365 nm; 5 J/cm(2)) can produce both strand breaks (SB) and CPD in human skin or blood cells. CPD were detected indirectly by both an immunofluorescence method and as T4 endonuclease V sensitive sites in the comet assay. These findings show that compounds other than fluoroquinolones and psoralen derivatives may contribute to CPD formation in skin cells in combination with UVA.

Skin photoprotection by natural polyphenols: anti-inflammatory, antioxidant and DNA repair mechanisms

Epidemiological, clinical and laboratory studies have implicated solar ultraviolet (UV) radiation in various skin diseases including, premature aging of the skin and melanoma and non-melanoma skin cancers. Chronic UV radiation exposure-induced skin diseases or skin disorders are caused by the excessive induction of inflammation, oxidative stress and DNA damage, etc. The use of chemopreventive agents, such as plant polyphenols, to inhibit these events in UV-exposed skin is gaining attention. Chemoprevention refers to the use of agents that can inhibit, reverse or retard the process of these harmful events in the UV-exposed skin. A wide variety of polyphenols or phytochemicals, most of which are dietary supplements, have been reported to possess substantial skin photoprotective effects. This review article summarizes the photoprotective effects of some selected polyphenols, such as green tea polyphenols, grape seed proanthocyanidins, resveratrol, silymarin and genistein, on UV-induced skin inflammation, oxidative stress and DNA damage, etc., with a focus on mechanisms underlying the photoprotective effects of these polyphenols. The laboratory studies conducted in animal models suggest that these polyphenols have the ability to protect the skin from the adverse effects of UV radiation, including the risk of skin cancers. It is suggested that polyphenols may favorably supplement sunscreens protection, and may be useful for skin diseases associated with solar UV radiation-induced inflammation, oxidative stress and DNA damage.

Main roads to melanoma

The characterization of the molecular mechanisms involved in development and progression of melanoma could be helpful to identify the molecular profiles underlying aggressiveness, clinical behavior, and response to therapy as well as to better classify the subsets of melanoma patients with different prognosis and/or clinical outcome. Actually, some aspects regarding the main molecular changes responsible for the onset as well as the progression of melanoma toward a more aggressive phenotype have been described. Genes and molecules which control either cell proliferation, apoptosis, or cell senescence have been implicated. Here we provided an overview of the main molecular changes underlying the pathogenesis of melanoma. All evidence clearly indicates the existence of a complex molecular machinery that provides checks and balances in normal melanocytes. Progression from normal melanocytes to malignant metastatic cells in melanoma patients is the result of a combination of down- or up-regulation of various effectors acting on different molecular pathways.

Factors related to being sunburnt in 7-year-old children in Sweden

BACKGROUND

Epidemiologic research shows that being sunburnt as a child is an important risk factor for cutaneous malignant melanoma (CMM). The purpose of this study was to investigate sunburn in relation to tanning habits and complexion among 7-year-old children living at different latitudes in Sweden.

METHODS

Two municipalities were chosen at latitudes 65 degrees N and 68 degrees N in the north of Sweden and two at latitude 57 degrees N in the south. Children born in 1994 and registered in the municipalities were to be included (N=1676). A questionnaire was sent to their parents asking about their children's tanning habits, and the children were examined. The analysis set comprised 1360 children who participated in the examination and whose parents answered the questionnaire (81.1%).

RESULTS

Twelve percent of all children had been sunburnt during the first 2 years of life compared to 44% between 2 and 4 years and 67% after 4. The children in the south at latitude 57 degrees N compared to Kiruna at latitude 68 degrees N and Piteå at 65 degrees N had a higher risk of ever being sunburnt during the first 2 years of life OR=1.87 (95% confidence interval (CI) 1.11-3.14) and 1.66 (0.95-2.90), respectively. The differences diminished with age. Sunscreen was an independent risk factor of being sunburnt between 2 and 7 years of age (not or seldom using sun screen was protective). Photosensitive skin type was the main risk factor for sunburns.

CONCLUSION

Swedish children are frequently sunburnt and children living in the south are more sunburnt than those in the north. Sunscreens that were seldom used or not used at all were found to be protective. These results support previous reports that photosensitive skin type is an important risk factor for suffering sunburn as a child and therefore increases the risk of cutaneous malignant melanoma.

Synergistic damage by UVA radiation and pollutants

Not only is skin cancer by far the most common human cancer but also the incidence of skin cancer has been increasing at an alarming rate in recent decades. Fortunately, most people now realize that sun exposure causes unattractive photoaging and skin cancer, so they do apply sunscreens conscientiously. However, until recently, most sunscreens did not adequately protect against ultraviolet A (UVA) radiation. Although UVA is indeed less erythrogenic and less carcinogenic than UVB, UVA directly causes photoaging and enhances UVB-induced skin cancer. Furthermore, recent research demonstrates that UVA combined with environmental pollutants (including cigarette smoke) significantly increases the risk of skin cancer. Similarly, previous research demonstrated another synergy between environmental pollutants and UV: When ozone exposure precedes UV exposure, there is enhancement of UV-induced depletion of protective vitamin E from the skin's stratum corneum. This article reviews experimental evidence that environmental pollutants (such as benzo[a]pyrene (BaP), a commonly used index of environmental pollution) are photosensitizers that generate reactive oxygen species (ROS) when exposed to UVA radiation. This in turn causes oxidative and genetic damage, leading to unattractive photodamage and carcinogenesis.

UVB and UVA initiate different pathways to p53-dependent apoptosis in melanocytes

The incidence of cutaneous malignant melanoma (CMM) has more than doubled in the past 25 years and continues to increase at over 3% per year across all age groups (Linos et al., this issue), and invasive and disseminated melanoma in young women has increased by almost 10% since 1992 (Purdue et al., 2008). Early detection and excision of CMM can result in successful treatment, but disseminated disease is resistant to current therapies and has a very poor prognosis (Garbe and Eigentler, 2007). Sunlight exposure is a major risk factor for melanoma. In this issue, Waster and llinger investigate the effects of UVB and UVA on melanocytes.

Another duel in the sun: weighing the balances between sun protection, tanning beds, and malignant melanoma

OBJECTIVE

The purpose of this report is to put the dueling factors of risk and prevention for melanoma in perspective for the thoughtful pediatric specialist to facilitate preteen preventive health counseling.

STUDY DESIGN

We examined the rate of malignant melanoma among Kentucky residents and compared this rate with indicators of tanning bed prevalence in a large metropolitan area and sunscreen sales from a major distributor. We obtained malignant melanoma annual incidence data from the Kentucky Cancer Registry, which recorded Kentucky population incidence rates over the years 1995 to 2004. The rates reflected 2 malignant melanoma classifications: pre-invasive cancer only, or both invasive and noninvasive cancers combined.

RESULTS

The age-adjusted incidence rate per hundred thousand for combined invasive and pre-invasive malignant melanoma swelled from 21.9 in 1995 to 31.3 in 2004. The respective invasive-only malignant melanoma incidence rates increased less dramatically, from 17.3 to 20.7, during this same 10-year time period. Since 1983, the number of separate tanning bed businesses increased from 1 in 1983 to 119 by the mid-1990s, and then declined to about 74 separate businesses by 2003. Sunscreen sales data is uneven between states and is currently inconclusive.

CONCLUSIONS

Although current data cannot draw a precise link between melanoma and the use of tanning beds, the associated risk is implicit, as the ultraviolet A (UVA) and ultraviolet B (UVB) radiation in tanning bed usage is a well-established melanoma risk factor. In advising patients, the pediatric specialist should consider that melanoma rates are poised as a balance of some known risk factors and a few potential preventive factors.

Neonatal blue-light phototherapy does not increase nevus count in 9-year-old children

OBJECTIVE

One of the most important risk factors for melanoma is the number of acquired common and atypical nevi in childhood. The role played by neonatal blue-light phototherapy in the increasing incidence of common and atypical melanocytic nevi in childhood or adolescence has been discussed recently with discordant results.

PATIENTS AND METHODS

We designed a multicenter study to assess the effects of neonatal blue-light phototherapy on nevus count in a cohort of 9-year-old children. We counted back and arm nevi as a function of size in 828 children included in a French photoprotection educational campaign. History of neonatal phototherapy, phototype, skin, hair and eye color, and sunburn were assessed through questionnaires to which both parents and children responded, and a nevus count was performed by trained nurses blinded to phototherapy history.

RESULTS

Mean nevus count was 16.7 per child. Twenty-two percent of the children had received neonatal blue-light phototherapy. Neonatal phototherapy had no effect on the nevus count irrespective of nevi location, nevi size, or phototype of the children. A light phototype, skin, and hair color; blue/green eyes; and history of sunburn were closely correlated with an increase in nevus count.

CONCLUSIONS

This study found no evidence for a major role of blue-light phototherapy on nevus count in 9-year-old children. It underlines the dominant effect of phototype characteristics and history of sunburn in childhood on the early development of melanocytic nevi.

How strong is the evidence that solar ultraviolet B and vitamin D reduce the risk of cancer?: An examination using Hill's criteria for causality

The ultraviolet-B (UVB)-vitamin D-cancer hypothesis was proposed in 1980. Since then, several ecological and observational studies have examined the hypothesis, in addition to one good randomized, controlled trial. Also, the mechanisms whereby vitamin D reduces the risk of cancer have been elucidated. This report aims to examine the evidence to date with respect to the criteria for causality in a biological system first proposed by Robert Koch and later systematized by A. Bradford Hill. The criteria of most relevance are strength of association, consistency, biological gradient, plausibility/mechanisms and experimental verification. Results for several cancers generally satisfy these criteria. Results for breast and colorectal cancer satisfy the criteria best, but there is also good evidence that other cancers do as well, including bladder, esophageal, gallbladder, gastric, ovarian, rectal, renal and uterine corpus cancer, as well as Hodgkin's and non-Hodgkin's lymphoma. Several cancers have mixed findings with respect to UVB and/or vitamin D, including pancreatic and prostate cancer and melanoma. Even for these, the benefit of vitamin D seems reasonably strong. Although ecological and observational studies are not generally regarded as able to provide convincing evidence of causality, the fact that humanity has always existed with vitamin D from solar UVB irradiance means that there is a wealth of evidence to be harvested using the ecological and observational approaches. Nonetheless, additional randomized, controlled trials are warranted to further examine the link between vitamin D and cancer incidence, survival and mortality.

On the relationship between erythemal and vitamin D action spectrum weighted ultraviolet radiation

Erythemally weighted solar ultraviolet (UV) radiation is often used to characterize the production of vitamin D in a human body. However, the vitamin D production action spectrum is different than that for erythemal UV. The vitamin D action spectrum weighted UV is more sensitive to UV-B, while the erythemal UV action spectrum has higher weighting coefficients than the vitamin D action spectrum in the UV-A part of the spectrum. Therefore, by using the erythemal UV as an estimate for the vitamin D action spectrum weighted UV can give results that differ by up to a factor of 5. This study examines the relationship between erythemal and vitamin D action spectrum weighted UV radiation using measurements of spectral UV at the surface by Brewer spectrophotometers that are part of the US and Canadian observational networks. It is shown that the ratio of vitamin D action spectrum weighted UV to erythemal UV is nearly constant for high levels of UV (UV Index greater than 5.5) and therefore vitamin D action spectrum weighted UV can be described in terms of erythemal UV. For lower levels of UV though this relationship should not be used. A simple formula that calculates vitamin D action spectrum weighted UV from UV Index is developed. An empirical formula that expresses the ratio of vitamin D action spectrum weighted UV to erythemal UV as a function of the solar zenith angle and column ozone is also suggested. The geographical distributions of vitamin D action spectrum weighted UV in the US and Canada are discussed.

Vitamin D deficiency in children and its management: review of current knowledge and recommendations

Given the recent spate of reports of vitamin D deficiency, there is a need to reexamine our understanding of natural and other sources of vitamin D, as well as mechanisms whereby vitamin D synthesis and intake can be optimized. This state-of-the-art report from the Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society was aimed to perform this task and also reviews recommendations for sun exposure and vitamin D intake and possible caveats associated with these recommendations.

Trends in UV irradiance of tanning devices in Norway: 1983-2005

Indoor tanning increases skin cancer risk, but the importance of different parts of the UV spectrum is unclear. We assessed irradiance of tanning devices in Norway for the period 1983-2005. Since 1983, all tanning models needed approval before being sold or used. UV Type 3 limits were valid from late 1992 (<0.15 W m(-2) for CIE-weighted, i.e. erythemally weighted, short and long wave irradiances). We analyzed data from 90% of the approved tanning models (n = 446 models) and two large inspection surveys in 1998/1999 and 2003 (n = 1,341 tanning devices). Mean CIE-weighted short wave irradiance of approved models increased from 0.050 W m(-2) (95% confidence interval [CI] 0.045-0.055) in 1983-1992 to 0.101 W m(-2) (95% CI 0.098-0.105) in 1993-2005, and mean long wave from 0.091 W m(-2) (95% CI 0.088-0.095) to 0.112 W m(-2) (95% CI 0.109-0.115), respectively. Inspection surveys revealed short wave irradiances much higher than that approved. In 1998-1999, only 28% (293/1034) of the devices were equipped with correct sunlamps and only 1 out of 130 inspected establishments fulfilled all requirements. In 2003, corresponding numbers were 59% (180/307) of devices and 2 out of 52 establishments. Mean short and long wave irradiances of the inspected tanning devices in 2003 were 1.5 and 3.5 times, respectively, higher than the irradiance of natural summer sun in Oslo. In conclusion, the short wave irradiance has increased in indoor tanning devices in Norway over the last 20 years. Due to the high long wave irradiance throughout this period, the percentage of short wave irradiance was much lower than for natural sun.

The Dose Rate of UVA Treatment Influences the Cellular Response of HaCaT Keratinocytes

The contribution of UV exposure to the etiology of skin cancer and photoaging is undisputed. However, the effect of altering the intensity or dose rate of UV, which varies considerably with geographical location, the time of day or year, and the use of sunscreens, is not understood. In this study, the effect of altering the dose rate of UVA was investigated in the immortalized human keratinocyte cell line, HaCaT. Lowering the dose rate of UVA resulted in increased cytotoxicity, which correlated with increases in both lipid peroxidation and DNA damage. Furthermore, exposure at low dose rate did not appear to reduce the ability of UVA to induce the phenomenon of persistent genomic instability. Pretreatment with the antioxidant vitamin E significantly protected against UVA dose-rate effects observed with respect to lipid peroxidation and survival. Additionally, cell populations irradiated at low dose rate exhibited a shift towards a more pro-oxidant state. Taken together, these observations suggest an oxidative stress mechanism is underlying the UVA dose-rate effect. This study demonstrates that dose rates must be included as a key factor when evaluating the biological effects of UVA, especially considering the concerns, which exist regarding the efficacy and photostability of sunscreens to UVA.

Effect of UVA fluence rate on indicators of oxidative stress in human dermal fibroblasts

During the course of a day human skin is exposed to solar UV radiation that fluctuates in fluence rate within the UVA (290-315 nm) and UVB (315-400 nm) spectrum. Variables affecting the fluence rate reaching skin cells include differences in UVA and UVB penetrating ability, presence or absence of sunscreens, atmospheric conditions, and season and geographical location where the exposure occurs. Our study determined the effect of UVA fluence rate in solar-simulated (SSR) and tanning-bed radiation (TBR) on four indicators of oxidative stress---protein oxidation, glutathione, heme oxygenase-1, and reactive oxygen species--in human dermal fibroblasts after receiving equivalent UVA and UVB doses. Our results show that the higher UVA fluence rate in TBR increases the level of all four indicators of oxidative stress. In sequential exposures when cells are exposed first to SSR, the lower UVA fluence rate in SSR induces a protective response that protects against oxidative stress following a second exposure to a higher UVA fluence rate. Our studies underscore the important role of UVA fluence rate in determining how human skin cells respond to a given dose of radiation containing both UVA and UVB radiation.

Exposure to sunlamps, tanning beds, and melanoma risk

OBJECTIVE

To estimate the separate effects of sunlamp and tanning bed device use on melanoma risk.

METHODS

Population-based case-control study of 423 cases of melanoma and 678 controls in the state of New Hampshire. Exposure data, including sunlamp and tanning bed use, were collected by telephone interview. Associations were evaluated using logistic regression analyses.

RESULTS

About 17% of participants ever used a sunlamp, and most use (89%) occurred before 1980. The OR was 1.39 (95% CI 1.00-1.96) for ever using a sunlamp, 1.23 (95% CI 0.81-1.88) for those starting sunlamp use <20 years, and 1.71 (95% CI 1.00-2.92) for those starting >/=20 years. Data suggested increasing risk with number of sunlamp uses and with duration of use (tests of trend p = 0.02). The overall prevalence of tanning bed use was 22% and most use (83%) occurred after 1980. The OR was 1.14 (95% CI 0.80-1.61) for ever using a tanning bed; there was no evidence that risk increased with frequency or duration of use. The OR was 1.96 (95% CI 1.06-3.61) for having used both devices.

CONCLUSION

Results suggest a modest association between sunlamp use and melanoma risk, and increasing risk with greater frequency and duration of use. No association with tanning bed use was found, but sufficient lag time may not have elapsed to assess a potential effect.

Extremely high levels of melanoma in Tauranga, New Zealand: possible causes and comparisons with Australia and the northern hemisphere

The objective of the study was to determine the incidence of melanoma in the Tauranga region of New Zealand, to compare these findings within Australasia and the northern hemisphere, and to understand the causes of the relatively high rates in Tauranga. Data were obtained from retrospective review of histology reports from the public and private health systems in greater Tauranga (Tauranga and Western Bay of Plenty Districts). Primary cutaneous melanomas (including both invasive and in situ melanomas) reported during 2003 were included. Age-standardized melanoma rates were calculated for the entire population as well as for the non-Maori population of the region, identified from the 2001 New Zealand Census. The age-standardized incidence of invasive melanoma in the non-Maori population of the greater Tauranga region was 79/100,000. The age-standardized rate for the entire population was 70/100,000. The rate of in situ disease was 78/100,000 for non-Maori and 72/100,000 for the entire population. The Tauranga region of New Zealand has an exceptionally high incidence of invasive and in situ melanomas. This is likely related to environmental, geographical and societal factors, including relatively high levels of UV exacerbated in recent times by ozone depletion, relatively cool summer temperatures which encourage outdoor exposure, and relatively fair skin colouring.

Photoprotection

Sun exposure is the main cause of photocarcinogenesis, photoageing, and photosensitivity; thus, photoprotection is an important issue. In a skin cancer prevention strategy, behavioural measures--eg, wearing sun protective clothes and a hat and reducing sun exposure to a minimum--should be preferred to sunscreens. Often this solution is deemed to be unacceptable in our global, outdoor society, and sunscreens could become the predominant mode of sun protection for various societal reasons (eg, healthiness of a tan, relaxation in the sun). The application of a liberal quantity of sunscreen has been shown to be by far the most important factor for effectiveness of the sunscreen, followed by the uniformity of application and the specific absorption spectrum of the agent used. The sunscreen market--crowded by numerous products--shows various differences worldwide. Nevertheless, sunscreens should not be abused in an attempt to increase time in the sun to a maximum. Controversies about safety of sunscreens and clinical recommendations are discussed.

Stimulation of NEIL2-mediated oxidized base excision repair via YB-1 interaction during oxidative stress

The recently characterized enzyme NEIL2 (Nei-like-2), one of the four oxidized base-specific DNA glycosylases (OGG1, NTH1, NEIL1, and NEIL2) in mammalian cells, has poor base excision activity from duplex DNA. To test the possibility that one or more proteins modulate its activity in vivo, we performed mass spectrometric analysis of the NEIL2 immunocomplex and identified Y box-binding (YB-1) protein as a stably interacting partner of NEIL2. We show here that YB-1 not only interacts physically with NEIL2, but it also cooperates functionally by stimulating its base excision activity by 7-fold. Moreover, YB-1 interacts with the other NEIL2-associated BER proteins, namely, DNA ligase III alpha and DNA polymerase beta and thus could form a large multiprotein complex. YB-1, normally present in the cytoplasm, translocates to the nucleus during UVA-induced oxidative stress, concomitant with its increased association with and activation of NEIL2. NEIL2-initiated base excision activity is significantly reduced in YB-1-depleted cells. YB-1 thus appears to have a novel regulatory role in NEIL2-mediated repair under oxidative stress.

Update on sun protection and tanning in children

PURPOSE OF REVIEW

In this article we examine the latest information regarding pediatric sun protection and specifically focus on the impact of indoor tanning on children.

RECENT FINDINGS

We examine and discuss the prevailing views and trends on ultraviolet radiation exposure, sun protection and the attendant adverse health effects among children. We identify the challenges related to limiting ambient ultraviolet exposure in children. As children, particularly adolescents, gain an understanding of sun protection, their use of ultraviolet radiation protection does not increase concordantly. We discuss health policies regarding ultraviolet radiation protection, compliance with these policies and potential methods to increase compliance. We also examine addiction-like behavior and other psychosocial factors affecting those who are regular indoor tanners. Finally, we consider possible alternatives to ultraviolet radiation induced tanning and whether encouraging these options leads to a confusing, mixed message from healthcare providers.

SUMMARY

In this article we examine and discuss current practices, attitudes and recent trends in sun protection. We discuss indoor tanning, with special emphasis on the potential addictive qualities of ultraviolet radiation. Our goal is to identify opportunities and future directions to promote sun safety and protect children from harmful ultraviolet radiation exposure.

Direct Detection of Singlet Oxygen Generated by UVA Irradiation in Human Cells and Skin

UVA light produces deleterious biological effects in which singlet oxygen plays a major role. These effects comprise a significant risk of carcinogenesis in the skin and cataract formation of the eye lens. Singlet oxygen is generated by UVA light absorption in endogenous molecules present in the cells. To elucidate the primary processes and sources of singlet oxygen in tissue, it is a major goal to uncover the hidden process of singlet oxygen generation, in particular in living tissue. When exposing keratinocytes or human skin in vivo to UVA laser light (355 nm) at 6 J/cm2, we measured the luminescence of singlet oxygen at 1,270 nm. This is a positive and direct proof of singlet oxygen generation in cells and skin by UVA light. Moreover, a clear signal of singlet oxygen luminescence was detected in phosphatidylcholine suspensions (water or ethanol) irradiated by UVA. Oxidized products of phosphatidylcholine are the likely chromophores because phosphatidylcholine itself does not absorb at 355 nm. The signal intensity was reduced by mannitol or super oxide dismutase. Additionally, the monochromatic UVA irradiation at 355 nm leads to upregulation of the key cytokine IL-12. This affects the balance of UV radiation on the immune system, which is comparable to effects of broadband UVA irradiation.

Ultraviolet-A radiation induces changes in cyclin G gene expression in mouse melanoma B16-F1 cells

Background

We have previously shown that ultraviolet-A (UVA) radiation enhances metastatic lung colonization capacity of B16-F1 melanoma cells. The aim of this study was to examine changes in expression profile of genes in mouse melanoma B16-F1 cells exposed to UVA radiation.

Results

B16-F1 melanoma cells were exposed to a single UVA radiation dose of 8 J/cm² and mRNA was isolated 4 h after the end of UVA exposure. Atlas™ Mouse Cancer 1.2 cDNA expression arrays were used for the large-scale screening to identify the genes involved in the regulation of carcinogenesis, tumor progression and metastasis. Physiologically relevant UVA dose induced differential expression in 9 genes in the UVA exposed melanoma cells as compared to the unexposed control cells. The expression of seven genes out of nine was upregulated (HSC70, HSP86, α-B-crystallin, GST mu2, Oxidative stress induced protein OSI, VEGF, cyclin G), whereas the expression of two genes was down-regulated (G-actin, non-muscle cofilin). The gene expression of cyclin G was mostly affected by UVA radiation, increasing by 4.85-folds 4 hour after exposure. The analysis of cyclin G protein expression revealed 1.36-fold increase at the 6 hour time point after UVA exposure. Cell cycle arrest in G2/M phase, which is known to be regulated by cyclin G, occurred at 4-h hour time-point, peaking 8 hours after the end of UVA irradiation, suggesting that cyclin G might play a role in the cell cycle arrest.

Conclusion

Our results suggest that UVA radiation-induces changes in the expression of several genes. Some of these changes, e.g. in expression of cyclin G, possibly might affect cell physiology (cell cycle arrest).

Melanoma, long wavelength ultraviolet and sunscreens: Controversies and potential resolutions

Although sunlight is known to cause melanoma, there has been considerable controversy as to the importance of short (UVB) and long (UVA) ultraviolet (UV) wavelengths in causing melanoma, leading to uncertainty in how best to prevent this cancer. This uncertainty has been compounded by the difficulties in assaying the UVA protection abilities of sunscreens, as compared to widely accepted measures of UVB screening by the sun protection factor (SPF). This review discusses the controversies surrounding UVA causation of melanoma in both human and animal models and the use of sunscreens to prevent melanoma. In addition, it details the development of an electron paramagnetic resonance (EPR) technique, initially used to determine the wavelength dependence (or action spectrum) of intramelanocyte radical generation to resolve these controversies in the Xiphophorus model. It is shown how this EPR technique allows a sunscreen protection factor to be determined, that is weighted to the melanocyte, and how this also allows study of the wavelength-dependent screening ability of sunscreens.

Mediating Variables in a Parent Based Intervention to Reduce Skin Cancer Risk in Children

The present study examined theoretical mediators of a parent-based intervention on sunbathing tendencies and sunburn frequencies based on the work of Turrisi et al. [Turrisi, R., Hillhouse, J., Heavin, S., Robinson, J., Adams, M., & Berry, J. (2004). Journal of Behavioral Medicine, 27, 393-412.]. Three hundred and forty parents in two regions of the United States were educated about the dangers of risky sun behavior and how to convey information about skin cancer prevention to their children. Attitudes toward sunbathing, health beliefs, appearance beliefs, and social normative beliefs were examined and found to be significant mediators of program effects on sunbathing tendencies and sunburn frequencies. The findings are discussed with respect to maximizing the effectiveness of future skin cancer interventions with children.

Regulation of human skin pigmentation and responses to ultraviolet radiation

Pigmentation of human skin is closely involved in protection against environmental stresses, in particular exposure to ultraviolet (UV) radiation. It is well known that darker skin is significantly more resistant to the damaging effects of UV, such as photocarcinogenesis and photoaging, than is lighter skin. Constitutive skin pigmentation depends on the amount of melanin and its distribution in that tissue. Melanin is significantly photoprotective and epidermal cells in darker skin incur less DNA damage than do those in lighter skin. This review summarizes current understanding of the regulation of constitutive human skin pigmentation and responses to UV radiation, with emphasis on physiological factors that influence those processes. Further research is needed to characterize the role of skin pigmentation to reduce photocarcinogenesis and to develop effective strategies to minimize such risks.

Determination of Wavelength-Specific UV Protection Factors of Sunscreens in Intact Skin by EPR Measurement of UV-Induced Reactive Melanin Radical

There remains an unmet need for skin tissue-based assays for the measurement of the UVA protection and efficacy of sunscreens. Here we describe development of a novel electron paramagnetic resonance assay that uses the photogeneration of reactive melanin radical as a measure of UV light penetration to melanocytes in situ in skin. We have used areas of focal melanocytic hyperplasia in the skin of Monodelphis domestica to model the human nevus. We show that we are able to use this assay to determine the monochromatic protection factors (mPF) of research and commercial sunscreens at specific narrow wavebands of UVB, UVA and blue visible light. Both commercial sunscreens, a sun protection factor (SPF) 4 and an SPF 30 product, had mPFs in the UVB range that correlated well with their claimed SPF. However, their mPF in the UVA ranges were only about one-third of claimed SPF. This technique can be used to design and assay sunscreens with optimally balanced UVA and UVB protection.

Ambient UVB and melanoma risk in the United States: a case-control analysis

PURPOSE

Exposure to ultraviolet-B (UVB) radiation is a well-established risk factor for human cutaneous malignant melanoma. Intermittent and cumulative exposures from UVB have been estimated most often by interview questionnaire. This study assessed cumulative UVB using a ground-based measurement instrument to estimate the association between UVB and melanoma.

METHODS

Population-based, incident cases of melanoma (n = 380) and frequency-matched controls (n = 364) residing in Connecticut at diagnosis were interviewed between 1987 and 1989 about recreational and vacation activities, sun-protection practices, occupation, and other factors. Using a residential history, regression estimates of lifetime UVB were derived from ambient measures of UVB, adjusted for intermittent exposure.

RESULTS

Cases and controls received 29% of lifetime mean UVB in the first 15 years of life. Number of days per year in recreational activity during childhood and late adulthood were associated with increased melanoma risk. When estimating lifetime UVB adjusted for intermittent exposure, melanoma risk peaked at a 5.7-fold increased risk in the ninth decile.

CONCLUSION

Sporadic and chronic sun exposure play a role in melanoma etiology. Skin-protection practices should be encouraged across levels of sun intensity, not only in childhood but throughout adulthood.

Pimecrolimus Cream in Repigmentation of Vitiligo

BACKGROUND

Vitiligo is a chronic disease that mostly affects children and young adults. Nowadays many treatment options are available; however, most of them have limited efficacy and in most cases would result in undesirable complications.

OBJECTIVE

To determine the extent of repigmentation according to the location of the lesions after applying topical cream pimecrolimus 1% in vitiligo patients.

MATERIALS AND METHODS

Thirty consecutive patients with vitiligo lesions affecting less than 20% of body surface area without any previous history of spontaneous repigmentation were treated with pimecrolimus cream 1% twice daily for 12 weeks. The extent of repigmentation in vitiligo lesions was determined in each patient after 6 and 12 weeks.

RESULTS

Moderate to excellent response (repigmentation >26%) was observed in 6.6 and 25.9% of vitiligo lesions 6 and 12 weeks after treatment, respectively. More responsive lesions were located on the trunk, face and elbow (85.7, 75 and 70%).

CONCLUSION

Pimecrolimus cream 1% results in repigmentation in vitiligo in different extents according to the location of the lesion; however, to clearly prove its efficacy as monotherapy or in combination with other available treatment options, double-blind placebo-controlled studies are essential.

Melanocyte biology and skin pigmentation

Melanocytes are phenotypically prominent but histologically inconspicuous skin cells. They are responsible for the pigmentation of skin and hair, and thereby contribute to the appearance of skin and provide protection from damage by ultraviolet radiation. Pigmentation mutants in various species are highly informative about basic genetic and developmental pathways, and provide important clues to the processes of photoprotection, cancer predisposition and even human evolution. Skin is the most common site of cancer in humans. Continued understanding of melanocyte contributions to skin biology will hopefully provide new opportunities for the prevention and treatment of skin diseases.

Mutagenicity of ultraviolet A radiation in the lacI transgene in Big Blue mouse embryonic fibroblasts

Sunlight ultraviolet A (UVA) irradiation has been implicated in the etiology of human skin cancer. A genotoxic mode of action for UVA radiation has been suggested that involves photosensitization reactions giving rise to promutagenic DNA lesions. We investigated the mutagenicity of UVA in the lacI transgene in Big Blue mouse embryonic fibroblasts. UVA irradiation of these cells at a physiologically relevant dose of 18J/cm(2) caused a 2.8-fold increase in the lacI mutant frequency relative to control, i.e., 12.12+/-1.84 versus 4.39+/-1.99 x 10(-5) (mean+/-S.D.). DNA sequencing analysis showed that of 100 UVA-induced mutant plaques and 54 spontaneously arisen control plaques, 97 and 51, respectively, contained a minimum of one mutation along the lacI transgene. The vast majority of both induced- and spontaneous mutations were single base substitutions, although less frequently, there were also single and multiple base deletions and insertions, and tandem base substitutions. Detailed mutation spectrometry analysis revealed that G:C-->T:A transversions, the signature mutations of oxidative DNA damage, were significantly induced by UVA irradiation (P<0.003). The absolute frequency of this type of mutations was 7.4-fold increased consequent to UVA irradiation as compared to control (3.38 versus 0.454 x 10(-5); P<0.00001). These findings are in complete agreement with those previously observed in the cII transgene of the same model system, and reaffirm the notion that intracellular photosensitization reactions causing promutagenic oxidative DNA damage are involved in UVA genotoxicity.

Comment on “The effects on human health from stratospheric ozone depletion and its interactions with climate change” by M. Norval, A. P. Cullen, F. R. de Gruijl, J. Longstreth, Y. Takizawa, R. M. Lucas, F. P. Noonan and J. C. van der Leun, Photochem. Photobiol. Sci., 2007, 6, 232

An increase in solar ultraviolet-B (UVB) radiation reaching the earth's surface is an important consequence of stratospheric ozone depletion. UVB has important effects on human health, both beneficial and harmful. Recent research has found that solar UVB reduces the risk of over 20 types of cancer, respiratory diseases caused by viruses, autoimmune diseases, and, likely, several other diseases, in addition to the well-known effects on bone diseases. On the other hand, solar UVB is an important risk factor for non-melanoma skin cancer and cataracts. Human epidemiological studies have provided evidence that solar UVA may be a more important risk factor for melanoma than UVB. If this result is correct, melanoma risk is not related to ozone depletion. We consider the net effect of solar UVB on human health to be beneficial at or near current levels.

Vitamin D: the secosteroid hormone and human reproduction

Vitamin D is a secosteroid with an endocrine mechanism of action which is sequentially synthesized in humans in the skin, liver and kidneys. The active hormone, 1alpha,25-dihydrocholecalciferol [1,25(OH)2D3], is often considered only in terms of its role in controlling calcium and phosphorus homeostasis. However, cumulative evidence points to the presence of vitamin D receptors in many tissues. The present article summarizes key points regarding the participation of vitamin D in pregnancy and breastfeeding. During pregnancy, sufficient vitamin D concentrations are needed not only to address the growing demand for calcium on the part of the fetus, but also to participate in fetal growth, development of the nervous system, lung maturation and fetal immune system function. Hypovitaminosis D has been related to the development of diabetes, pre-eclampsia and fetal neurological disorders. During pregnancy and lactation, calcium from the maternal skeleton is mobilized, with a rise in bone turnover and a reduction in bone mass. It is advisable for pregnant and nursing women to maintain adequate levels of vitamin D, through small doses of solar exposure to facilitate natural formation of the hormone or by ingesting appropriate vitamin supplements. Further studies are needed to clarify the many gaps in knowledge and elucidate the role of vitamin D in the context of reproduction. Confirmation of experimental observations relating to the risks of hypovitaminosis D would have important public health implications.

Sun exposure and malignant lymphoma: A population-based case–control study in Germany

Although some causes for malignant lymphoma are known their etiology is not well understood so far. We analyze the relationship between sun exposure and malignant lymphoma in a multicenter, population-based case-control study. Patients with malignant lymphoma (n = 710, 18-80 years) were prospectively recruited in 6 study regions in Germany. For each case, a gender, region and age-matched control was drawn from population-registers. In personal interviews, lifetime holidays spent in sunny climate, outdoor leisure activities and sunbed or sunlamp use were recorded. On basis of job task-specific supplementary questionnaires, an occupational physician assessed the cumulative working time outside. Odds ratios (OR) and 95%-confidence-intervals (CI) were calculated using conditional logistic regression analysis, adjusted for smoking and alcohol consumption. To increase statistical power, patients with specific lymphoma subentities were additionally compared with the entire control group using unconditional logistic regression. We observed a reduced overall lymphoma risk among subjects having spent vacations at sunny climates or frequently used sunbeds or sunlamps. The analysis of lymphoma subentities revealed similar results with the exception of T-NHL and follicular lymphoma which were positively associated with outdoor leisure activities. While cumulative working time outside appeared unrelated to NHL overall and most subentities, it was negatively associated with follicular lymphoma and weakly positively to HL. This data suggest that exposure to natural and artificial ultraviolet radiation may reduce the OR for lymphoma in this study population.